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1.
针对抑郁症治疗完全缓解率低,运用临床思维方法,依靠循证医学证据,首先分析了抗抑郁药物的选择、优化、更换和联合用药的治疗效益.然后辩证分析并比较了药物与心理治疗,以及药物与心理治疗的单独与联合应用对重性抑郁急性和长期治疗的疗效,以及严重重性抑郁、严重慢性抑郁的短期和长期疗效以及费用效益,为确定治则、选择治法提供帮助. 相似文献
2.
袁勇贵 《医学与哲学(人文社会医学版)》2012,33(2)
卒中后抑郁是脑卒中后常见的并发症,其发病率高,明显降低患者生活质量.卒中后抑郁症的发病机制非常复杂.目前认为社会、心理、生物学因素等均在其中扮演一定的角色.卒中后抑郁的治疗应首选药物治疗,在单一药物疗效欠佳时可加用物理治疗和心理治疗. 相似文献
3.
袁勇贵 《医学与哲学(人文社会医学版)》2012,(1):18-19
卒中后抑郁是脑卒中后常见的并发症,其发病率高,明显降低患者生活质量。卒中后抑郁症的发病机制非常复杂。目前认为社会、心理、生物学因素等均在其中扮演一定的角色。卒中后抑郁的治疗应首选药物治疗,在单一药物疗效欠佳时可加用物理治疗和心理治疗。 相似文献
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5.
《医学与哲学(人文社会医学版)》2018,(4)
心理治疗适宜性关注的是患者是否适合接受心理治疗,以及适合接受何种心理治疗方法的问题。对患者治疗适宜性的评估一是为患者选择药物或心理治疗提供了重要参考;二是预测患者接受某种心理治疗方法后的治疗效果,有助于治疗师更有针对性地制定治疗计划,最终增进治疗效果;三是有利于促进心理治疗中单个流派"包治百病"到各个流派"专病专治"的规范化转变。本文对心理动力学流派治疗适宜性的研究概况、主要结果和发展方向进行了分析和总结,以为中国心理治疗与咨询理论研究与实践提供有益参考。 相似文献
6.
《医学与哲学(人文社会医学版)》2018,(10)
平衡心理治疗是一种建立在东方哲学体系上的,整合了精神分析、认知疗法、行为疗法、叙事治疗以及积极心理学等多种心理治疗流派的治疗取向。本个案探讨平衡心理治疗对青少年抑郁症患者的治疗效果。以1例青少年抑郁症患者为研究对象,采用8次平衡心理治疗,每周1次。在治疗前、治疗第四周后、治疗第八周后、治疗结束一个月后采用抑郁自评量表(PHQ-9)和焦虑自评量表(GAD-7)评估症状的严重程度。治疗后患者的抑郁和焦虑症状明显缓解,在随访时已能每天正常学习,生活作息规律,社会功能基本恢复。 相似文献
7.
抑郁症认知治疗理论及实践进展 总被引:8,自引:0,他引:8
认知治疗分化为认知行为与认知分析治疗两个流派。抑郁的贝克认知模型、归因模型、自我价值关联模型以及抑郁的注意过程等认知理论为认知治疗奠定了基础。认知行为治疗、认知行为分析系统心理治疗以及基于冥想的认知治疗等已经在实践中被较有力的临床证据检验。认知治疗在抑郁症的治疗中已显示出广泛的应用前景。 相似文献
8.
认知治疗分化为认知行为与认知分析治疗两个流派.抑郁的贝克认知模型、归因模型、自我价值关联模型以及抑郁的注意过程等认知理论为认知治疗奠定了基础.认知行为治疗、认知行为分析系统心理治疗以及基于冥想的认知治疗等已经在实践中被较有力的临床证据检验.认知治疗在抑郁症的治疗中已显示出广泛的应用前景. 相似文献
9.
《医学与哲学(人文社会医学版)》2016,(2)
为探讨人际心理治疗(IPT)、认知行为治疗(CBT)对躯体形式障碍(SD)的疗效,采用汉密尔顿抑郁量表、汉密尔顿焦虑量表对81例SD患者进行临床评估,根据治疗方法的不同分为A组,IPT联合度洛西汀;B组,CBT联合度洛西汀;C组,仅用度洛西汀。治疗后三组评分与治疗前比较,均有显著性下降;治疗后A组和B组的评分与C组比较,均有显著性下降;治疗后A组和B组的评分,差异无统计学意义。因此,IPT和CBT均可显著提高躯体形式障碍的疗效,IPT在疗效上与认知行为治疗相当。 相似文献
10.
广泛性焦虑障碍心理治疗、药物治疗均可选择.心理治疗主要是CBT.药物治疗主要是抗抑郁药物,SSRI、SNRI是一线选择,NICE推荐舍曲林作为初始治疗药物.对于难治性的患者,可以试用第二代抗精神病药物,如喹硫平.如果药物治疗有效,最佳治疗时间为一年. 相似文献
11.
