单双相抑郁患者的临床特征及药物联合心理疗法的效果分析

doi:10.3760/cma.j.issn.1007-1245.2023.10.022

摘要/Abstract

摘要：

目的　探讨单双相抑郁患者的临床特征以及对其进行药物联合心理疗法的临床效果。方法　选取2020年1月至2022年1月临沂市精神卫生中心收治的单相抑郁患者以及双相抑郁患者，各46例，分为单相抑郁组和双相抑郁组。单相抑郁组男20例，女26例，年龄14～43（27.64±6.31）岁，受教育年限5～14（8.31±3.21）年，以抗抑郁剂以及情感稳定剂进行治疗。双相抑郁组男19例，女27例，年龄15～44（27.91±6.14）岁，受教育年限4～15（8.65±3.07）年，以心境稳定剂、抗抑郁剂以及镇静催眠药进行治疗。两组患者均接受药物联合心理干预的综合治疗方法，比较两组患者临床特征，认知功能损害情况以及经药物联合心理疗法治疗前后汉密尔顿抑郁量表（HAMD）评分。统计学方法采用t检验、χ²检验。结果　双相抑郁组双相障碍家族史、心境不稳定的患者比例及汉密尔顿焦虑量表（HAMA）评分、生活事件量表（LES）评分均高于单相抑郁组［19.57%（9/46）比2.17%（1/46）、32.61%（15/46）比13.04%（6/46）、（13.42±2.13）分比（7.73±1.24）分、（42.32±4.58）分比（28.69±4.16）分］，首发年龄低于单相抑郁组［（25.41±3.78）岁比（32.58±3.41）岁］，差异均有统计学意义（χ²=7.20、5.00，t=15.66、14.94、9.55，均P<0.05）；双相抑郁组患者错误反应次数、持续错误次数、随机错误次数均高于单相抑郁组［（19.63±2.54）次比（15.41±2.67）次、（13.76±2.71）次比（9.46±1.38）次、（7.12±1.68）次比（4.89±0.74）次］，正确反应次数、完成分类数均低于单相抑郁组［（28.63±3.26）次比（32.58±3.47）次、（2.45±0.34）次比（5.41±0.69）次］，TMT-A时间长于单相抑郁组［（62.36±7.18）s比（48.69±5.24）s］，差异均有统计学意义（t=7.77、9.90、8.24、5.63、26.10、10.43，均P<0.05）；治疗前，单相抑郁组HAMD评分为（24.56±4.63）分，双相抑郁组HAMD评分为（25.37±4.52）分，经药物联合心理疗法治疗后，单相抑郁组、双相抑郁组HAMD评分均降低，其中双相抑郁组高于单相抑郁组［（12.54±1.32）分比（8.23±1.74）分］，差异有统计学意义（t=13.38，P<0.05）。结论　单双相抑郁患者在临床特征上差异较为明显，后者遗传倾向高，发病较早，能够通过问卷调查进行一定程度上的区分，且双相抑郁对于患者的认知功能损害更为严重，治疗难度较大，预后也相对较差，临床治疗时应对两者进行进一步鉴别区分，并实施针对性干预。

关键词:

单相抑郁, 双相抑郁, 临床特征, 认知损害

Abstract:

Objective To investigate the clinical characteristics of patients with unipolar and bipolar depressions and the clinical effect of drug combined psychotherapy. Methods　From January 2020 to January 2022, 46 patients with unipolar depression treated at Linyi Mental Health Center were selected as a unipolar depression group, and 46 patients with bipolar depression as a bipolar depression group. In the unipolar depression group, there were 20 males and 26 females; they were 14-43 (27.64±6.31) years old; they took 5-14 (8.31±3.21) years education. In the bipolar depression group, there were 19 males and 27 females; they were 15-44 (27.91±6.14) years old; they took 4-15 (8.65±3.07) years education. The unipolar depression group were treated with antidepressants and emotional stabilizers, and the bipolar depression group with mood stabilizer, antidepressant and sedative hypnotic drugs. Both groups were treated with drugs and psychological intervention. The clinical features, cognitive impairment, and Hamilton Depression Scale (HAMD) scores before and after drugs combined with psychological therapy were compared between the two groups. t and χ² tests were applied. Results　The proportions of the patients with family history of bipolar disorder, mood instability and scores of Hamilton Anxiety Scale and Life Events Scale (LES), and the age of first episode were 19.57% (9/46), 32.61% (15/46), (13.42±2.13), (42.32±4.58), and (25.41±3.78) years in the bipolar depression group, and were 2.17% (1/46), 13.04% (6/46), (7.73±1.24), (28.69±4.16), and (32.58±3.41) years in the unipolar depression group, with statistical differences (χ²=7.20 and 5.00; t=15.66, 14.94, and 9.55; all P<0.05). The numbers of errors, persistent errors, and random errors were higher, the numbers of correct reactions and completed classification were lower, and the TMT-A time was longer in the bipolar depression group than in the unipolar depression group [(19.63±2.54) times vs. (15.41±2.67) times, (13.76±2.71) times vs. (9.46±1.38) times, (7.12±1.68) times vs. (4.89±0.74) times, (28.63±3.26 times vs.(32.58±3.47) times, (2.45±0.34) times vs. (5.41±0.69) times, and (62.36±7.18) s vs. (48.69±5.24) s], with statistical differences (t=7.77, 9.90, 8.24, 5.63, 26.10, and 10.43; all P<0.05). Before the treatment, there was no statistical difference in the score of HAMD between the unipolar depression group and the bipolar depression group [(24.56±4.63) vs. (25.37±4.52)]. After medication combined with psychotherapy, the scores of HAMD in both groups decreased, and the score in the bipolar depression group was higher than that in the unipolar depression group [(12.54±1.32) vs. (8.23±1.74)], with a statistical difference (t=13.38, P<0.05). Conclusions There are obvious differences in clinical characteristics between patients with unipolar and bipolar depressions. The latter has high genetic tendency and early onset, and can be distinguished to a certain extent through questionnaire survey. Moreover, patients with bipolar depression have more serious cognitive impairment and are more difficult to treat, with relatively poor prognosis. Patients with unipolar and bipolar depressions should be clinically treated in different ways and intervened targetedly.

Key words:

Unipolar depression, Bipolar depression, Clinical features, Impairment of cognitive function

高兰王婷婷崔付新张清清王相立.

单双相抑郁患者的临床特征及药物联合心理疗法的效果分析 [J]. 国际医药卫生导报, 2023, 29(10): 1430-1434.

Gao Lan, Wang Tingting, Cui Fuxin, Zhang Qingqing, Wang Xiangli.

Clinical characteristics of patients with unipolar and bipolar depressions and effect analysis of drug combined with psychotherapy [J]. International Medicine and Health Guidance News, 2023, 29(10): 1430-1434.

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