回忆治疗联合米氮平治疗老年人抑郁症的疗效研究

发布时间：2018-09-07 09:16

【摘要】：背景抑郁症是精神科常见的疾病之一,老年人由于生活能力下降、社会活动减少及慢性躯体疾病容易出现孤独、寂寞、自卑等情绪,这些不良情绪使得其容易出现抑郁症。但由于其症状表现不典型,常被繁多的躯体症状所掩盖,导致家庭、社会及医护人员对老年抑郁症的识别率低,且常被误诊为其他疾病,或被认为是机体衰老的正常表现,而未得到足够的重视。老年人一旦确诊抑郁症,应及时给予相应治疗,否则会导致不良结果。老年抑郁症一般采用药物治疗联合心理干预。治疗抑郁症的药物很多,米氮平是四环类哌嗪类化合物,是具有去甲肾上腺素和5-羟色胺双重抑制作用的抗抑郁药物。此外,米氮平是新型抗抑郁中仅有的一个H1受体强拮抗作用的抗抑郁药,有助于镇静和增进食欲,减少夜间觉醒和延长总睡眠时间。该药有较好的耐受性,几乎无抗胆碱能作用,其治疗剂量对心血管系统无影响。许多研究显示,米氮平对老年患者疗效肯定,安全性好,甚至对年龄80岁的患者均具有较好的安全性和耐受性。由于医学模式的转变和以人的健康为中心的整体治疗观的确立,国内外有关老年抑郁心理干预的研究不断深入。回忆治疗是一种简便易行的心理干预手段,是通过对过去事件、情感、及想法的回顾,帮助人们增加幸福感、提高生活质量及对现有环境的适应能力。回忆治疗的理论基础主要有Erikson的心理社会发展理论和Atchley的持续理论。研究证实,运用回忆治疗可以有效防止或减轻老年抑郁症状,提高自尊感,有助于抑郁老年人应对危机、失落及生活变故,并提高生活满意度及生存质量。目的探讨回忆治疗联合米氮平治疗老年人抑郁症的疗效,及对人际关系,社会功能的影响。方法老年抑郁患者80例,随机分成米氮平组(40例)和回忆治疗联合米氮平组(40例)。米氮平组接受口服米氮平治疗和健康教育,回忆治疗联合米氮平组在此基础上施行8周的回忆治疗。应用HAMD-24量表、MADRS量表比较治疗前后抑郁症状改善情况,应用PSP量表比较治疗前后社会功能恢复情况。结果回忆治疗联合米氮平组HAMD-24评分明显改善时间提前到治疗后2周。治疗8周后,回忆治疗联合米氮平组HAMD-24评分、MADRS评分和症状改善效果优于米氮平组,PSP评分提高程度也大于单用米氮平组。结论米氮平治疗老年抑郁症安全有效,回忆疗法联合米氮平治疗老年人抑郁症的起效快,疗效更优于单用米氮平,有助于人际交往、社会功能的恢复,值得推广。
[Abstract]:Background Depression is one of the common diseases in psychiatric department. The elderly people are prone to loneliness, inferiority complex and so on because of the decline of life ability, the decrease of social activities and the chronic body disease. These bad emotions make them prone to depression. However, because its symptoms are not typical, they are often masked by various body symptoms, resulting in low recognition rate of senile depression among family, society and medical staff, and are often misdiagnosed as other diseases, or as normal signs of body aging. Without getting enough attention. Once diagnosed depression, the elderly should be given timely treatment, otherwise will lead to adverse results. Drug therapy combined with psychological intervention is generally used for senile depression. There are many antidepressants for depression. Mezapine is a tetracyclic piperazine compound and is an antidepressant with dual inhibitory effects of norepinephrine and serotonin. In addition, mirtazapine is the only new antidepressant with strong antagonistic effect of H1 receptor, which helps to calm down and increase appetite, reduce nocturnal arousal and prolong total sleep time. The drug has good tolerance, almost no anticholinergic effect, its therapeutic dose has no effect on cardiovascular system. Many studies have shown that mirtazapine has good efficacy and safety in elderly patients, and even has good safety and tolerance for patients aged 80 years. Due to the change of medical model and the establishment of holistic view of treatment centered on human health, the research on psychological intervention of senile depression at home and abroad has been deepened. Recall therapy is a simple psychological intervention, which can help people increase their happiness, improve their quality of life and adapt to the existing environment by reviewing past events, emotions and thoughts. The theory of recall therapy is based on Erikson's theory of psycho-social development and Atchley's theory of persistence. The study proved that memory therapy can effectively prevent or alleviate depression symptoms, improve self-esteem, help the elderly to cope with crisis, loss and life changes, and improve life satisfaction and quality of life. Objective to investigate the effect of memory therapy combined with mizapine on elderly depression and its influence on interpersonal relationship and social function. Methods 80 elderly patients with depression were randomly divided into two groups: metozapine group (n = 40) and memory therapy combined with metozapine group (n = 40). The patients in the mirtazapine group received oral mirtazapine therapy and health education, and the memory therapy combined with miazapine group was used for 8 weeks. The depression symptoms before and after treatment were compared with HAMD-24 scale and the recovery of social function before and after treatment with PSP scale. Results the improvement time of HAMD-24 score in memory therapy combined with mirtazapine group was advanced to 2 weeks after treatment. After 8 weeks of treatment, the effect of memory therapy combined with miazapine group on HAMD-24 score and symptom improvement was better than that of mianzapine group, and the improvement degree of memory therapy combined with mirtazapine group was also higher than that of single metozapine group. Conclusion Mitzapine is safe and effective in the treatment of senile depression. Memory therapy combined with mizapine is more effective than metozapine alone in the treatment of senile depression. It is helpful to interpersonal communication and social function recovery. It is worth popularizing.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R749.4

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