本文選題：內(nèi)觀認(rèn)知療法 + 老年抑郁��； 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:隨著人口老齡化進(jìn)程的加速,中國(guó)社會(huì)逐步進(jìn)入老齡社會(huì)。一系列的老齡問(wèn)題接踵而來(lái),老年抑郁就是對(duì)老年人的晚年生活影響較大的一種疾病,對(duì)社會(huì)、家庭都有巨大的影響。本研究通過(guò)對(duì)老年抑郁患者在藥物治療的基礎(chǔ)上,合并分散內(nèi)觀認(rèn)知治療后,老年抑郁患者的改善狀況,特別是老年抑郁患者對(duì)自殺的態(tài)度的改善,從而不斷的開(kāi)拓內(nèi)觀認(rèn)知治療的新領(lǐng)域,并使我們對(duì)內(nèi)觀認(rèn)知治療的原理、步驟更加熟悉,并且為老年抑郁患者的治療開(kāi)拓思路,提供更加經(jīng)濟(jì)、有效、安全、實(shí)用的輔助治療方法。方法:將天津市安定醫(yī)院2015年7月至2016年6月,老年科住院病人中,符合本研究入組標(biāo)準(zhǔn),且符合排除標(biāo)準(zhǔn)的,老年抑郁患者共70名為觀察對(duì)象,隨機(jī)分為研究組及對(duì)照組。研究組在服用藥物治療的基礎(chǔ)上,合并內(nèi)觀認(rèn)知療法,患者持續(xù)治療兩周,在此期間,每天在指導(dǎo)下,進(jìn)行2小時(shí)的內(nèi)觀認(rèn)知治療。對(duì)照組患者,在藥物治療的基礎(chǔ)上,合并常規(guī)日常心理治療。研究采用單盲法進(jìn)行評(píng)估,分別在患者入組時(shí)、進(jìn)行內(nèi)觀治療兩周后,各進(jìn)行一次各項(xiàng)評(píng)估。由醫(yī)生使用漢密爾頓抑郁量表(HAMD)、漢密爾頓焦慮量表(HAMA)、老年抑郁量表(GDS)、簡(jiǎn)易智能精神狀態(tài)檢查量表(MMSE)、日常生活能力量表(ADL)評(píng)估;由患者自行使用抑郁自評(píng)量表(SDS)、焦慮自評(píng)量表(SAS)評(píng)估;并用自殺風(fēng)險(xiǎn)評(píng)估量表(NGASR)及自殺危險(xiǎn)因素評(píng)估表來(lái)評(píng)價(jià)患者對(duì)自殺的態(tài)度。結(jié)果:(1)兩組研究結(jié)果顯示,自殺風(fēng)險(xiǎn)評(píng)估量表總評(píng)分,均較治療前有明顯改善。經(jīng)配對(duì)t檢驗(yàn)比較,兩組組內(nèi)差異,均有明顯臨床意義(P0.01)。采用獨(dú)立樣本t檢驗(yàn)比較組間差異,治療前,兩組間自殺風(fēng)險(xiǎn)評(píng)估量表評(píng)分,差異無(wú)臨床意義(P0.05)。治療后,研究組自殺風(fēng)險(xiǎn)評(píng)估量表評(píng)分較對(duì)照組,有明顯改善,差異有顯著臨床意義(P0.01)。(2)兩組研究結(jié)果顯示,自殺危險(xiǎn)因素量表總評(píng)分,均較治療前有明顯改善。經(jīng)配對(duì)t檢驗(yàn)比較,兩組組內(nèi)差異,均有顯著臨床意義(P0.01)。采用獨(dú)立樣本t檢驗(yàn)比較,治療前,兩組間自殺危險(xiǎn)因素評(píng)分,差異無(wú)臨床意義(P0.05)。治療后,研究組自殺危險(xiǎn)因素評(píng)分較對(duì)照組,有明顯改善,差異有顯著臨床意義(P0.01)。(3)兩組研究結(jié)果顯示,簡(jiǎn)明精神狀態(tài)量表總評(píng)分,均較治療前有明顯改善。經(jīng)配對(duì)t檢驗(yàn)比較,兩組組內(nèi)差異均有顯著臨床意義(P0.01)。采用獨(dú)立樣本t檢驗(yàn)比較組間差異,研究組與對(duì)照組間簡(jiǎn)明精神狀態(tài)量表評(píng)分,治療前與治療后相比較,差異均無(wú)明顯臨床意義(P0.05)。(4)兩組研究結(jié)果顯示,日常生活能力量表評(píng)分,均較治療前有明顯改善。經(jīng)配對(duì)t檢驗(yàn)比較,兩組組內(nèi)差異,均有顯著臨床意義(P0.01)。采用獨(dú)立樣本t檢驗(yàn)比較組間差異,治療前,兩組間日常生活能力量表評(píng)分,差異均無(wú)明顯臨床意義(P0.05)。治療后,研究組日常生活能力量表評(píng)分較對(duì)照組,有明顯改善,差異有顯著臨床意義(P0.01)。(5)兩組研究結(jié)果顯示,抑郁自評(píng)量表總評(píng)分,均較治療前有明顯改善。經(jīng)配對(duì)t檢驗(yàn)比較,兩組組內(nèi)比較,差異均有顯著統(tǒng)臨床意義(P0.01)。采用獨(dú)立樣本t檢驗(yàn)比較組間差異,治療前,兩組間抑郁自評(píng)量表評(píng)分,差異無(wú)明顯臨床意義(P0.05)。治療后,研究組抑郁自評(píng)量表評(píng)分較對(duì)照組有明顯改善,差異有臨床意義(P0.05)。(6)兩組研究結(jié)果顯示,焦慮自評(píng)量表評(píng)分,均較治療前有明顯改善。經(jīng)配對(duì)t檢驗(yàn)比較,兩組組內(nèi)比較,差異均有明顯臨床意義(P0.01)。采用獨(dú)立樣本t檢驗(yàn)比較組間差異,治療前,兩組間焦慮自評(píng)量表評(píng)分,差異無(wú)臨床意義(P0.05)。治療后,研究組焦慮自評(píng)量表評(píng)分較對(duì)照組有明顯改善,差異有明顯臨床意義(P0.01)。(7)兩組研究結(jié)果顯示,漢密爾頓抑郁量表總評(píng)分,均較治療前有明顯改善。經(jīng)配對(duì)t檢驗(yàn)比較,兩組組內(nèi)差異均有顯著臨床意義(P0.01)。采用獨(dú)立樣本t檢驗(yàn)比較組間差異,治療前,兩組間漢密爾頓抑郁量表評(píng)分差異無(wú)臨床意義(P0.05)。治療后,研究組較對(duì)照組漢密爾頓抑郁量表評(píng)分提示有明顯改善,差異有臨床意義(P0.05)。(8)兩組研究結(jié)果顯示,漢密爾頓焦慮量表總評(píng)分,均較治療前有明顯改善。經(jīng)配對(duì)t檢驗(yàn)比較,兩組組內(nèi)差異均有顯著臨床意義(P0.01)。采用獨(dú)立樣本t檢驗(yàn)比較兩組間差異,治療前,兩組間漢密爾頓焦慮量表評(píng)分,差異均無(wú)明顯臨床意義(P0.05)。治療后,研究組漢密爾頓焦慮量表評(píng)分較對(duì)照組有明顯改善,差異有顯著臨床意義(P0.01)。(9)兩組研究結(jié)果顯示,老年抑郁量表總評(píng)分,均較治療前有明顯改善。經(jīng)配對(duì)t檢驗(yàn)比較,兩組組內(nèi)差異均有明顯臨床意義(P0.01)。采用獨(dú)立樣本t檢驗(yàn)比較組間差異,治療前,兩組間老年抑郁量表評(píng)分均無(wú)明顯臨床意義(P0.05)。治療后,研究組老年抑郁量表評(píng)分較對(duì)照組明顯改善,且差異有明顯臨床意義(P0.01)。