Laura B. Allen Kamila S. White David H. Barlow M. Katherine Shear Jack M. Gorman Scott W. Woods 《Journal of psychopathology and behavioral assessment》2010,32(2):185-192
Research evaluating the relationship of comorbidity to treatment outcome for panic disorder has produced mixed results. The
current study examined the relationship of comorbid depression and anxiety to treatment outcome in a large-scale, multi-site
clinical trial for cognitive-behavior therapy (CBT) for panic disorder. Comorbidity was associated with more severe panic
disorder symptoms, although comorbid diagnoses were not associated with treatment response. Comorbid generalized anxiety disorder
(GAD) and major depressive disorder (MDD) were not associated with differential improvement on a measure of panic disorder
severity, although only rates of comorbid GAD were significantly lower at posttreatment. Treatment responders showed greater
reductions on measures of anxiety and depressive symptoms. These data suggest that comorbid anxiety and depression are not
an impediment to treatment response, and successful treatment of panic disorder is associated with reductions of comorbid
anxiety and depressive symptoms. Implications for treatment specificity and conceptual understandings of comorbidity are discussed. 相似文献
12.
Andre Dessaulles Susan M. Johnson Wayne H. Denton 《The American journal of family therapy》2013,41(5):345-353
Emotion-focused therapy (EFT) for couples was compared to pharmacotherapy in the treatment of major depressive disorder. Eighteen distressed couples in which the female partner met diagnostic criteria for major depressive disorder were randomly assigned to 16 weekly sessions of emotion-focused therapy or pharmacotherapy with desipramine, trimipramine, or trazadone. Twelve couples completed the study. Both interventions were equally effective in symptom reduction. There was some evidence that females receiving EFT made greater improvement after the conclusion of treatment than those receiving pharmacotherapy. The results suggest EFT might be useful in the treatment of comorbid major depressive disorder and relational distress. 相似文献
13.
Saskia de Maat Ph.D. Rien Van M.D. Ph.D. Marielle Hendriksen M.Sc. Simone Kool M.D. Ph.D. Gerda van Aalst M.D. 《Psychoanalytic Inquiry》2013,33(6):614-625
Short-Term Psychoanalytic Supportive Psychotherapy (SPSP) is a face-to-face, individual psychotherapy, consisting of sixteen sessions in six months (first eight weekly, then eight fortnightly sessions). It is rooted in psychoanalytic theory. Its primary aim is to cure depression. A secondary goal is to reduce a patient's vulnerability to depression. The emphasis is on supportive techniques that counter regression and foster psychological growth. The putative process consists in experiencing a relational dissonance, i.e., feeling two contradictory relationships in the therapeutic situation simultaneously, one determined by the past, the other by the present. We assume an important curative factor is to experience, mostly unconsciously, an adequate gratification of developmental needs inadequately met in early infancy and, therefore, manifesting themselves in the archaic aspects of the therapeutic relationship. SPSP unfolds as a discourse in which we distinguish nine levels. Each regards a specific subject, which at that level is the focus of the interaction between patient and therapist. The efficacy of SPSP in ambulatory patients presenting a DSM-IV defined, mild to moderate major depressive disorder has been tested in five randomized clinical trials. The results have been aggregated in a mega-analysis. They suggest that, in the treatment of outpatients with mild to moderate major depressive disorder, SPSP and pharmacotherapy are equally efficacious and that the combination of SPSP and pharmacotherapy is more efficacious than pharmacotherapy alone but not than SPSP alone. We, therefore, consider SPSP a valuable extension to the existing options for the treatment of depressed patients. 相似文献
14.
Seasonal affective disorder is a common variant of recurrent major depressive disorder or bipolar disorder. Treatment with bright artificial light has been found to be effective in this condition. However, for patients who do not respond to light therapy or those who lack compliance, conventional drug treatment with antidepressants also has been proposed. Substances with selective serotonergic or noradrenergic mechanisms should be preferred over older antidepressants. Although there are a number of open and controlled studies evaluating different compounds, these studies were often limited by relatively small sample sizes. Furthermore, there are no studies specifically addressing bipolar seasonal depression. This article will review the published literature on pharmacotherapy of seasonal affective disorder. 相似文献
15.
Betsy D. Kennard Sunita M. Stewart Jennifer L. Hughes Robin B. Jarrett Graham J. Emslie 《Cognitive and behavioral practice》2008,15(4):387-399
Relapse rates for children and adolescents with major depressive disorder (MDD) range from 30% to 40% within 1 to 2 years after acute treatment. Although relapse rates are high, there have been relatively few studies on the prevention of relapse in youth. While acute phase pharmacotherapy has been shown to reduce symptoms rapidly in depressed youth, children and adolescents frequently report ongoing residual symptoms and often relapse following acute treatment. Recent adult trials have begun examining augmentation with psychosocial treatment after successful medication treatment to enhance medication response and prevent future relapse. This strategy has not yet been examined in youth with depression. Here we present initial efforts to develop a sequential, combination treatment strategy to promote rapid remission and to prevent relapse in depressed youth. We describe efforts to adapt CBT to prevent relapse (RP-CBT) in youth who respond to pharmacotherapy. The goals of RP-CBT include: preventing relapse, increasing wellness, and developing skills to promote and sustain well-being. We describe the rationale for, components of, and methods used to develop RP-CBT. The results from a small open series sample demonstrate feasibility and indicate that youth appear to tolerate RP-CBT well. A future test of the treatment in a randomized controlled trial is described. 相似文献
16.
