癫痫青少年共病焦虑、抑郁相关因素研究及系统式家庭治疗

发布时间：2018-07-15 19:27

【摘要】：第一部分癫痫青少年共病焦虑、抑郁相关因素研究目的：评估癫痫青少年共病焦虑、抑郁（ADAE）的现状和相关影响因素。方法：收集275例癫痫青少年一般资料和临床资料(包括发作类型、发作频率、发作形式、发病病因、病程、及用药数量)；对275例癫痫青少年和170例正常青少年采用汉密尔顿焦虑量表（HAMA)、汉密尔顿抑郁表(HAMD)、社会支持评定量表（SSRS）、家庭功能评定(FAD)、系统家庭动力学自评量表(SSFD)进行评估。采用t检验、x2检验、方差分析、Pearson相关性分析、多元逐步回归分析、Logistic回归分析等方法，应用SPSS19.0软件完成数据统计。结果：(1)癫痫青少年心理异常(焦虑或抑郁)发生率53.85%，焦虑、抑郁的发生率分别为34.23%、41.54%，焦虑和抑郁共病率为40.71%，重度焦虑为17.98%，重度抑郁为19.44%，消极自杀想法发生率24.09%。（2）发作频率、病程、发作类型、发作形式、服药数量与癫痫青少年共病焦虑、抑郁相关，发作频率是癫痫共病焦虑的危险因素，联合使用AEDs是癫痫共病抑郁的危险因素。(3)癫痫青少年以及ADAE家庭动力紊乱，家庭气氛、个性化是焦虑、抑郁的主要危险因素。（4）癫痫青少年以及ADAE家庭功能缺陷，行为控制是癫痫青少年共病焦虑的主要危险因素。(5)癫痫青少年以及ADAE社会支持差，总体社会支持是癫痫青少年共病焦虑、抑郁的保护因素。结论:(1)ADAE普遍存在；（2）ADAE受生物、抗癫痫药物、心理、社会因素多维度影响。（3）发作频率、联合使用AEDs、家庭气氛、个性化、行为控制是ADAE的危险因素，总体社会支持是ADAE的保护因素。第二部分癫痫青少年共病焦虑、抑郁的系统式家庭治疗目的：探讨系统式家庭治疗干预癫痫青少年共病焦虑、抑郁(ADAE)的疗效。方法：104例ADAE被分为两组，即干预组（58例）和对照组（46例），干预组给予系统式家庭治疗（SFT）联合抗癫痫药物治疗（AEDs），对照组只给予AEDs。采用t检验、x2检验、Pearson相关性分析、多元逐步回归分析、Logistic回归分析等方法，应用SSPS19.0软件完成数据统计。结果：(1)两组治疗后发作频率明显下降（P＜0.05)，但干预组比对照组下降更明显（P＜0.05)；（2）干预组干预前后焦虑、抑郁明显下降（P＜0.01）而对照组无明显变化（P＞0.05)，，两组比较差异有统计学差异（P＜0.05)；（3）干预组干预前后家庭动力、家庭功能明显变好、社会支持增加（P＜0.05)，而对照组无明显变化（P＞0.05)，两组比较差异有统计学差异（P＜0.05)；（4）发作频率、家庭气氛、焦虑变化是抑郁变化的重要影响因素；主观支持、家庭气氛、行为控制、抑郁变化是焦虑变化的重要影响因素，抑郁变化是发作频率变化的重要影响因素。抑郁情绪的变化是发作频率变化的重要影响因素。结论:（1）SFT联合AEDs治疗ADAE比单用AEDs治疗疗效更好，不仅癫痫发作频率下降，而且改善患儿焦虑、抑郁情绪，改善家庭动力、家庭功能以及提高社会支持。（2）SFT用于干预癫痫青少年共病焦虑、抑郁是可行的和有效的。
[Abstract]:The first part is about the correlation factors of comorbidity anxiety and depression among adolescents with epilepsy.
Objective: to assess the status and related factors of comorbid anxiety and depression (ADAE) in adolescents with epilepsy.
Methods: the general data and clinical data of 275 adolescents with epilepsy were collected, including the types of seizures, the frequency of seizures, the form of seizures, the etiology, the course of the disease, and the number of drugs used. The Hamilton Anxiety Scale (HAMA), the Hamilton depression table (HAMD), the social support rating scale (SSRS), and the family were used in 275 cases of epileptic adolescents and 170 normal adolescents. Functional assessment (FAD) and systematic family dynamics self rating scale (SSFD) were evaluated. The methods of t test, x2 test, variance analysis, Pearson correlation analysis, multivariate stepwise regression analysis, Logistic regression analysis and so on were used to complete the data statistics with SPSS19.0 software.
Results: (1) the incidence rate of psychological abnormalities (anxiety or depression) was 53.85%, anxiety and depression were 34.23%, 41.54%, the incidence of anxiety and depression was 40.71%, severe anxiety was 17.98%, severe depression was 19.44%, the incidence rate of negative suicide thought 24.09%. (2), the course of disease, the type of attack, the form of seizure, the quantity of taking medicine and epilepsy. Epileptic adolescents were associated with anxiety and depression, and the frequency of the seizures was a risk factor for the common anxiety disorder of epilepsy. The combined use of AEDs was a risk factor for common epilepsy and depression. (3) epileptic adolescents and ADAE family dynamics, family atmosphere, individualization, anxiety and depression. (4) epileptic adolescents and ADAE family function defects, Control is the main risk factor of common disease anxiety in juvenile epileptic adolescents. (5) the social support of epileptic adolescents and ADAE social support is poor, and the overall social support is the protective factor of common disease anxiety and depression in juvenile epileptic adolescents.
