认知行为疗法对首发抑郁障碍患者认知功能的影响

doi:10.3969/j.issn.1004-583X.2024.04.004

摘要/Abstract

摘要：

目的探索认知行为疗法(cognitive behavior therapy, CBT)对首发抑郁障碍患者认知功能的影响。方法纳入2020年1月至2021年12月在云南省精神病医院住院治疗的符合入组标准的首发抑郁障碍患者64例作为研究对象,按照入组先后顺序先分入联合组(32例),再分入对照组(32例),对照组单服艾司西酞普兰治疗,联合组口服艾司西酞普兰的基础上,联合CBT,使用威斯康辛卡片分类测验(Wsiconsin card sorting test, WCST)、斯特鲁普试验(Struse color word test, Stroop)评估患者治疗前后的认知功能。采用SPSS分析2组治疗前后组内、组间的差异性。结果 2组在治疗前WCST和Stroop评分差异无明显统计学意义(P>0.05);治疗第8周末,2组总应答数(total response, RA)、正确应答数(correct response, RC)、持续正确数(persistent correct, RP)、持续错误数(persistent error, RPE)评分均显著改善,但联合组RC、RP、RPE评分优于对照组,差异具有统计学意义(P <0.05);2组冲突反应时、中性反应时、干扰反应时减分明显,但联合组减分更明显,差异具有统计学意义(P <0.05)。结论认知行为疗法能够改善首发抑郁障碍患者的认知功能。

关键词: 认知行为疗法, 抑郁障碍, 认知功能

Abstract:

Objective To explore the effect of cognitive behavior therapy (CBT) on cognitive function in patients with first-episode depressive disorder. Methods Sixty-four eligible patients with first-episode depressive disorder hospitalized in Mental Hospital of Yunnan Province from January 2020 to December 2021 were included as study objects. According to the inclusion order, the first 32 cases were as the combined group (CBT plus escitalopram), and the last 32 cases were as the control group (escitalopram alone). Patients' cognitive function was assessed by the Wsiconsin card sorting test (WCST) and the Struse color word test (Stroop). SPSS was used to analyze the differences between the two groups before and after treatment. Results There were no differences in WCST and Stroop scores between groups before treatment (P >0.05). At the end of the 8th week of treatment, the scores of total response (RA), correct response (RC), persistent correct (RP), and persistent error (RPE) in the two groups were significantly improved (P <0.05), and the scores of RC, RP and RPE in the combination group were significantly better than those of the control group (P <0.05). The scores of conflict response, neutral response and interference response were significantly decreased in the two groups, the decreases were more significant in the combined group relative to the control group (P <0.05). Conclusion Cognitive behavioral therapy can improve cognitive function in patients with first-episode depressive disorder.

Key words: cognitive behavioral therapy, depressive disorder, cognitive function

中图分类号:

R749.42

陆香秀, 王海明, 张轶杰, 邱尔仙. 认知行为疗法对首发抑郁障碍患者认知功能的影响[J]. 临床荟萃, 2024, 39(4): 320-324.

Lu Xiangxiu, Wang Haiming, Zhang Yijie, Qiu Erxian. Effect of cognitive behavioral therapy on cognitive function in patients with first-episode depressive disorder[J]. Clinical Focus, 2024, 39(4): 320-324.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.04.004

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I4/320

图/表 3

表1 2组抑郁障碍患者均衡性检验[(%)/(P 25,P 75)/($\bar{x}±s$)]

Tab.1 Balance test for patients with depressive disorders

项目	联合组( $n$ =26)	对照组( $n$ =25)	$t$ / $Z$ /χ²值	$P$ 值
性别(例)
男女	12 14	10 15	0.197	0.657
年龄(岁)	41.58±13.72	38.00±12.32	-0.978	0.333
婚姻状态(例)
未婚	8	8
已婚	16	14	0.314	0.855
离异/丧偶	2	3
受教育程度(例)
初中	9	9
高中	10	5	2.791	0.593
大专	3	6
本科	3	4
硕士及以上	1	1
抑郁障碍家族史(例)
无有	17 9	15 10	0.158	0.691
是否吸烟(例)
无有	20 6	17 8	0.510	0.475
是否饮酒(例)
无有	18 8	20 5	0.778	0.378
基线时HAMD总分(分)	30.31±4.02	31.52±4.38	1.031	0.308
8周末艾司西酞普兰的用量(mg/d)	14.62±4.67	15.20±4.20	0.469	0.641

