本文選題：抑郁癥 + 心理干預(yù)��； 參考：《重慶醫(yī)科大學(xué)》2012年博士論文

【摘要】：【背景】抑郁癥是當(dāng)今在全球嚴(yán)重影響人類健康的重大疾病，其發(fā)病率、復(fù)發(fā)率、自殺率、犯罪率高。大量研究顯示，抑郁癥患者對傳統(tǒng)治療（包括藥物治療、ECT、CBT等）的依從性較低，其主要原因是傳統(tǒng)治療的療程長、費用高、副作用大、治療過程中患者面臨多種障礙等。開發(fā)和驗證新的安全、經(jīng)濟、快捷、易行的治療技術(shù)既是滿足抑郁癥臨床治療的迫切需要，更成為現(xiàn)代醫(yī)學(xué)研究的熱點和難點。 文獻(xiàn)報道用MB和EFT分別治療抑郁癥后均能一定程度緩解患者癥狀，但整合兩種技術(shù)治療抑郁癥是否有效抑或療效更佳卻極少報道。本研究希望通過觀察MBEFT治療不同類型的抑郁癥的療效和安全性，并初步探討其治療抑郁癥的電生理機制，為嘗試研發(fā)抑郁癥治療的新技術(shù)奠定基礎(chǔ)。 【目的】（1）評價MBEFT干預(yù)不同類型的門診首發(fā)抑郁癥患者的臨床效果。（2）驗證MB治療抑郁癥的療效。（3）比較MBEFT、MB對抑郁癥不同臨床癥候群的改善效果，為今后在臨床個性化運用提供指導(dǎo)。（4）通過對抑郁癥患者心理干預(yù)前后HRV的變化，探討MBEFT、MB對抑郁癥患者自主神經(jīng)系統(tǒng)的作用規(guī)律。 【方法】 第一部分為臨床試驗研究。研究對象為按照DSM-Ⅳ標(biāo)準(zhǔn)診斷為首次發(fā)作的抑郁癥患者，年齡在18～60歲共51例，以病人就診順序隨機入組的原則，分為MBEFT治療組25例和MB治療組26例；選取正常對照組（即HAMD-17項總分＜7，其他條件與治療組完全匹配)25人，隨機分為MBEFT對照組14例和MB對照組11例。對所有被試在履行知情同意程序后采集臨床資料，并使用HAMD、SDS、SAS臨床量表評定，作為治療前（基線期）病情的嚴(yán)重程度和臨床癥侯群的評定。MBEFT治療組和對照組接受每天1次，每次40分鐘的MBEFT干預(yù)，連續(xù)7天。MB治療組和對照組的接受每天1次，每次30分鐘的MB干預(yù)，連續(xù)7天。每次心理干預(yù)都在神經(jīng)科學(xué)中心心理治療室由作者本人完成。于治療結(jié)束、隨訪1周、2周、1月、3月、6月，對所有被試分別使用HAMD、SDS、SAS臨床量表評定，評價近期、中期療效。 第二部分為電生理試驗部分。參加第一部分實驗的所有被試于第1天（治療前），使用RM6240多道生理信號記錄儀記錄靜息態(tài)下5min的ECT，作為HRV的基線值。分別于第3、5、8天（治療結(jié)束）、第15天（隨訪第1周）、第35天（隨訪1月）時采集靜息態(tài)下的心電記錄5min。使用RM6240多道生理信號采集處理系統(tǒng)做HRV頻域分析。根據(jù)各受試組不同時點的HRV指標(biāo)（LF、HF、LF/HF）的變化規(guī)律，反映交感-副交感神經(jīng)系統(tǒng)的功能狀態(tài)及平衡性，探討MBEFT、MB影響抑郁癥患者自主神經(jīng)活動的作用規(guī)律。 【結(jié)果】第一部分臨床評定結(jié)果 （1）抑郁癥患者中女性顯著多于男性，共病焦慮者高達(dá)70%，共病組的HAMD均分顯著高于單純抑郁癥組。與MB治療抑郁癥相比，MBEFT治療依從性高，但失訪率也高，其中男性失訪率遠(yuǎn)遠(yuǎn)高于女性。 （2）兩種技術(shù)治療抑郁癥均有效，兩種方法在改善臨床癥狀方面無統(tǒng)計學(xué)差異。治療結(jié)束時MBEFT組52%的患者可達(dá)臨床痊愈，，36%的患者可達(dá)顯著水平，12%的患者有改善；MB組60%可達(dá)到臨床痊愈水平，40%為臨床顯著改善。 （3）MBEFT治療結(jié)束后療效穩(wěn)定，隨訪至3月、6月療效進(jìn)一步顯現(xiàn)，HAMD評分可達(dá)正常對照組水平。MB治療結(jié)束至隨訪3月，療效進(jìn)一步顯著；隨訪至6月，療效有所減弱；隨訪過程中， HAMD評分始終不能降至正常對照組水平，病人有部分癥狀殘存，預(yù)示隨著時間推移，部分病例有復(fù)然的趨勢。 （4）MBEFT適用于不同嚴(yán)重程度的抑郁癥的治療。1個療程治療結(jié)束時顯示中度組癥狀改善情況優(yōu)于輕度、重度兩組；但隨訪1月比較，重度組療效優(yōu)于輕、中度組；隨訪6月比較，三組組間無差異。 （5）MB適用于不同嚴(yán)重程度的抑郁癥的治療。1個療程治療結(jié)束時顯示，中度組癥狀改善情況可達(dá)顯效水平，輕度、重度兩組均可達(dá)到臨床痊愈水平。