Abstract:

Objective To evaluate the efficacy of cognitive behavioral therapy for depression in advanced schistosomiasis pa? tients. Methods A total of 60 advanced schistosomiasis patients with major depressive disorder were divided into a combination therapy group（30 cases）who received sertraline plus cognitive behavior therapy and a monotherapy group（30 cases）who re? ceived sertraline only. Before the treatment and at the 1st，2nd，4th，8th week after the treatment，the efficacy and safety were as? sessed with the HAMD17 item score and the related factor points and TESS. The effective rate，side effect rate and relapse rate in six months were calculated and compared between the two groups. Results At the end of 8th week after the treatment，the total scores of HAMD，factor scores of cognitive impairment，retardation factor scores and sleep disturbance factor scores in the 2 groups were statistically decreased compared with those before the treatment（P < 0.05 or P < 0.01） . The factor scores in the com? bined therapy group were lower than those in the monotherapy group. The effective rate in the combination therapy group was 86.7%（26/30），and it was significantly higher than that in the monotherapy group（56.7%，17/30）， （χ2 = 6.65，P < 0.05） . The doses of the drug were lower in the combination therapy group than those in the monotherapy group（t = 2.25，P < 0.05） . Within six months，the relapse rate was 13.3% in the combination therapy group，and it was significantly lower than that in the monothera? py group（46.7%） （χ2 =7.937，P < 0.025） . The side effect rate was 23.3% in the combination therapy group and that was 26.7% in the monotherapy group，and there was no statistically significant difference between the two groups（P > 0.05） . Conclusion The combination therapy（drug combined with cognitive behavioral therapy）is effective in advanced schistosomiasis patients with depression， and it also can reduce the amount of medication and the relapse.

Key words: Advanced schistosomiasis； Depressive disorder；Sertraline； Cognitive behavioral therapy； Control study

摘要：

目的 探讨认知行为治疗对晚期血吸虫病 （晚血） 患者合并抑郁障碍的疗效。 方法 将60例符合入组标准的晚血合并抑郁障碍患者随机分为舍曲林合并认知行为治疗组 （联合治疗组） 和单用舍曲林药物治疗组 （单药治疗组）， 每组各 30例。所有研究对象于入组时及治疗后1、 2、 4、 8周采用汉密尔顿抑郁量表17项版 （HAMD17） 评分及相关因子分进行疗效评定， 采用治疗时出现的症状量表 （TESS） 评定不良反应， 并对两组的疗效、 不良反应发生率及半年内复发率进行统计分析。 结果 治疗8周末两组HAMD总分、 认知障碍因子分、 迟缓因子分及睡眠障碍因子分与入组时比较， 差异均有统计学意义 （P＜0.05或P＜0.01）， 联合治疗组分值均低于单药治疗组。治疗8周后联合治疗组痊愈率为86.7% （26/30）， 显著高于单药治疗组56.7% （17/30）（χ2 =6.65， P＜0.05）， 联合治疗组的用药剂量亦少于单药治疗组 （t =2.25， P＜0.05）。联合治疗组半年内复发率为13.3% （4/30）， 显著低于单药治疗组46.7% （14/30）（χ2 =7.937， P＜0.05）。联合治疗组不良反应发生率为 23.3%， 单药治疗组为26.7%， 两组比较差异无统计学意义 （P＞0.05）。 结论 药物联合认知行为治疗对晚血合并抑郁障碍的疗效明显， 并可减少用药量和复发。

关键词: 晚期血吸虫病； 抑郁症； 舍曲林； 认知行为治疗； 对照研究