内观认知疗法对老年抑郁患者自杀风险干预研究

发布时间：2018-04-25 09:16

本文选题：内观认知疗法 + 老年抑郁　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的:随着人口老龄化进程的加速,中国社会逐步进入老龄社会。一系列的老龄问题接踵而来,老年抑郁就是对老年人的晚年生活影响较大的一种疾病,对社会、家庭都有巨大的影响。本研究通过对老年抑郁患者在药物治疗的基础上,合并分散内观认知治疗后,老年抑郁患者的改善状况,特别是老年抑郁患者对自杀的态度的改善,从而不断的开拓内观认知治疗的新领域,并使我们对内观认知治疗的原理、步骤更加熟悉,并且为老年抑郁患者的治疗开拓思路,提供更加经济、有效、安全、实用的辅助治疗方法。方法:将天津市安定医院2015年7月至2016年6月,老年科住院病人中,符合本研究入组标准,且符合排除标准的,老年抑郁患者共70名为观察对象,随机分为研究组及对照组。研究组在服用药物治疗的基础上,合并内观认知疗法,患者持续治疗两周,在此期间,每天在指导下,进行2小时的内观认知治疗。对照组患者,在药物治疗的基础上,合并常规日常心理治疗。研究采用单盲法进行评估,分别在患者入组时、进行内观治疗两周后,各进行一次各项评估。由医生使用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、老年抑郁量表(GDS)、简易智能精神状态检查量表(MMSE)、日常生活能力量表(ADL)评估;由患者自行使用抑郁自评量表(SDS)、焦虑自评量表(SAS)评估;并用自杀风险评估量表(NGASR)及自杀危险因素评估表来评价患者对自杀的态度。结果:(1)两组研究结果显示,自杀风险评估量表总评分,均较治疗前有明显改善。经配对t检验比较,两组组内差异,均有明显临床意义(P0.01)。采用独立样本t检验比较组间差异,治疗前,两组间自杀风险评估量表评分,差异无临床意义(P0.05)。治疗后,研究组自杀风险评估量表评分较对照组,有明显改善,差异有显著临床意义(P0.01)。(2)两组研究结果显示,自杀危险因素量表总评分,均较治疗前有明显改善。经配对t检验比较,两组组内差异,均有显著临床意义(P0.01)。采用独立样本t检验比较,治疗前,两组间自杀危险因素评分,差异无临床意义(P0.05)。治疗后,研究组自杀危险因素评分较对照组,有明显改善,差异有显著临床意义(P0.01)。(3)两组研究结果显示,简明精神状态量表总评分,均较治疗前有明显改善。经配对t检验比较,两组组内差异均有显著临床意义(P0.01)。采用独立样本t检验比较组间差异,研究组与对照组间简明精神状态量表评分,治疗前与治疗后相比较,差异均无明显临床意义(P0.05)。(4)两组研究结果显示,日常生活能力量表评分,均较治疗前有明显改善。经配对t检验比较,两组组内差异,均有显著临床意义(P0.01)。采用独立样本t检验比较组间差异,治疗前,两组间日常生活能力量表评分,差异均无明显临床意义(P0.05)。治疗后,研究组日常生活能力量表评分较对照组,有明显改善,差异有显著临床意义(P0.01)。(5)两组研究结果显示,抑郁自评量表总评分,均较治疗前有明显改善。经配对t检验比较,两组组内比较,差异均有显著统临床意义(P0.01)。采用独立样本t检验比较组间差异,治疗前,两组间抑郁自评量表评分,差异无明显临床意义(P0.05)。治疗后,研究组抑郁自评量表评分较对照组有明显改善,差异有临床意义(P0.05)。(6)两组研究结果显示,焦虑自评量表评分,均较治疗前有明显改善。经配对t检验比较,两组组内比较,差异均有明显临床意义(P0.01)。采用独立样本t检验比较组间差异,治疗前,两组间焦虑自评量表评分,差异无临床意义(P0.05)。治疗后,研究组焦虑自评量表评分较对照组有明显改善,差异有明显临床意义(P0.01)。(7)两组研究结果显示,汉密尔顿抑郁量表总评分,均较治疗前有明显改善。经配对t检验比较,两组组内差异均有显著临床意义(P0.01)。采用独立样本t检验比较组间差异,治疗前,两组间汉密尔顿抑郁量表评分差异无临床意义(P0.05)。治疗后,研究组较对照组汉密尔顿抑郁量表评分提示有明显改善,差异有临床意义(P0.05)。(8)两组研究结果显示,汉密尔顿焦虑量表总评分,均较治疗前有明显改善。经配对t检验比较,两组组内差异均有显著临床意义(P0.01)。采用独立样本t检验比较两组间差异,治疗前,两组间汉密尔顿焦虑量表评分,差异均无明显临床意义(P0.05)。治疗后,研究组汉密尔顿焦虑量表评分较对照组有明显改善,差异有显著临床意义(P0.01)。(9)两组研究结果显示,老年抑郁量表总评分,均较治疗前有明显改善。经配对t检验比较,两组组内差异均有明显临床意义(P0.01)。采用独立样本t检验比较组间差异,治疗前,两组间老年抑郁量表评分均无明显临床意义(P0.05)。治疗后,研究组老年抑郁量表评分较对照组明显改善,且差异有明显临床意义(P0.01)。(10)采用Pearson相关分析对研究组年龄与各量表评分的差值进行相关分析,结果显示,年龄与治疗前后GDS评分差值、NGASR评分差值、自杀危险因素评分差值成负相关(r值分别为-0.350,-0.432,-0.445,P值分别为0.039,0.009,0.007),而与其他量表治疗前后评分的差值无明显相关性;分析对研究组病程与各量表评分的差值进行相关分析,结果显示,病程与治疗前后各量表评分的差值无明显相关性。结论:(1)在对老年抑郁患者合并内观认知治疗后,患者对自杀态度的认识有改善。(2)在对老年抑郁患者合并内观认知治疗后,患者的日常生活能力有改善。(3)老年抑郁患者在内观认知治疗后,主观及客观分析,对抑郁症状有改善。(4)老年抑郁患者在内观认知治疗后,主观及客观分析,对焦虑症状有改善。(5)内观认知疗法对改善老年抑郁患者智能及精神状态等认知功能方面效果与常规心理治疗相比较无明显差异。
[Abstract]:Objective: with the acceleration of the aging process of the population, Chinese society is gradually entering an aging society. A series of aging problems ensue, senile depression is a disease which has a great influence on the old life of the elderly, and has a great influence on the society and the family. This study combines the treatment of elderly depressed patients on the basis of drug treatment. After decentralization of cognitive treatment, the improvement of elderly depressive patients, especially the improvement of the attitude of the elderly depressive patients to suicide, thus constantly open up the new field of internal and cognitive treatment, and make us more familiar with the principles and steps of the internal cognitive treatment, and provide more economic for the treatment of the elderly depressed patients. Effective, safe and practical methods of adjuvant treatment. Methods: the Tianjin Anding Hospital from July 2015 to June 2016, the elderly hospitalized patients, in line with the standard of this study, and in line with the exclusion criteria, 70 elderly depressive patients were observed, randomly divided into the study group and the control group. The patients were treated with internal cognitive therapy for two weeks. During this period, the