Conclusion: (1) ADAE is common; (2) ADAE is influenced by many dimensions of biology, antiepileptic drugs, psychological and social factors. (3) the frequency of seizures, the combined use of AEDs, family atmosphere, individualization, behavior control are the risk factors of ADAE, and the overall social support is the protective factor of ADAE.
The second part is systematic family therapy for comorbid anxiety and depression in adolescents with epilepsy.
Objective: To explore the effect of systematic family therapy on comorbid anxiety and depression (ADAE) in adolescents with epilepsy.
Methods: 104 cases of ADAE were divided into two groups, namely, the intervention group (58 cases) and the control group (46 cases). The intervention group was given systematic family therapy (SFT) combined with antiepileptic drug therapy (AEDs). The control group was given AEDs. by t test, x2 test, Pearson correlation analysis, multivariate stepwise regression analysis, Logistic regression analysis and other methods, and completed by SSPS19.0 software. Data statistics.
Results: (1) the frequency of attack in the two groups was significantly decreased (P < 0.05), but the intervention group was more obvious than the control group (P < 0.05); (2) the anxiety and depression in the intervention group were significantly decreased (P < 0.01), while the control group had no significant changes (P > 0.05), and there was a statistically significant difference (P < 0.05) in the two groups (3), and (3) the family motivation before and after intervention group intervention, The family function was obviously better and the social support was increased (P < 0.05), while the control group had no significant changes (P > 0.05). There was a significant difference between the two groups (P < 0.05). (4) the attack frequency, family atmosphere, and anxiety were important factors for the depression, and the subjective support, family atmosphere, behavior control and depression were the important shadows of the anxiety changes. Noise factors and depression are important factors influencing the frequency of seizure. The change of depression is an important factor affecting the frequency of seizures.
Conclusion: (1) SFT combined with AEDs is better than single AEDs in the treatment of ADAE, not only the frequency of epileptic seizures is decreased, but also the anxiety, depression, family power, family function and social support are improved in the children. (2) SFT is used to interfere with the common disease anxiety of young people with epilepsy, and depression is feasible and effective.
【学位授予单位】：重庆医科大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R742.1

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