Mov Disord:认知行为疗法,有助于减轻帕金森患者的焦虑状态?

2021-08-04 Freeman MedSci原创

认知行为疗法,有助于减轻帕金森患者的焦虑状态?

尽管帕金森病(PD)以运动障碍,以静止性震颤、运动迟缓、僵硬和姿势不稳为主要特征,但至少有三分之一的患者还患有焦虑症。这些与运动症状的严重程度、生活质量的降低以及残疾和死亡率的增加密切相关。

PD的焦虑可能是病理生理和心理因素之间复杂相互作用的结果。由于其现象学上与抑郁症、自主神经功能紊乱和其他与PD相关的躯体症状(如消瘦)相重叠,它往往难以被识别。因此,PD中的焦虑被广泛地诊断和治疗不足。

尽管最常用的PD焦虑治疗方法是使用抗抑郁药和苯二氮卓类药物进行药物治疗,但还没有随机、安慰剂对照的临床试验来检验这些药物的疗效。此外,使用苯二氮卓类药物与不良的副作用有关,如认知功能降低、平衡问题和镇静,这可能增加跌倒的风险。鉴于这种副作用的风险,有必要采取非药物的心理治疗干预措施来治疗PD的焦虑。

认知行为疗法(CBT)是普通人群中最常用的治疗焦虑的心理疗法。在PD中,CBT已被证明对治疗抑郁症以及冲动控制障碍有效,但目前还没有关于CBT对焦虑有效性的随机对照试验(RCTs)。非对照研究显示了不同的结果,这可能是由于方法的不同(例如,小组vs个人治疗,面对面vs基于互联网的治疗),小的样本量,以及抑郁症和焦虑症混合症状患者的注册。

藉此,荷兰Maastricht University Medical Centre的Anja J.H. Moonen在一项多中心RCT中:评估专门用于治疗PD焦虑的CBT方案的临床有效性。

其主要假设:在降低焦虑症状水平方面,CBT比单纯的临床监测(CMO)更有效。

他们将48名患有焦虑症的PD患者按1:1的比例随机分为CBT和临床监测组( clinical monitor only, CMO)。此处的CBT方案是专门为解决PD的焦虑症状而开发的,包括每周10次的课程。

在基线、干预结束时、3个月后和6个月后(仅CBT组),由盲法评估员进行评估。主要结果指标是汉密尔顿焦虑量表(HARS)和帕金森焦虑量表(PAS)。

他们发现:CBT组和CMO组都显示出临床上相关的改善。

虽然汉密尔顿焦虑量表的结果没有组间差异(CBT组减少6.7分,CMO组减少3.9分;P=0.15),但在PAS总量上,CBT组有显著的统计学差异和临床相关差异(CBT组减少9.9分,而CMO组减少5.2分;P = 0.012).

这是因为PAS中情景性焦虑和回避行为的分量表得到了改善。这种较大的改善在3个月和6个月的随访中得以保持。

这个跨学科的研究,新颖之处在于:发现了CBT是治疗PD患者焦虑的有效方法,可减少情景性焦虑和社交性焦虑以及回避行为。

原文出处:
Moonen AJH, Mulders AEP, Defebvre L, et al.. Cognitive Behavioral Therapy for Anxiety in Parkinson's Disease: A Randomized Controlled Trial. Mov Disord. 2021 Feb 22. doi: 10.1002/mds.28533. Epub ahead of print. PMID: 33617699.

 

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    2021-09-23 cmsvly
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    2021-08-04 明天jing

    焦虑是当年年轻人的共同问题,需要认真对待。

    0

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