patients were treated with 2 hours of internal cognitive therapy under guidance. The control group was combined with routine routine psychotherapy on the basis of drug treatment. The doctors used the Hamilton Depression Scale (HAMD), the Hamilton Anxiety Scale (HAMA), the old age depression scale (GDS), the simple intelligent mental state examination scale (MMSE), the daily living capacity scale (ADL) assessment, the self-used self rating Depression Scale (SDS), the self rating Anxiety Scale (SAS) assessment, and the suicide risk assessment scale (NGASR). The assessment of suicide risk factors was used to evaluate the patient's attitude to suicide. Results: (1) the results of the two groups showed that the total score of the suicide risk assessment scale was significantly better than that before the treatment. Compared with the paired t test, the differences in the two groups had significant clinical significance (P0.01). The difference between the groups was compared with the independent sample t test. Before treatment, two groups were compared. The difference of suicidal risk assessment scale was no clinical significance (P0.05). After treatment, the score of suicide risk assessment scale was significantly improved in the study group, and there was significant clinical significance (P0.01). (2) the two groups of studies showed that the total score of suicide risk factors was significantly improved. Compared with the matched t test, two groups were compared. The differences in the group had significant clinical significance (P0.01). Compared with the independent sample t test, the scores of suicide risk factors between the two groups had no clinical significance (P0.05). After treatment, the scores of suicide risk factors in the study group were significantly improved and the difference had significant clinical significance (P0.01). (3) the two groups of research results showed the concise spirit. The total score of the state scale was significantly better than that before the treatment. Compared with the paired t test, the difference in the two groups had significant clinical significance (P0.01). The difference between the group and the control group was compared with the independent sample t test. There was no significant clinical significance between the study group and the control group (P0.05) before and after the treatment (P0.05). (4) The results of the two groups showed that the score of daily living capacity scale was significantly better than before the treatment. Compared with the paired t test, the difference in the two groups had significant clinical significance (P0.01). The difference between the groups was compared with the independent sample t test. Before the treatment, there was no significant clinical significance (P0.05) in the difference between the two groups of daily living energy table scores. After the study group, the score of daily life ability scale was better than that of the control group. The difference had significant clinical significance (P0.01). (5) the two groups of research results showed that the total score of the self rating Depression Scale was significantly better than that before the treatment. Compared with the matched t test, the difference in the two groups had significant clinical significance (P0.01). An independent sample t examination was used. There was no significant clinical significance between the two groups before treatment (P0.05). There was a significant improvement in the self rating depression scale of the study group compared with the control group (P0.05). (6) the results of the two groups showed that the self rating Anxiety Scale was significantly improved by the paired t test. Comparison, the difference in the two groups had significant clinical significance (P0.01). The independent sample t