隨訪至6月，中組、重度組療效穩(wěn)定，而輕度組療效有所下降，提示有復(fù)燃的可能。 （6）兩種療法對于抑郁癥臨床各癥侯群均有改善作用。治療結(jié)束及隨訪中，兩治療組的認(rèn)知障礙因子、遲緩因子的分值相對穩(wěn)定，組間差異不顯著（p＞0.05）。治療焦慮"軀體化因子、睡眠障礙因子方面，MBEFT中期療效明顯優(yōu)于MB組。MB中期隨訪結(jié)果預(yù)示病人的軀體化和睡眠障礙方面有復(fù)燃趨勢。 （7）兩種療法對于改善單純抑郁者、共病焦慮者的抑郁情緒均有效。 MBEFT治療抑郁共病焦慮的早期療效較好，但隨訪中HAMD分值有波動，而對單純抑郁組療效于隨訪1周有波動，隨訪1月、3月、6月都很穩(wěn)定。MB對于抑郁共病焦慮和單純抑郁的患者同樣有效。兩組間HAMD在隨訪1周、1月差異顯著。MBEFT治療抑郁共病焦慮者的焦慮情緒與MB效果無差異。 （8）醫(yī)患雙方在抑郁嚴(yán)重程度的評定上具有較好的一致性。也表明HAMD和SDS工具評定抑郁的有效。 （9）從自評（SDS、SAS）結(jié)果顯示，MBEFT、MB對于改善抑郁患者的抑郁、焦慮情緒均有效，且療效比較穩(wěn)定。隨訪至3月，兩種療法對緩解焦慮的療效更加顯著；但MBEFT的療效略優(yōu)于MB。MBEFT對抑郁癥（特別是共病焦慮的抑郁）療效優(yōu)于MB。 第二部分電生理實驗結(jié)果 （1）1個療程的MBEFT、MB干預(yù)均能顯著降低抑郁癥患者的LF值，達(dá)到正常人的水平；隨訪1周、1月LF值基本穩(wěn)定。實驗過程中兩個正常對照的LF值無顯著變化（p0.05）。 （2）1個療程的MBEFT、MB的干預(yù)均能顯著提升抑郁癥患者的HF值，使之達(dá)到正常人水平；兩種干預(yù)在隨訪中雖都有波動，但幅度不太大，差異不顯著。MB干預(yù)提高抑郁癥患者的HF值更明顯，但差異無統(tǒng)計學(xué)意義。與MBEFT組，MB組治療結(jié)束到隨訪1周，臨床痊愈率、顯效率均高于MBEFT組。兩組間HF的變化幅度與臨床療效的判斷結(jié)果比較一致。實驗過程中兩個正常對照的HF值無顯著變化（p0.05）。 （3）1個療程的MBEFT、MB干預(yù)顯著降低抑郁癥患者的LF/HF值，使之達(dá)到正常人水平；隨訪1周、1月LF/HF值比較穩(wěn)定。隨訪中這種差異逐漸消失。實驗過程中兩個正常對照的LF值無顯著變化（p0.05）�！窘Y(jié)論】 1. MBEFT、MB對不同嚴(yán)重程度的抑郁癥的抑郁、焦慮情緒改善均有效，但MBEFT對重度抑郁及抑郁共病焦慮者療效更佳，療效穩(wěn)定且持久。MB治療抑郁后仍有部分殘存癥狀（特別是焦慮/軀體化和睡眠障礙方面），預(yù)示有復(fù)燃的可能。 2. MBEFT、MB影響HF的變化幅度與臨床療效的判斷比較一致，提示HF可以作為臨床療效評價的一個靈敏的、客觀的、量化的指標(biāo)。MBEFT通過提高副交感神經(jīng)的興奮性，調(diào)節(jié)交感-副交感神經(jīng)系統(tǒng)的平衡而緩解抑郁癥狀。
[Abstract]:Background of the Invention Depression is a major disease affecting human health in the world today . Its incidence , recurrence rate , suicide rate and crime rate are high . A large number of studies show that depression patients have low compliance with traditional therapy ( including drug therapy , ECT , cbt , etc . ) . The main reason is that the treatment course is long , the cost is high , the side effect is large , and the patient is faced with various obstacles in the course of treatment . The new safety , economic , shortcut and easy treatment technique is not only the urgent need to satisfy the clinical treatment of depression , but also becomes the hot spot and difficult point of modern medical research .

