MBCT在持续性心境障碍患者中的随访研究及脑电分析

Follow up Study and EEG Analysis of Mindfulness Cognitive Therapy in Patients with Persistent Mood Disorder

摘要: 目的：探讨正念认知疗法(MBCT)在持续性心境障碍患者中的应用价值。方法：纳入本院2018年5月至2020年5月收治的60例持续性心境障碍患者，随机分为观察组和对照组。对照组给予帕罗西汀(20 mg/日)口服，观察组患者则给予正念认知疗法进行干预，包括正念进食葡萄干、全身扫描、正念呼吸训练、正念沟通、正念行走、正念伸展、正念冥想等。以8周为1个疗程，共干预4个疗程，每个疗程之间间隔4周。入院第1天和出院后6个月、12个月后，分别采用焦虑自评量表(SAS)和抑郁自评量表(SDS)评估两组患者的心理状态，简易智力状态检查量表(MMSE)评估两组患者智力状况及认知功能的缺损情况，简明健康状况调查表(SF-36)评估两组患者的生活质量，并对两组患者进行事件相关电位检查，比较P300和N400潜伏期和波幅的变化。结果：出院6个月、12个月时两组患者SAS和SDS逐渐下降，差异有统计学意义(P < 0.05)，且观察组各时间点SAS和SDS均显著低于对照组(P < 0.05)。出院6个月、12个月时，除定向力维度外，两组患者MMSE其余维度评分均逐渐上升，差异有统计学意义(P < 0.05)，且除定向维度外，观察组各时间点各维度评分均显著高于对照组(P < 0.05)。出院6个月、12个月时，SF-36各维度评分均逐渐上升，差异有统计学意义(P < 0.05)，且观察组各时间点各维度评分均显著高于对照组(P < 0.05)。出院6个月、12个月时，P300潜伏期和N400潜伏期均逐渐缩小，P300波幅和N400波幅均逐渐上升，差异有统计学意义(P < 0.05)，且观察组各时间点P300潜伏期和N400潜伏期均显著小于对照组，P300波幅和N400波幅显著大于对照组(P < 0.05)。结论：通过正念认知疗法对持续性心境障碍患者进行干预，可以尽快帮助其学习并逐渐掌握应对情绪转变和处理负面情绪的方法，从而显著减轻负面情绪，有效降低复发率，改善认知功能，提高生活质量。

Abstract: Objective: To explore the application value of mindfulness cognitive therapy in patients with persistent mood disorder. Methods: A total of 60 patients with persistent mood disorder admitted to our hospital from May 2018 to May2020 were randomly divided into observation group and control group. The control group was given paroxetine (20 mg/days) orally, while the observation group was given mindfulness cognitive therapy, including mindfulness eating raisins, whole body scanning, mindfulness breathing training, mindfulness communication, mindfulness walking, mind- fulness stretching, mindfulness meditation, etc. 8 weeks as a course of treatment, a total of 4 courses of intervention, with an interval of 4 weeks between each course. On the first day of admission, 6 months and 12 months after discharge, self rating Anxiety Scale (SAS) and self rating Depression Scale (SDS) were used to evaluate the psychological status of the two groups, the mini mental state examination (MMSE) was used to assess the mental status and cognitive impairment of the two groups of patients, and the short form Health Questionnaire (SF-36) was used to evaluate the quality of life of the two groups of patients. The latency and amplitude of P300 and N400 were compared. Results: At 6 and 12 months after discharge, SAS and SDS of the two groups gradually decreased, and the difference was statistically significant (P < 0.05), and SAS and SDS of the observation group at each time point were significantly lower than those of the control group (P < 0.05). At 6 and 12 months after discharge, except for the orientation dimension, the MMSE scores of the two groups increased gradually, and the difference was statistically significant (P < 0.05). Besides the orientation dimension, the MMSE scores of the observation group at each time point were significantly higher than those of the control group (P < 0.05). At 6 and 12 months after dis-charge, the scores of SF-36 increased gradually, and the difference was statistically significant (P < 0.05), and the scores of each dimension at each time point in the observation group were significantly higher than those in the control group (P < 0.05). At 6 and 12 months after discharge, P300 latency and N400 latency decreased gradually, while P300 amplitude and N400 amplitude increased gradually, with statistical significance (P < 0.05). P300 latency and N400 latency at each time point in the observation group were significantly less than those in the control group, and P300 amplitude and N400 amplitude were significantly greater than those in the control group (P < 0.05). Conclusion: Mindfulness cognitive therapy for patients with persistent mood disorder can help them learn as soon as possible and gradually master the methods of coping with emotional change and dealing with negative emotions, so as to significantly reduce negative emotions, effective reduction of recurrence race, improve cognitive function and the quality of life.