自助认知行为疗法在撤减抑郁症患者苯二氮[艹卓]类药物中的效果观察  

Efficacy of cognitive behavioral self-help therapy for depression disorder to withdraw from long-term benzodiazepine use

作　　者：钱国英[1] 蔡丽丽 费锦锋[1] 杨胜良[1] 钟华[1] QIAN Guoying;CAI Lili;FEI Jinfeng;YANG Shengliang;ZHONG Hua(Department of Psychiatry,Huzhou Third Municipal Hospital,Huzhou,Zhejiang 313000,China)

机构地区：[1]湖州市第三人民医院精神科,浙江湖州313000

出　　处：《中华全科医学》2024年第8期1381-1384,共4页Chinese Journal of General Practice

基　　金：浙江省医药卫生创新人才支持计划项目(2020RC036);湖州市科学技术局公益性应用研究项目(2019GY07)。

摘　　要：目的探讨认知行为自助疗法(CBT-SH)在抑郁症患者撤减苯二氮[艹卓]类药物(BZD)中的疗效和安全性。方法选择2020年4月—2022年3月于湖州市第三人民医院复诊的符合入组标准的抑郁症患者80例,采用随机数表法分为研究组(40例)与对照组(40例)。研究组使用催眠药物剂量递减疗法联合CBT-SH撤减BZD,对照组则单用递减疗法撤减BZD。干预前后评估患者的精神症状、睡眠质量及躯体状况,干预后评估撤药反应。整个干预过程设定为8周。比较2组撤减BZD的成功率及撤药反应的差异。结果8周末,研究组的成功停用率高于对照组[52.5%(21/40)vs.27.5%(11/40)],差异有统计学意义(P=0.017);研究组的BZD剂量低于对照组[0.0(0.0,3.8)mg/d vs.3.0(0.0,4.8)mg/d],差异有统计学意义(P=0.035)。撤药反应主要表现为虚弱感、噪声敏感、头晕,研究组撤药反应发生率低于对照组[50.0%(20/40)vs.77.5%(31/40)],差异有统计学意义(P=0.011);研究组患者苯二氮[艹卓]类药物戒断症状问卷(BWSQ)评分低于对照组(P<0.05)。2组患者17项汉密尔顿抑郁量表(HAMD-17)、汉密尔顿焦虑量表(HAMA)、匹茨堡睡眠质量指数量表(PSQI)评分比较差异均无统计学意义(P>0.05)。所有患者躯体指标均无有临床意义的变化。结论催眠药物剂量递减疗法联合CBT-SH用于抑郁症患者撤减BZD药物,成功率高,撤药反应发生率低、程度轻。Objective To evaluate the efficacy and security of tapering off long-term benzodiazepine(BZD)use for depression disorder,and to evaluate the value of additional cognitive behavioral therapy-self help(CBT-SH).Methods An 8-week randomized controlled trial was conducted in which 80 patients with depression who returned to the Huzhou Third Municipal Hospital from April 2020 to March 2022 and met the enrollment criteria were assigned to tapering off plus CBT-SH(intervention group,n=40),or tapering off alone(control group,n=40).The patients'mental symptoms,sleep quality,and physical status were assessed before and after intervention,and the withdrawal symptoms were assessed after intervention.The discontinuation rate of BZD and withdrawal symptoms between the two groups were compared after intervention.Results At the end of 8th week,the discontinuation rate of BZD in the intervention group was higher than that in the control group[52.5%(21/40)vs.27.5%(11/40),P=0.017];the daily dose of BZD in the intervention group was lower than that in the control group[0.0(0.0,3.8)mg/d vs.3.0(0.0,4.8)mg/d,P=0.035].The withdrawal symptoms mainly showed feeling faint,noise sensitivity and dizziness.The frequency of withdrawal symptoms in the intervention group was lower than that in the control group[50.0%(20/40)vs.77.5%(31/40),P=0.011],the scores of benzodiazepine withdrawal symptom questionnaire(BWSQ)in the intervention group were significantly lower than that in the control group(P<0.05).There were no significant differences in the scores of the 17-item Hamilton depression scale(HAMD-17),Hamilton anxiety scale(HAMA),and Pittsburgh sleep quality index(PSQI)between the two groups(P>0.05).No clinically significant changes were found in somatic indices in all patients.Conclusion In patients with stabilized depression disorder,the addition of CBT-SH can be used during the time of benzodiazepine withdrawal to enhance the discontinuation rate of benzodiazepine and reduce withdrawal symptoms.

关 键 词：抑郁症 苯二氮[艹卓]类 催眠药物剂量递减疗法 认知行为疗法 

分 类 号：R749.4[医药卫生—神经病学与精神病学]