It is hoped that the therapeutic effect and safety of different types of depression can be achieved by observing the therapeutic effect and safety of the two techniques in the treatment of depression , and the electrophysiological mechanism for the treatment of depression is also discussed .

Objective : ( 1 ) To evaluate the clinical effect of MBTA on depressive patients with different types of outpatients . ( 2 ) To evaluate the effect of MB on depression in patients with depression . ( 3 ) To compare the effects of MBTs and MB on different clinical symptoms of depression . ( 4 ) To explore the effect of MBTs and MB on autonomic nervous system of patients with depression .

Methodology

The first part was the study of clinical trials . The subjects were diagnosed as depressive patients with first episode according to DSM - IV criteria , 51 patients aged between 18 and 60 years , and randomly entered into the group according to the sequential order of the patients , including 25 patients with MBTT treatment group and 26 MB treatment groups .
Twenty - five patients were randomly divided into two groups : control group ( n = 14 ) and control group ( n = 11 ) .

The second part is the electrophysiological test part . All the subjects who participated in the first part of the experiment were tested on the first day ( before treatment ) , and the ECT in the resting state was recorded by the RM6240 multi - channel physiological signal recorder for 5min . The frequency domain of HRV was measured by using the RM6240 multi - channel physiological signal acquisition and processing system .

The results of clinical evaluation of the first part of the results

( 1 ) There were more than 70 % of the patients with depression , 70 % of the patients with comorbid anxiety and 70 % of the patients with comorbid anxiety . Compared with the patients treated with MB , the treatment compliance was high , but the rate of follow - up was also high , among which the male lost rate was much higher than that of women .

( 2 ) Both techniques were effective in the treatment of depression . There were no statistical differences between the two methods in the improvement of clinical symptoms . 52 % of patients at the end of treatment could be recovered clinically , 36 % had a significant level and 12 % had improvement ;
60 % of MB group can achieve clinical cure level , 40 % is clinically significant improvement .

( 3 ) After treatment , the curative effect was stable after the end of the treatment , and the curative effect was further improved in the follow - up to March and June .
Follow - up to June showed a decrease in efficacy ;
During the follow - up period , the scores of these patients could not be reduced to the normal control group , and the patients had partial symptoms remaining , which indicated that some cases had a tendency to recover over time .

( 4 ) MBTs was suitable for the treatment of depression with different severity . At the end of treatment , the symptoms of moderate group were better than that of mild and severe groups .
However , the efficacy of severe group was better than that of mild and moderate group in the follow - up period .
There was no difference among the three groups after 6 months of follow - up .

( 5 ) MB is suitable for the treatment of depression with different severity . At the end of the course of treatment , the improvement of moderate group symptoms can reach the clinical cure level . After the follow - up to June , the effect of moderate group and severe group is stable , while the curative effect of mild group is decreased , indicating the possibility of reburning .

(6)涓ょ鐤楁硶瀵逛簬鎶戦儊鐥囦復(fù)搴婂悇鐥囦警緹ゅ潎鏈夋敼鍠勪綔鐢

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