中国临床心理学杂志

认知行为治疗对强迫障碍患者药物治疗依从性的影响

作者：罗佳孟繁强刘竞郭志华黄悦勤李占江

单位：1. 首都医科大学附属北京安定医院/临床心理学系国家精神心理疾病临床医学研究中心精神疾病诊断与治疗北京市重点实验室北京 100088 2. 北京大学第六医院北京大学精神卫生研究所卫生部精神卫生学重点实验室北京 100191

分类号：R395.5

出版年,卷(期):页码：2018,26(1):175-178

摘要：

目的：通过随机对照研究，分析评价认知行为治疗（CBT）对强迫障碍（OCD）患者药物治疗依从性的影响。方法：对分别接受5-羟色胺再摄取抑制剂（SSRIs）治疗（简称药物治疗组）或SSRIs联合CBT组（简称联合治疗组）的80例门诊OCD患者的药物治疗依从性进行随访研究。按照治疗方案随机分为SSRIs组（40例）和SSRIs联合CBT组（40例），被试在24周之前终止药物治疗则定义为脱落；基线时Y-BOCS的评分大于24分，则定义为高分组，反之则是低分组。结果：联合治疗组的脱落率为15%（6/40），药物治疗组的脱落率为40%（16/40），差异具有统计学意义（χ²=6.270，P<0.05）；基线时Y-BOCS低分组的脱落率为36.4%（16/44），Y-BOCS高分组脱落率为16.7%（6/36），差异具有统计学意义（χ²=3.853，P<0.05）；24周末完成组和脱落组Y-BOCS第4周末减分率分别为（14.62%±27.96%）和（4.42%±9.56%），差异具有统计学意义（t=-2.43，P<0.05）。回归分析结果显示：药物治疗脱落的发生和治疗的方案相关，药物治疗时联合运用CBT可降低脱落率（OR=0.279，95% CI（0.092，0.848）），有助于提高OCD患者药物治疗的依从性。结论：相对于单纯药物治疗，药物联合CBT治疗能够显著提高OCD患者的服药依从性，使患者从随后的治疗中获得更多的收获，减少症状反复。

Objective:To evaluate the drug compliance between the group of 5-selective serotonin reuptake inhibitor (SSRIs) treatment and the group of SSRIs combining cognitive-behavioral therapy(CBT) for obsessive-compulsive disorder (OCD). Methods:80 patients met the DSM-Ⅳ criteria for OCD were randomly assigned to group of SSRIs(n=40) and com-bined therapy group(n=40). The basic demographic data, the score of Y-BOCS and HAMA at base line and the score-reduc-ing rate of Y-BOCS at the 4th week of the study were analyzed to learn the influence the medicine-taking compliance by Bi-nary Logistic Analysis. The drop out was defined as that the patient discontinued the drug at the 24th week. At baseline, the participants with Y-BOCS score greater than 24 was defined as the high score group, whereas those with lower than or equal to 24 was low score group. Results:The dropout rate of the combined treatment group was 15%(6/40). The rate of drop out in the SSRIs group was 40%(16/40). And the difference was statistically significant(χ²=6.270, P<0.05). The drop-out rate of the low and high score group were 36.4%(16/44) and 16.7%(6/36) respectively. And the difference is statistically significant(χ²=3.853, P<0.05). The score-reducing rate of Y-BOCS at the 4th week in the completer and drop out group were respectively(14.62%±27.96%) and(4.42%±9.56%), which showed significant difference(t=-2.43, P<0.05). Regression analysis showed whether the combination of CBT is an important factor affecting the adherence of the drug[OR=0.279, 95% CI(0.092, 0.848)]. Conclusion:Drug combination CBT can significantly improve the medication compliance of patients with OCD and have the patient get long-term benefits which maybe reduce recurrence.