test was used to compare the differences between groups. Before treatment, the two groups had no clinical significance (P0.05). After treatment, the scores of self rating Anxiety Scale were significantly improved in the study group, and there were significant clinical significance (P0.01). (7) two groups. The results showed that the total score of Hamilton depression scale was significantly better than before the treatment. Compared with the paired t test, the differences in the two groups had significant clinical significance (P0.01). The difference between the two groups was compared with the independent sample t test. Before treatment, there was no clinical significance between the two groups (P0.05). After treatment, the study group was treated. Compared with the control group Hamilton Depression Scale score, the difference was significantly improved (P0.05). (8) the two groups of results showed that the total score of Hamilton's anxiety scale was significantly better than before the treatment. Compared with the paired t test, the difference in the two groups had significant clinical significance (P0.01). The independent sample t test was used to compare the two groups. Difference, before treatment, the Hamilton Anxiety Scale score between the two groups had no significant clinical significance (P0.05). After treatment, the score of Hamilton anxiety scale was significantly improved in the study group compared with the control group, and the difference had significant clinical significance (P0.01). (9) the results of the two groups showed that the total score of the elderly depression scale was significantly better than that before the treatment. Compared with the paired t test, the difference in the two groups had significant clinical significance (P0.01). The difference between the groups was compared with the independent sample t test. Before the treatment, there was no significant clinical significance (P0.05) for the Senile Depression Scale score between the groups (P0.05). After treatment, the scores of the elderly depression scale were significantly improved in the study group, and there were significant clinical significance (P0.01) (10). The difference between the age and the scale of the study group was analyzed by Pearson correlation analysis. The results showed that the difference of age and GDS score, the difference of NGASR score, and the difference of suicide risk factors were negatively correlated (r value was -0.350, -0.432, -0.445, P value respectively, respectively), and it was evaluated before and after the treatment of other scales. There was no significant correlation between the difference of the scores; the analysis of the difference between the course of disease and the scale of each scale showed that the difference between the course of disease and the scale of each scale before and after treatment had no significant correlation. Conclusion: (1) the understanding of the patient's attitude to suicide was improved after the treatment of senile depressive patients with internal cognitive cognitive treatment. (2) in the senile depression. The patient's daily living ability improved after the depression patients combined with the internal cognitive treatment. (3) the elderly depressive patients were subjective and objective analysis after the internal cognitive treatment, and improved the depressive symptoms. (4) the elderly depressed patients were subjective and objective analysis after the internal cognitive treatment, and improved the anxiety symptoms. (5) the internal cognitive therapy was used to improve the senile depression. The cognitive function of patients with depression and mental state was not significantly different from that of conventional psychotherapy.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.4

【参考文献】