[1]王培佳,王尔东,郁仁强,等.心理剧联合药物对伴童年创伤抑郁症患者焦虑抑郁、应对方式及自发低频振幅的影响[J].第三军医大学学报,2020,42(02):111-118.
 WANG Peijia,WANG Erdong,YU Renqiang,et al.Effects of psychodrama combined with antidepressants on anxiety and depression, coping style and neuroimaging features in patients with major depressive disorder and childhood trauma[J].J Third Mil Med Univ,2020,42(02):111-118.
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心理剧联合药物对伴童年创伤抑郁症患者焦虑抑郁、应对方式及自发低频振幅的影响(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
42卷
期数:
2020年第02期
页码:
111-118
栏目:
神经科学
出版日期:
2020-01-30

文章信息/Info

Title:
Effects of psychodrama combined with antidepressants on anxiety and depression, coping style and neuroimaging features in patients with major depressive disorder and childhood trauma
作者:
王培佳1王尔东2郁仁强3胡潇予1周俊鑫1黄杰1夏兴文1李晓梅1陈军君1吕发金3胡华1
400016 重庆,重庆医科大学附属第一医院: 精神科1,放射科3 ;215006 江苏 苏州,苏州大学艺术学院2
Author(s):
WANG Peijia1 WANG Erdong2 YU Renqiang3 HU Xiaoyu1 ZHOU Junxin1 HUANG Jie1 XIA Xingwen1 LI Xiaomei1 CHEN Junjun1 LYU Fajin3 HU Hua1

1Department of Psychiatry, 3Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016; 2School of Art of Soochow University, Suzhou, Jiangsu Province, 215006, China

关键词:
抑郁症童年创伤(易术)心理剧功能磁共振成像焦虑抑郁症状应对方式
Keywords:
major depressive disorder childhood trauma (Yishu) psychodrama functional magnetic resonance imaging anxiety and depressive symptoms coping style
分类号:
R445.2;R749.055;R749.4
文献标志码:
A
摘要:

目的从临床症状、应对方式、神经影像学3个方面比较抗抑郁药物联合(易术)心理剧和抗抑郁药物联合普通心理健康教育对伴童年创伤抑郁症患者的效果。方法在重庆医科大学附属第一医院精神科门诊收集伴童年创伤抑郁症患者,采用简单随机化分组的方法将其分为药物联合(易术)心理剧干预组(观察组,16例)与抗抑郁药物联合普通心理健康教育组(对照组,16例)进行前瞻性病例对照研究,两组患者均以选择性5-羟色胺再摄取抑制剂(selective serotonin reuptake inhibitors, SSRIs)为主要抗抑郁药,服用6个月。以贝克抑郁自评量表(Beck depression inventor-13 item,BDI-13)、贝克焦虑自评量表(Beck anxiety inventor, BAI)、特质应对方式问卷(trait coping style questionnaire,TCSQ)及静息态功能磁共振(resting-state functional MRI, rs-fMRI)的自发低频振幅(amplitude of low frequency fluctuation, ALFF)为观察指标,比较干预结束后两组患者各指标的变化值差异。结果经过6个月的干预,两组患者之间的BDI、BAI变化值无明显差异,但是观察组TCSQ积极(P<0.05)及TCSQ消极(P<0.01)均较对照组改善更明显。rs-fMRI检查获得了19个交互作用脑区(经过P<0.05的FDR校正),事后检验发现,干预后观察组与对照组相比,观察组左内侧额上回激活增强趋势明显(P>0.05)、右侧海马旁回(P<0.01)激活增强较多,左侧楔前叶(P<0.05)激活减弱较多。结论抗抑郁药物联合(易术)心理剧干预在改变伴童年创伤抑郁症患者的应对方式方面较联合普通心理健康教育效果可能更好,这可能与(易术)心理剧可以通过增强右侧海马旁回激活和减弱左侧楔前叶的激活,从而减弱负性经历对情绪和认知-应对的负面影响有关。(易术)心理剧可用于伴童年创伤抑郁症患者的药物联合治疗中。

Abstract:

ObjectiveTo compare the effects of the combination of (Yishu) psychodrama versus general mental health education with antidepressants on clinical symptoms, coping style and neuroimaging features in patients with major depressive disorder (MDD) who experienced childhood trauma. MethodsThis prospective case-control study was conducted in MDD patients with childhood trauma recruited from our department of psychiatry. The patients were randomly assigned into observation group (n=16) for treatment with antidepressants combined with (Yishu) psychodrama and control group (n=16) treated with antidepressants and general mental health education, and selective serotonin reuptake inhibitors (SSRIs) was used as the main antidepressants for 6 months in both groups. After the interventions, the patients were assessed using Beck Depression Inventory-13 item (BDI-13), Beck Anxiety Inventory (BAI), and Trait Coping Style Questionnaire (TCSQ), and the amplitude of low frequency fluctuations (ALFF) in resting functional magnetic resonance imaging (fMRI) was determined and compared between the two groups. ResultsAfter 6 months of intervention, no significant differences were found in the changes of BDI score (P>0.05) or BAI score (P>0.05) between the two groups, but the changes in TCSQ positive score (P<0.05) and TCSQ negative score (P<0.01) differed significantly between them. Resting fMRI results showed 19 interactive brain regions (corrected by FDR, P<0.05) in these patients. Post hoc analysis revealed that after the intervention, the patients in the observation group, as compared with the control patients, tended to have enhanced activation of the left medial superior frontal gyrus (P>0.05) and showed significant enhancement of activation in the right parahippocampal gyrus (P<0.01) with attenuated activation in the left precuneus lobe (P<0.05). ConclusionAntidepressants combined with psychodrama can more effectively modify the coping style of depressed patients with childhood trauma than the combination of medications and general mental health education, possibly due to the effect of psychodrama to enhance the activation of the right parahippocampal gyrus and attenuate the activation of the left anterior cuneiform lobe, which leads to reduction of the adverse effects of negative experiences on emotion and cognition-coping. Psychodrama combined with medications can be used in the treatment of depressed patients with childhood trauma.

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更新日期/Last Update: 2020-01-29