(10)采用Pearson相關(guān)分析對(duì)研究組年齡與各量表評(píng)分的差值進(jìn)行相關(guān)分析,結(jié)果顯示,年齡與治療前后GDS評(píng)分差值、NGASR評(píng)分差值、自殺危險(xiǎn)因素評(píng)分差值成負(fù)相關(guān)(r值分別為-0.350,-0.432,-0.445,P值分別為0.039,0.009,0.007),而與其他量表治療前后評(píng)分的差值無(wú)明顯相關(guān)性;分析對(duì)研究組病程與各量表評(píng)分的差值進(jìn)行相關(guān)分析,結(jié)果顯示,病程與治療前后各量表評(píng)分的差值無(wú)明顯相關(guān)性。結(jié)論:(1)在對(duì)老年抑郁患者合并內(nèi)觀認(rèn)知治療后,患者對(duì)自殺態(tài)度的認(rèn)識(shí)有改善。(2)在對(duì)老年抑郁患者合并內(nèi)觀認(rèn)知治療后,患者的日常生活能力有改善。(3)老年抑郁患者在內(nèi)觀認(rèn)知治療后,主觀及客觀分析,對(duì)抑郁癥狀有改善。(4)老年抑郁患者在內(nèi)觀認(rèn)知治療后,主觀及客觀分析,對(duì)焦慮癥狀有改善。(5)內(nèi)觀認(rèn)知療法對(duì)改善老年抑郁患者智能及精神狀態(tài)等認(rèn)知功能方面效果與常規(guī)心理治療相比較無(wú)明顯差異。
[Abstract]:Objective: with the acceleration of the aging process of the population, Chinese society is gradually entering an aging society. A series of aging problems ensue, senile depression is a disease which has a great influence on the old life of the elderly, and has a great influence on the society and the family. This study combines the treatment of elderly depressed patients on the basis of drug treatment. After decentralization of cognitive treatment, the improvement of elderly depressive patients, especially the improvement of the attitude of the elderly depressive patients to suicide, thus constantly open up the new field of internal and cognitive treatment, and make us more familiar with the principles and steps of the internal cognitive treatment, and provide more economic for the treatment of the elderly depressed patients. Effective, safe and practical methods of adjuvant treatment. Methods: the Tianjin Anding Hospital from July 2015 to June 2016, the elderly hospitalized patients, in line with the standard of this study, and in line with the exclusion criteria, 70 elderly depressive patients were observed, randomly divided into the study group and the control group. The patients were treated with internal cognitive therapy for two weeks. During this period, the patients were treated with 2 hours of internal cognitive therapy under guidance. The control group was combined with routine routine psychotherapy on the basis of drug treatment. The doctors used the Hamilton Depression Scale (HAMD), the Hamilton Anxiety Scale (HAMA), the old age depression scale (GDS), the simple intelligent mental state examination scale (MMSE), the daily living capacity scale (ADL) assessment, the self-used self rating Depression Scale (SDS), the self rating Anxiety Scale (SAS) assessment, and the suicide risk assessment scale (NGASR). The assessment of suicide risk factors was used to evaluate the patient's attitude to suicide. Results: (1) the results of the two groups showed that the total score of the suicide risk assessment scale was significantly better than that before the treatment. Compared with the paired t test, the differences in the two groups had significant clinical significance (P0.01). The difference between the groups was compared with the independent sample t test. Before treatment, two groups were compared. The difference of suicidal risk assessment scale was no clinical significance (P0.05). After treatment, the score of suicide risk assessment scale was significantly improved in the study group, and there was significant clinical significance (P0.01). (2) the two groups of studies showed that the total score of suicide risk factors was significantly improved. Compared with the matched t test, two groups were compared. The differences in the group had significant clinical significance (P0.01). Compared with the independent sample t test, the scores of suicide risk factors between the two groups had no clinical significance (P0.05). After treatment, the scores of suicide risk factors in the study group were significantly improved and the difference had significant clinical significance (P0.01). (3) the two groups of research results showed the concise spirit. The total score of the state scale was significantly better than that before the treatment. Compared with the paired t test, the difference in the two groups had significant clinical significance (P0.01). The difference between the group and the control group was compared with the independent sample t test. There was no significant clinical significance between the study group and the control group (P0.05) before and after the treatment (P0.05). (4) The results of the two groups showed that the score of daily living capacity scale was significantly better than before the treatment. Compared with the paired t test, the difference in the two groups had significant clinical significance (P0.01). The difference between the groups was compared with the independent sample t test. Before the treatment, there was no significant clinical significance (P0.05) in the difference between the two groups of daily living energy table scores. After the study group, the score of daily life ability scale was better than that of the control group. The difference had significant clinical significance (P0.01). (5) the two groups of research results showed that the total score of the self rating Depression Scale was significantly better than that before the treatment. Compared with the matched t test, the difference in the two groups had significant clinical significance (P0.01). An independent sample t examination was used. There was no significant clinical significance between the two groups before treatment (P0.05). There was a significant improvement in the self rating depression scale of the study group compared with the control group (P0.05). (6) the results of the two groups showed that the self rating Anxiety Scale was significantly improved by the paired t test. Comparison, the difference in the two groups had significant clinical significance (P0.01). The independent sample t test was used to compare the differences between groups. Before treatment, the two groups had no clinical significance (P0.05). After treatment, the scores of self rating Anxiety Scale were significantly improved in the study group, and there were significant clinical significance (P0.01). (7) two groups. The results showed that the total score of Hamilton depression scale was significantly better than before the treatment. Compared with the paired t test, the differences in the two groups had significant clinical significance (P0.01). The difference between the two groups was compared with the independent sample t test. Before treatment, there was no clinical significance