认知行为疗法联合米氮平对SSRIs治疗无效的广泛性焦虑症患者的效果  

The effect of cognitive behavioural therapy combined with mirtazapine in generalized anxiety disorder patients who do not respond to SSRIs

作　　者：丰超 周常杰 周雯 FENG Chao;ZHOU Changjie;ZHOU Wen(Department of Psychology,Rocket Army Specialty Medical Center,Beijing 100088,China)

机构地区：[1]火箭军特色医学中心心理科,北京100088

出　　处：《国际精神病学杂志》2023年第5期1045-1047,1054,共4页Journal Of International Psychiatry

摘　　要：目的探究认知行为疗法联合米氮平在选择性5-羟色胺再摄取抑制剂(SSRIs)无效的广泛性焦虑症患者中的应用效果。方法回顾性选取2020年6月~2023年1月期间于我院接受SSRIs治疗无效的120例广泛性焦虑症患者作为研究对象,根据不同治疗方案进行分组,每组60例。对照组采取米氮平治疗,观察组采取认知行为疗法联合米氮平治疗。观察两组临床疗效、治疗前后精神症状(广泛性焦虑障碍量表(GAD-7))、内分泌激素(甲状腺素(T4)、促肾上腺皮质激素(ACTH)、三碘甲状腺原氨酸(T3)、促甲状腺激素(TSH))及误工时间变化。结果观察组总有效率95.00%(57/60)高于对照组83.33%(50/60)(P<0.05);治疗后观察组GAD-7评分较对照组低;治疗后观察组血清TSH、ACTH水平低于对照组(P<0.05);治疗后两组T3、T4水平与治疗前相比、治疗后两组间T3、T4水平相比,均无显著差异(P>0.05);治疗后,观察组误工时间短于对照组(P<0.05)。结论认知行为疗法联合米氮平对SSRIs无效的广泛性焦虑症患者效果显著,可改善患者精神症状,调节神经内分泌激素,减少误工时间。Objective To explore the application of cognitive behavioral therapy combined with mirtazapine in patients with generalized anxiety disorder who do not respond to selective 5-hydroxytryptamine reuptake inhibitors(SSRIs).Methods One hundred and twenty patients with generalized anxiety disorder who were treated at our hospital between June 2020 and January 2023 with ineffective SSRIs were retrospectively selected as study subjects and grouped according to different treatment protocols,with 60 cases in each group.The control group was treated with mirtazapine and the observation group was treated with cognitive behavioural therapy combined with mirtazapine.The score of generalized anxiety disorder 7-item scale(GAD-7),thyroxine(T4),adrenocorticotropic hormone(ACTH),triiodothyronine(T3),thyrotropin(TSH),and the time of missed work were compared between two groups.Results The total effective rate of observation group was 95.00%(57/60)higher than that of control group 83.33%(50/60)(P<0.05).After treatment,the GAD-7 scores in the observation group were lower than those in the control group.After treatment,the serum TSH and ACTH levels in the observation group were lower than those in the control group(P<0.05).There were no significant differences in T3 and T4 levels between the two groups after treatment compared with before treatment and between the two groups after treatment(P>0.05).After treatment,the observation group had shorter workrelated delays than the control group(P<0.05).Conclusion Cognitive behavioral therapy combined with Mirtazapine is effective in the treatment of patients with generalized anxiety disorder who do not respond to SSRIs.It can improve the psychiatric symptoms and cognitive function,regulate neuroendocrine hormones,and reduce the time lost from work.

关 键 词：认知行为疗法 广泛性焦虑症 神经内分泌激素 

分 类 号：R749.05[医药卫生—神经病学与精神病学]