表1 2组抑郁障碍患者均衡性检验[(%)/(P 25,P 75)/($\bar{x}±s$)]

Tab.1 Balance test for patients with depressive disorders

项目	联合组( $n$ =26)	对照组( $n$ =25)	$t$ / $Z$ /χ²值	$P$ 值
性别(例)
男女	12 14	10 15	0.197	0.657
年龄(岁)	41.58±13.72	38.00±12.32	-0.978	0.333
婚姻状态(例)
未婚	8	8
已婚	16	14	0.314	0.855
离异/丧偶	2	3
受教育程度(例)
初中	9	9
高中	10	5	2.791	0.593
大专	3	6
本科	3	4
硕士及以上	1	1
抑郁障碍家族史(例)
无有	17 9	15 10	0.158	0.691
是否吸烟(例)
无有	20 6	17 8	0.510	0.475
是否饮酒(例)
无有	18 8	20 5	0.778	0.378
基线时HAMD总分(分)	30.31±4.02	31.52±4.38	1.031	0.308
8周末艾司西酞普兰的用量(mg/d)	14.62±4.67	15.20±4.20	0.469	0.641

表2 2组治疗前后WCST的变化(分)

Tab.2 Inter-group comparison of WCST score before and after treatment

组别	例数	RA		RC		RP		RPE
组别	例数	干预前	第8周	干预前	第8周	干预前	第8周	干预前	第8周
联合组	26	91.35±10.37	78.00±7.30^*	42.62±2.38	52.62±5.15^*	12.96±2.65	21.00±2.42^*	34.12±3.20	25.27±4.49^*
对照组	25	86.24±12.92	76.00±8.56^*	43.00±2.55	47.68±4.43^*	14.00±2.99	15.72±3.86^*	34.88±2.71	29.32±4.21^*
$t$ 值		-1.560	-0.899	0.557	-3.660	1.316	-5.883	0.918	3.318
$P$ 值		0.125	0.373	0.580	0.001	0.194	<0.001	0.363	0.002

表2 2组治疗前后WCST的变化(分)

Tab.2 Inter-group comparison of WCST score before and after treatment

组别	例数	RA		RC		RP		RPE
组别	例数	干预前	第8周	干预前	第8周	干预前	第8周	干预前	第8周
联合组	26	91.35±10.37	78.00±7.30^*	42.62±2.38	52.62±5.15^*	12.96±2.65	21.00±2.42^*	34.12±3.20	25.27±4.49^*
对照组	25	86.24±12.92	76.00±8.56^*	43.00±2.55	47.68±4.43^*	14.00±2.99	15.72±3.86^*	34.88±2.71	29.32±4.21^*
$t$ 值		-1.560	-0.899	0.557	-3.660	1.316	-5.883	0.918	3.318
$P$ 值		0.125	0.373	0.580	0.001	0.194	<0.001	0.363	0.002

表3 2组治疗前后Stroop的变化(分)

Tab.3 Inter-group comparison of Stroop score before and after treatment

组别	例数	冲突反应时		中性反应时		干扰反应时
组别	例数	干预前	第8周	干预前	第8周	干预前	第8周
联合组	26	300.62±25.31	246.00±19.25^*	258.92±19.77	211.69±7.89^*	58.04±7.62	43.65±4.32^*
对照组	25	304.80±24.27	265.68±18.51^*	254.20±15.35	221.88±14.60^*	58.68±7.06	48.84±6.59^*
$t$ 值		0.602	3.720	-0.950	3.117	0.312	3.338
$P$ 值		0.550	0.001	0.347	0.003	0.757	0.002

表3 2组治疗前后Stroop的变化(分)

Tab.3 Inter-group comparison of Stroop score before and after treatment

组别	例数	冲突反应时		中性反应时		干扰反应时
组别	例数	干预前	第8周	干预前	第8周	干预前	第8周
联合组	26	300.62±25.31	246.00±19.25^*	258.92±19.77	211.69±7.89^*	58.04±7.62	43.65±4.32^*
对照组	25	304.80±24.27	265.68±18.51^*	254.20±15.35	221.88±14.60^*	58.68±7.06	48.84±6.59^*
$t$ 值		0.602	3.720	-0.950	3.117	0.312	3.338
$P$ 值		0.550	0.001	0.347	0.003	0.757	0.002

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