基金项目：

国家科技支撑计划课题：神经症早期识别与治疗方案优化研究（2007BAI17B01）；国家科技支撑计划：常见心理疾患认知行为治疗技术规范及示范模式建设（2009BAI77B11）

作者简介：

参考文献：

1 Khan A, Schwartz K, Redding N, et al. Psychiatric diagnosis and clinical trial completion rates:analysis of the FDA SBA reports. Neuropsychopharmacology Official Publication o...,2007, 32(11):2422-2430
2 孙静, 陈峥, 贾妍, 等. 强迫性障碍患者5年随访及影响预后因素研究. 精神医学杂志, 2016, 3:216-219
3 Health NCCF. NICE guideline-Obsessive-Compulsive disorder[EB/OL], 2005
4 Stein DJ, Koen N, Fineberg N, et al. A 2012 evidence-based algorithm for the pharmacotherapy for obsessive-compulsive disorder. Current psychiatry reports, 2012, 14(3):211-219
5 Koran LM, Hanna GL, Hollander E, et al. Practice guideline for the treatment of patients with obsessive-compulsive disorder. American Journal of Psychiatry, 2007, 164(7 Suppl):5-53
6 罗佳, 李占江, 杨祥云, 等. 认知行为治疗对未服药强迫障碍患者的大样本病例研究. 中国临床心理学杂志, 2017 25(2):299-303
7 Rabe-Jablonska J, Bienkiewicz W. Anxiety disorders in the fourth edition of the classification of mental disorders prepared by the American Psychiatric Association:diagnostic and statistical manual of mental disorders (DMS-IV——options book. Psychiatria Polska, 1994, 28(2):255-268
8 张一, 孟凡强, 崔玉华, 等. 修改耶鲁-布朗强迫量表的临床信度和效度研究. 中国心理卫生杂志, 1996, 5:205-207
9 马弘, 汪向东, 王希林. 心理卫生量表评定手册. 北京:中国心理卫生杂志社, 1999. 194-223
10 孟繁强, 李占江, 罗佳, 等. 认知行为治疗联合药物治疗与单纯药物治疗强迫障碍患者的随机对照研究. 中华精神科杂志, 2015, 6(48):324-330
11 罗佳, 李占江, 韩海英, 等. 单一认知行为治疗对强迫障碍患者的疗效. 中国心理卫生杂志, 2011, 12:910-914
12 Mancebo MC, Pinto A, Rasmussen SA, et al. Development of the Treatment Adherence Survey-patient version(TAS-P) for OCD. Journal of Anxiety Disorders, 2008, 22(1):32-43
13 Belotto-Silva C, Diniz JB, Malavazzi DM, et al. Group cognitive-behavioral therapy versus selective serotonin reuptake inhibitors for obsessive-compulsive disorder:a practical clinical trial. Journal of Anxiety Disorders, 2012, 26(1):25-31
14 Santana L, Versiani M, Mendlowicz MV, et al. Predictors of adherence among patients with obsessive-compulsive disorder undergoing naturalistic pharmacotherapy. Journal of Clinical Psychopharmacology, 2010, 30(1):86-88
15 Diniz JB, Malavazzi DM, Fossaluza V, et al. Risk factors for early treatment discontinuation in patients with obsessivecompulsive disorder. Clinics(Sao Paulo, Brazil), 2011, 66(3):387-393
16 Diniz JB, Fontenelle LF. Obsessive-compulsive disorder:how should we manage treatment nonadherence. Neuropsychiatry, 2013, 3(5):451-453
17 Vrbova K, Kamaradova D, Latalova K, et al. Self-stigma and adherence to medication in patients with psychotic disorders——cross-sectional study. Neuro Endocrinology Letters, 2014, 35(7):645-652
18 Hansen AM, Hoogduin CA, Schaap C, et al. Do drop-outs differ from successfully treated obsessive-compulsives? Behaviour Research and Therapy, 1992, 30(5):547-550
19 王瑞权, 吴义高, 江芹, 等. 强迫症患者的治疗依从性及其影响因素研究. 精神医学杂志, 2007, 3:144-146
20 Aderka IM, Anholt GE, van Balkom AJ, et al. Differences between early and late drop-outs from treatment for obsessive-compulsive disorder. Journal of Anxiety Disorders, 2011, 25(7):918-923
21 Santana L, Fontenelle JM, Yucel M, et al. Rates and correlates of nonadherence to treatment in obsessive-compulsive disorder. Journal of Psychiatric Practice, 2013, 19(1):42-53

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