帕罗西汀联合认知行为疗法治疗强迫症的临床对照研究

摘要

Objective To compare the clinical efficacy of paroxetine and paroxetine combined with cognitive behavioral therapy in the treatment of obsessive - compulsive disorder(OCD). Methods 86 patients who met the CCMD - 3 diagnostic criteria for OCD were divided into the study group and the control group,each group was 43 cases with quasi - ramdomization method. The two groups was treated with paroxetine,and the study group received cognitive behavioral therapy once a week. All cases were observed for 12 weeks. Before treatment,after treatment for 4 weeks,8 weeks and 12 weeks,the Yale - Brown Obsessive Compulsive Scale(Y - BOCS), Hamilton Anxiety Scale(HAMA)were used to evaluate the clinical curative effect of the two groups. After treatment for 4 weeks, 8 weeks,12 weeks,Treatment Emergent Symptom Scale(TESS)was applied to assess the adverse reactions. Results After 4 weeks treatment,the Y - BOCS scores of two groups decreased than those of before treatment(P < 0. 01),and the HAMA score of the study group was lower than that of the control group(P < 0. 01). At the end of the 8th week,the Y - BOCS total score of the study group was lower than that of the control group(P < 0. 05). After 12 weeks treatment,the score of compulsive behavior factor of the study group was lower than that of the control group(P < 0. 05),the total effective rate of the study group was higher than the control group (86. 05% vs. 62. 79% ,P < 0. 05),and there was no statistically significant difference between the incidence of adverse reactions of the two groups(16. 28% vs. 20. 93% ,P > 0. 05). Conclusion Paroxetine combined with cognitive behavioral therapy and paroxetine therapy alone can effectively relieve the symptoms of patients with OCD,but paroxetine combined with cognitive behavioral therapy is better than paroxetine therapy alone in the treatment,especially the improvement of compulsive behavior is more outstanding.%目的：比较单用帕罗西汀与帕罗西汀联合认知行为疗法对强迫症的临床疗效。方法采用半随机法将符合《中国精神障碍分类与诊断标准（第3版）》（CCMD -3）强迫症诊断标准的86例患者分为研究组和对照组各43例，两组均给予帕罗西汀治疗，研究组在此基础上给予每周1次的认知行为治疗，均观察12周。于治疗前和治疗后第4、8、12周分别采用耶鲁-布朗强迫量表（Y - BOCS）、汉密尔顿焦虑量表（HAMA）评定临床疗效，于治疗第4、8、12周采用副反应量表（TESS）评定不良反应。结果治疗4周末起两组 Y - BOCS 总评分均较治疗前低（P 均＜0.01），研究组 HAMA 评分低于对照组（P ＜0.01），第8周末起研究组 Y - BOCS 评分低于对照组（P ＜0.05）；治疗12周末，研究组强迫行为因子评分低于对照组（P ＜0.05），且研究组总有效率高于对照组（86.05％ vs.62.79％，P ＜0.05），研究组和对照组不良反应发生率差异无统计学意义（16.28％ vs.20.93％，P ＞0.05）。结论单用帕罗西汀与帕罗西汀联合认知行为疗法均可缓解强迫障碍患者症状，但帕罗西汀联合认知行为疗法的效果优于单用帕罗西汀治疗，尤其对强迫行为的改善更为突出。