CAJ | 학술논문

目的：探讨抗抑郁药合并认知治疗对社区老年抑郁症患者残留症状的临床疗效。方法选择符合美国精神障碍诊断与统计手册第4版（DSM-Ⅳ）抑郁症的诊断标准，且经过充足抗抑郁药物治疗20周以上，症状部分缓解而未达到痊愈的患者106例，按随机数字表法分为临床管理组（CM组）52例和合并认知治疗组（CBT组）54例，连续治疗20周。分别比较两组患者入组前与治疗后4、10、20周的汉密顿抑郁量表（HAMD）评分、缓解率以及48周复燃率；并对治疗前后进行特质应对方式问卷（TCSQ）评定。结果治疗第4周末，CBT组HAMD总分、焦虑因子分显著下降；治疗第20周末，两组HAMD总分、焦虑因子分、睡眠因子分、抑郁因子分均明显下降，与CM组的差异均有统计学意义（P＜0.05或0.01）。CBT组有效率为68.5％（37/54），CM组为42.3％（22/52）；CBT组完全缓解率（24.1%）较CM组（13.5%）高；随访48周，CBT组复燃率（22.2%）较CM组（42.3%）低；TCSQ结果显示，CBT组患者表现出更多积极的应对方式。结论抗抑郁药配合认知治疗是改善社区老年抑郁症残留症状的有效措施，在一定程度上可以减少复燃率，可能与患者应对方式的改变有关。
목적：탐토항억욱약합병인지치료대사구노년억욱증환자잔류증상적림상료효。방법선택부합미국정신장애진단여통계수책제4판（DSM-Ⅳ）억욱증적진단표준，차경과충족항억욱약물치료20주이상，증상부분완해이미체도전유적환자106례，안수궤수자표법분위림상관리조（CM조）52례화합병인지치료조（CBT조）54례，련속치료20주。분별비교량조환자입조전여치료후4、10、20주적한밀돈억욱량표（HAMD）평분、완해솔이급48주복연솔；병대치료전후진행특질응대방식문권（TCSQ）평정。결과치료제4주말，CBT조HAMD총분、초필인자분현저하강；치료제20주말，량조HAMD총분、초필인자분、수면인자분、억욱인자분균명현하강，여CM조적차이균유통계학의의（P＜0.05혹0.01）。CBT조유효솔위68.5％（37/54），CM조위42.3％（22/52）；CBT조완전완해솔（24.1%）교CM조（13.5%）고；수방48주，CBT조복연솔（22.2%）교CM조（42.3%）저；TCSQ결과현시，CBT조환자표현출경다적겁적응대방식。결론항억욱약배합인지치료시개선사구노년억욱증잔류증상적유효조시，재일정정도상가이감소복연솔，가능여환자응대방식적개변유관。
Objective To investigate the efficacy of anti- depression drugs combined with congnitive behavioral therapy on the residual symptoms of community elderly depression patients. Methods 106 patients met the diagnostic criteria of Amer-ican Diagnostic and Statistical Mannual of Mental Disorders- 4(DSM- Ⅳ)for depression and treated with ful dose anti- depression drugs over 20 weeks were selected. The 106 cases whose symptoms were partly remitted were randomized into clinical man-agement group (CM group) or combined with congnitive behavioral therapy group (CBT group) and treated for 20 weeks. HAMD, remission rate and the currence rate after 48 weeks were compared between the two groups respectively before and 4,10,20 weeks after treatment. Besides, a trait coping style questionnaire (TCSQ) was made before and after treatment. Results At the end of the 4th week,the score of HAMD, anxiety factor of CBT group declined dramatical y, while the scores of HAMD, anxiety factor, sleep factor, depression factor of CBT group al descended obviously at the end of the 20th week. There were significant differences between the two groups. The remission rate of CBT group was 68.5%(37/54) ,while that of CM group was 42.3%(22/52). Complete remission rate (24.1%) of CBT group was higher than that of CM group (13.5%).Moreover, the currence rate (22.2%) of CBT group was relatively lower than CM group(42.3%) after 48 weeks.In additition, TCSQ showed more positive coping style. Conclusion Anti- depression drugs combined with congnitive behavioral therapy is effective on the residual symptoms of depression. It may reduce the recurrence through the change of the coping style.