认知行为治疗和症状特异性药物治疗伴焦虑和抑郁的喉切除术后咽喉癌患者的回顾性比较(英文)

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背景:喉切除术是一种常见的治疗喉癌损伤性手术作,可导致巨大的压力,但如何能减轻手术带来的心理影响知道甚少。目标:比较认知行为治疗(CBT)与药物治疗对喉切除术后咽喉癌患者焦虑和抑郁症状的治疗效果。方法:回顾湖州市第三人民医院2009年3月至2013年5月心理门诊中喉切除术后患有抑郁症或焦虑症患者的病历,确定63例患者曾接受过8周一对一的CBT治疗(其中无法说话的患者以书面形式作出回应),以及56例患者曾接受过8周的盐酸丁螺环酮治疗(n=11)、舍曲林治疗(n=9)或两种药物联合治疗(n=36)。治疗的选择(CBT或药物)是根据病人的陈述偏好而定的。采用焦虑自评量表(SAS)和抑郁自评量表(SDS)分别评估治疗前后的焦虑和抑郁症状。结果:治疗8周后,两组的SAS平均分和SDS平均分都明显下降,(根据焦虑自评量表和抑郁自评量表评分标准)伴有有焦虑或者抑郁症状患者的百分比也显著下降了。但是,两种治疗方法之间没有显著差异。药物治疗组32%的参患者在治疗过程出现一个或多个不良反应,但这些都没有严重到需要停药治疗。讨论:CBT是一种有效的、短期的治疗手段,可用于减少一个人被诊断患有癌症或接受癌症治疗后往往产生的焦虑和抑郁症状。众多证据表明,这些心理症状的治疗可以提高癌症患者的生活质量和减短疾病的病程,所以肿瘤学家和其他临床医生需要定期筛查癌症患者和其他危及生命的慢性病患者的抑郁和焦虑症状,如果存在的话,就需要积极对这些症状进行治疗。这项研究表明,CBT对于即使无法说话的癌症患者来说也是有效的。 Background: Laryngectomy is a common type of surgical treatment of laryngeal cancer that can cause tremendous stress, but little is known about how to reduce the psychological impact of surgery. Objectives: To compare the therapeutic effect of cognitive behavioral therapy (CBT) with medical therapy on anxiety and depression in patients with laryngectomy after laryngectomy. Methods: The records of patients with depression or anxiety after laryngectomy in psychology clinic from March 2009 to May 2013 in Huzhou Third People’s Hospital were retrospectively reviewed. It was confirmed that 63 patients had received one-on-eight CBT treatment (Of which non-speaking patients responded in writing) and 56 patients who received buspirone hydrochloride (n = 11) for 8 weeks, sertraline (n = 9) or a combination of both (n = 36). The choice of treatment (CBT or medication) is based on the patient’s stated preference. Anxiety and depression symptoms were assessed by SAS and SDS respectively. RESULTS: After 8 weeks of treatment, SAS scores and SDS scores were significantly decreased in both groups (the percentage of patients with symptoms of anxiety or depression also significantly decreased (based on the anxiety self-rating scale and the depression self-rating scale) It’s However, there was no significant difference between the two treatments. Thirty-two percent of participants in the drug-treated group experienced one or more adverse reactions during the course of treatment, but none of these were serious enough to require discontinuation. Discussion: CBT is an effective, short-term treatment that can be used to reduce the symptoms of anxiety and depression that often occur when a person is diagnosed with cancer or treated with cancer. Numerous evidence suggests that the treatment of these psychological symptoms can improve the quality of life of cancer patients and reduce the duration of the disease. Therefore, oncologists and other clinicians need to regularly screen for the symptoms of depression and anxiety in cancer patients and other life-threatening chronic diseases, If there is, then these symptoms need to be actively treated. This study shows that CBT is also effective for even inexpressible cancer patients.
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