《Cognitive behaviour therapy》2013,42(3):209-220
The current study examined the effectiveness of brief cognitive behavior therapy (CBT) for severe mood disorders in an acute naturalistic setting. The sample included 951 individuals with either major depressive disorder (n = 857) or bipolar disorder with depressed mood (n = 94). Participants completed a battery of self-report measures assessing depression, overall well-being, and a range of secondary outcomes both before and after treatment. We found significant reductions in depressive symptoms, worry, self-harm, emotional lability, and substance abuse, as well as significant improvements in well-being and interpersonal relationships, post-treatment. Comparable to outpatient studies, 30% of the sample evidenced recovery from depression. Comparison of findings to benchmark studies indicated that, although the current sample started treatment with severe depressive symptoms and were in treatment for average of only 10 days, the overall magnitude of symptom improvement was similar to that of randomized controlled trials. Limitations of the study include a lack of control group, a limitation of most naturalistic studies. These findings indicate that interventions developed in controlled research settings on the efficacy of CBT can be transported to naturalistic, “real world” settings, and that brief CBT delivered in a partial hospital program is effective for many patients with severe depressive symptoms. 相似文献
17.
Forrest Scogin Jodie Shackelford Noelle Rohen Jamie Stump Mark Floyd Nancy McKendree-Smith Christine Jamison 《Journal of Clinical Geropsychology》2001,7(4):271-283
Geriatric depression is a relatively commonly occurring mental disorder. A subpopulation of depressed older adults are those who have engaged in or completed pharmacotherapy, yet continue to experience depressive symptoms. We review the prevalence, psychosocial effects, and treatment of residual symptoms of depression in older adults. Data from previous studies conducted by our group are presented to support our contention that residual symptoms of geriatric depression are treatable through psychosocial means. 相似文献
18.
Pharmacotherapy and psychotherapy are generally effective treatments for major depressive disorder (MDD); however, research suggests that patient preferences may influence outcomes. We examined the effects of treatment preference on attrition, therapeutic alliance, and change in depressive severity in a longitudinal randomized clinical trial comparing pharmacotherapy and psychotherapy. Prior to randomization, 106 individuals with MDD reported whether they preferred psychotherapy, antidepressant medication, or had no preference. A mismatch between preferred and actual treatment was associated with greater likelihood of attrition, fewer expected visits attended, and a less positive working alliance at session 2. There was a significant indirect effect of preference match on depression outcomes, primarily via effects of attendance. These findings highlight the importance of addressing patient preferences, particularly in regard to patient engagement, in the treatment of MDD. 相似文献
19.
Personality dysfunction can influence the onset and maintenance of depressive symptoms. When both depression and personality dysfunction are present, it is important to develop an integrated treatment plan that addresses both conditions. A case example is used to illustrate how features of borderline personality disorder can influence the assessment and treatment of major depression. Specific challenges encountered by the therapist include: 1) differentiating borderline personality from depressive symptoms, 2) maintaining the therapeutic alliance, 3) managing impulsivity and self-destructive tendencies, 4) staying focused on long-term therapeutic goals, and 5) coping with noncompliance. Over the course of 27 sessions, the client was able to make positive changes in mood, self-image, and impulsive tendencies. Although the client's borderline personality traits complicated the course of treatment for depression, neglecting these personality problems would have left the client vulnerable to depressive relapse. 相似文献
20.
Jürgen Brunner 《Psychotherapeut》2016,61(4):285-293
Current meta-analyses convincingly show the effectiveness of psychotherapy. For many mental disorders psychotherapy is the therapy of choice and superior to an exclusive pharmacotherapy. A psychotherapy is still effective far beyond the end of psychotherapy. Mild and moderate depressive episodes can be successfully treated by psychotherapy alone. A combination treatment is indicated for severe depressive episodes and a chronic course. Cognitive behavior therapy (CBT) is the method of choice for anxiety disorders where CBT can be initiated in order to build up self-efficacy and medication can be omitted at first. A combination treatment is only indicated when the response is insufficient. For obsessive-compulsive disorder with predominantly compulsive behavior CBT with exposure and reaction management is the method of choice. Combination treatment is indicated particularly for predominantly obsessive thoughts and comorbid depression. In posttraumatic stress disorder a trauma-focussed CBT is the method of choice. For posttraumatic stress disorder selective serotonin reuptake inhibitors are indicated only for comorbid disorders. For all disorders benzodiazepines should be prescribed only in justifiable exceptional cases for short-term administration. For individualized differential indications the effects of simultaneous psychopharmacotherapy on the therapeutic process must be taken into consideration. 相似文献