between the two groups (P0.05). After treatment, the study group was treated. Compared with the control group Hamilton Depression Scale score, the difference was significantly improved (P0.05). (8) the two groups of results showed that the total score of Hamilton's anxiety scale was significantly better than before the treatment. Compared with the paired t test, the difference in the two groups had significant clinical significance (P0.01). The independent sample t test was used to compare the two groups. Difference, before treatment, the Hamilton Anxiety Scale score between the two groups had no significant clinical significance (P0.05). After treatment, the score of Hamilton anxiety scale was significantly improved in the study group compared with the control group, and the difference had significant clinical significance (P0.01). (9) the results of the two groups showed that the total score of the elderly depression scale was significantly better than that before the treatment. Compared with the paired t test, the difference in the two groups had significant clinical significance (P0.01). The difference between the groups was compared with the independent sample t test. Before the treatment, there was no significant clinical significance (P0.05) for the Senile Depression Scale score between the groups (P0.05). After treatment, the scores of the elderly depression scale were significantly improved in the study group, and there were significant clinical significance (P0.01) (10). The difference between the age and the scale of the study group was analyzed by Pearson correlation analysis. The results showed that the difference of age and GDS score, the difference of NGASR score, and the difference of suicide risk factors were negatively correlated (r value was -0.350, -0.432, -0.445, P value respectively, respectively), and it was evaluated before and after the treatment of other scales. There was no significant correlation between the difference of the scores; the analysis of the difference between the course of disease and the scale of each scale showed that the difference between the course of disease and the scale of each scale before and after treatment had no significant correlation. Conclusion: (1) the understanding of the patient's attitude to suicide was improved after the treatment of senile depressive patients with internal cognitive cognitive treatment. (2) in the senile depression. The patient's daily living ability improved after the depression patients combined with the internal cognitive treatment. (3) the elderly depressive patients were subjective and objective analysis after the internal cognitive treatment, and improved the depressive symptoms. (4) the elderly depressed patients were subjective and objective analysis after the internal cognitive treatment, and improved the anxiety symptoms. (5) the internal cognitive therapy was used to improve the senile depression. The cognitive function of patients with depression and mental state was not significantly different from that of conventional psychotherapy.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R749.4

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