不同治疗方案对中老年双相抑郁发作患者认知功能的影响  

Effects of Different Treatment Regimens on Cognitive Function in Middle-aged and Elderly Patients with Bipolar Depressive Episodes

作　　者：李洁[1] 李奕[1] 彭顺梅 LI Jie;LI Yi;PENG Shun-mei(Department of Acute Psychiatry, the Fourth People's Hospital of Chengdu, Chengdu 610036, China)

机构地区：[1]成都市第四人民医院急性精神科

出　　处：《临床误诊误治》2019年第9期39-43,共5页Clinical Misdiagnosis & Mistherapy

基　　金：四川省医学科研课题(S17013)

摘　　要：目的 探究不同治疗方案对中老年双相抑郁发作患者认知功能的影响。方法 选取我院2017年7月—2018年7月收治的100例中老年双相抑郁发作患者,根据不同治疗方案分为对照组( n =62)与观察组( n =38),对照组予碳酸锂联合喹硫平治疗,观察组予改良电休克治疗(modified electric convulsive therapy, MECT)联合碳酸锂治疗,均治疗8周。观察两组临床疗效,比较治疗前后汉密尔顿抑郁量表(hamilton depression scale, HAMD)、Bech-Rafaelsen躁狂量表(Bech-Rafaelsen mania scale, BRMS)及简易精神状态量表(mini-mental state examination, MMSE)评分,记录不良反应发生情况。结果 观察组、对照组治疗总有效率分别为92.11%、75.81%,比较差异有统计学意义( P =0.039)。与对照组比较,观察组治疗后HAMD评分及BRMS评分降低,差异有统计学意义( P <0.05);与本组治疗前比较,两组治疗后HAMD评分及BRMS评分显著下降,定向能力、记忆力、注意力与计算能力、回忆能力、语言能力及MMSE总评分均升高,差异有统计学意义( P < 0.001)。观察组、对照组不良反应总发生率分别为31.58%、37.10%,比较差异无统计学意义( P >0.05),且调整药物剂量症状即自行缓解。结论 MECT联合碳酸锂治疗中老年双相抑郁发作患者可显著改善躁狂、抑郁等情感症状,在一定程度上改善认知功能,且安全性好。Objective To investigate the effects of different treatment regimens on cognitive function in middle-aged and elderly patients with bipolar depressive episodes. Methods According to different treatment regimens, 100 elderly patients with bipolar depressive episodes who were treated in our hospital from July 2017 to July 2018 were divided into the control group ( n =62) and the observation group ( n =38). The control group was treated with lithium carbonate combined with quetiapine, and the observation group was treated with modified electric convulsive therapy (MECT) combined with lithium carbonate. Both groups were treated for 8 weeks. The clinical curative effect, scores of Hamilton Depression Scale (HAMD), Bech-Rafaelsen Mania Scale (BRMS) and Mini-Mental State Examination (MMSE) were compared between the two groups. The incidence of adverse reactions was recorded. Results The total response rates of the observation group and the control group were 92.11% and 75.81%, respectively ( P =0.039). The HAMD score and BRMS score of the observation group were significantly decreased after treatment, compared with those of the control group ( P <0.05). HAMD scores and BRMS scores of both groups were significantly decreased after treatment. However, scores of orientation ability, memory, attention and computing power, ability to recall, language competence and total score of MMSE were increased ( P <0.001). The total incidence rates of adverse reactions in the observation group and the control group were 31.58% and 37.10%, respectively ( P >0.05), suggesting no significant difference, and the adverse reactions were relieved after dose adjustment. Conclusion The combined treatment with MECT and lithium carbonate for middle-aged and elderly patients with bipolar depressive episodes can significantly relieve the emotional symptoms such as mania and depression. In addition, it can improve the cognitive function to a certain extent, with good safety.

关 键 词：双相情感障碍 抗精神病药 电惊厥疗法 认知障碍 

分 类 号：R749.4[医药卫生—神经病学与精神病学]