艾司西酞普兰联合虚拟现实认知行为疗法治疗抑郁症的临床观察

孙枞昊 金欣 戴红 陈静 吕亮 费锦锋

[關键词] 抑郁症;艾司西酞普兰;认知行为疗法;虚拟现实

[中图分类号] R749.4          [文献标识码] B          [文章编号] 1673-9701（2021）29-0108-05

Clinical observation of escitalopram combined with virtual reality cognitive behavioral therapy in treatment of depression

SUN Conghao   JIN Xin   DAI Hong   CHEN Jing   LYU Liang   FEI Jinfeng

Department of Psychiatry， Huzhou Third People's Hospital in Zhejiang Province， Huzhou   313000， China

[Abstract] Objective To investigate the clinical effect of cognitive behavioral therapy based on virtual reality （VR-CBT） combined with conventional drugs in the treatment of depression. Methods A total of 159 patients with depression diagnosed and treated in our hospital from May 2019 to May 2020 were divided into the escitalopram（ES） group， the cognitive behavioral therapy（CBT） group and the VR-CBT group according to the random number table method， with 53 patients in each group. The ES group was given ES orally， once a day; the CBT group was given CBT for 1 hour each time， 3 times a week， on the basis of the ES group; the VR-CBT group was given VR-CBT for 1 hour each time， 3 times a week， on the basis of the ES group. All the 3 groups were treated for 3 months continuously. Before and after treatment， each group was given 17 items of Hamilton Depression Scale （HAMD） and Self-rating Depression Scale （SDS） to assess the degree of depression， and the reduction of HAMD score was used as the criterion of efficacy， and the cognitive function was assessed by Wisconsin Card Sorting Test （WCST） and Number Sign Conversion Test （DSST）. During treatment， treatment safety was assessed by Treatment Emergent Symptom Scale （TESS）. Results After treatment， the total effective rates of the CBT group （82.35%） and the VR-CBT group （92.31%） were higher than that of the ES group （67.31%）， and that of the VR-CBT group was higher than that of the CBT group ，the difference was statistically significant（P<0.05）. After treatment， the HAMD and SDS scores of all groups were lower than those before treatment， and the scores of the CBT and VR-CBT groups were lower than those of the ES group， and those of the VR-CBT group were lower than those of the CBT group ，the difference was statistically significant（P<0.05）. After treatment， the percentage of WCST correct response and the DSST score in all groups were higher than those before treatment， and those of the CBT and VR-CBT groups were higher than those of the ES group， and those of the VR-CBT group were higher than those of the CBT group，the difference was statistically significant （P<0.05）. During treatment， no statistically significant differences were observed in TESS scores at each time point in each group （P>0.05）. Conclusion The combination of ES and VR-CBT in the treatment of depression has a significant effect， which is significantly better than the combination of ER and traditional CBT. It can significantly reduce the depression degree of patients， improve cognitive function， and has a good safety， which is worthy of clinical promotion and application.

[Key words] Depression; Escitalopram; Cognitive behavioral therapy; Virtual reality

抑郁症患者以明显而持久的情绪低落为主要表现，同时伴有思维迟缓、意志活动抑制、认知功能受损等，严重者可出现自杀意图或行为[1]。对于抑郁症的治疗包括药物与心理治疗，药物治疗以选择性5-羟色胺再摄取抑制剂为主，然而单纯药物治疗常效果不佳[2]。因此结合有效心理治疗对于抑郁症患者具有重大意义。常用的心理治疗包括支持性心理疗法、认知行为疗法（Cognitive behavioral therapy，CBT）、人际疗法等，其中CBT的疗效在临床上已得到公认[3]。近年来，随着虚拟现实技术（Virtual reality，VR）的发展，VR-CBT已广泛应用于精神卫生领域，其可通过模拟现实，给予视、听、触、嗅等多种感官刺激从而改变患者的不合理认知，相较于传统CBT，具有更好的沉浸感与交互性，已在成瘾、肥胖等治疗中有了较好应用[4]。因此，本研究探讨VR-CBT联合艾司西酞普兰（Escitalopram，ES）治疗抑郁症的临床疗效，现报道如下。

1 资料与方法

1.1 一般资料

选取2019年5月至2020年5月我院诊治的159例抑郁症患者，按随机数字表法分为ES组、CBT组和VR-CBT组，各53例，纳入标准：①符合《精神障碍诊断与统计手册》[5]中有关抑郁症的诊断标准;②年龄18～65岁;③初中以上文化程度;④17项汉密尔顿抑郁量表（Hamilton depression scale，HAMD）评分>17分;⑤患者或监护人均签署知情同意书。排除标准：①合并严重躯体疾病者;②双向情感障碍者;③具有酗酒、药物依赖、认知障碍、严重自杀倾向其中一项者;④妊娠或哺乳期妇女。剔除和脱落标准：①出现严重并发症或病情恶化而无法继续治疗;②依从性差而无法配合完成治疗。……