單用西酞普蘭與聯合心理干預治療合并軀體疾病的抑郁癥療效觀察

劉艷，葛曉丹，宋威

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單用西酞普蘭與聯合心理干預治療合并軀體疾病的抑郁癥療效觀察

劉艷，葛曉丹，宋威

[摘要]目的：觀察單用西酞普蘭與聯合心理干預對合并軀體疾病的抑郁癥(MDD)患者治療的效果及安全性。方法：符合標準的入組患者共57例，均給予單用西酞普蘭口服治療(單純組)，療程共6周；另外雙日就診或入院患者在就診或入院當日及以后每周復診或查房期間輔以心理干預處理(聯合組)，共7次。治療前后采用漢密頓抑郁量表(HAMD)評分，以減分率評價臨床療效及安全性。結果：2組HAMD的基線評分分別為(25.1±7.1)和(25.3±6.6)分，經治療逐漸下降，療程末降到(9.8±1.7)和(8.1±1.4)分，和基線相比差異有統計學意義(P<0.05)。有效比例聯合組為85.19%，顯著高于單純組的53.33%(χ2=5.21，P<0.05)。部分患者服藥期間有惡心、嗜睡和便秘等不適。結論：單用西酞普蘭治療合并軀體疾病的MDD患者有一定作用，輔以心理干預能進一步提高療效，而且能減少聯用抗抑郁藥物可能發生的副作用和對所合并軀體疾病的不利影響。

[關鍵詞]抑郁癥；軀體疾病；西酞普蘭；心理干預

Clinical observation of citalopram alone and combined psychological intervention therapy in treatment of depression associated with physical illnessLIUYan,GEXiao-dan,SONGWei.(AffiliatedDongfangPeople'sHospitalofXuzhouMedicalCollege，Jiangsu221004,China)

【Abstract】Objective:To observe the efficacy and safety of citalopram alone and combined psychological intervention in treatment of major depressive disorder (MDD) patients with physical illness.Methods:57 cases of patients of MDD with physical illness were chosen and given a single oral treatment with citalopram (single treatment group),for a total of six weeks;some other two-day visit or hospitalized patients were combined with psychological intervention treatment (combined treatment group),for a total of seven times.Before and after the treatment Hamilton Depression Scale (HAMD) scores were employed to evaluate the clinical efficacy and safety(by the decreased rate).Results:HAMD baseline scores for the two groups were (25.1±7.1) and (25.3±6.6), which gradually decreased after the treatment.By the end of the treatment the scores declined to (9.8±1.7) and(8.1±1.4) respectively,and the difference was statistically significant compared to the baseline(P<0.05).The effective rate of the combined treatment group was 85.19%,significantly higher than 53.33% of the single treatment group (χ2=5.21,P<0.05).Discomfort such as nausea,drowsiness and constipation occurred in some patients during the medication.Conclusion:Citalopram alone in treatment of MDD patients with physical illness may be of some effect.Citalopram combined with psychological intervention can further improve the efficacy,reduce the side effects caused by antidepressant drugs and alleviate the adverse effects on the physical illness.

【Key words】Depressive disorder; Physical illness; Citalopram; Psychological intervention

抑郁癥(MDD)和軀體疾病合并存在的現象臨床上也比較常見，抗抑郁治療大多能獲得較好的療效[1]，而且對合并的軀體疾病也能起到改善作用[2]。但是規范的抗抑郁治療的療程多較長，而且必須足量用藥，這樣就容易出現藥物的副作用，甚至影響到合并的軀體疾病。因此對合并軀體疾病的MDD患者抗抑郁治療是值得探討的課題。有學者指出對這些患者應采取個體化的綜合治療，如社會支持、心理干預和藥物治療的聯合等[3]。西酞普蘭為選擇性5-羥色胺再攝取抑制劑(SSRIs)，副作用較小，可首選用于合并軀體疾病的MDD治療[3]。為此，我們對一組合并軀體疾病的MDD患者給予單用西酞普蘭治療，同時給予心理干預處理，旨在觀察對合并軀體疾病的MDD患者的意義。……