甘麦大枣汤加减方联合认知行为干预对精神分裂症超高危人群的干预作用及对认知功能、生活质量及血清5-HT、MT、TSH水平的影响

doi:10.12092/j.issn.1009-2501.2019.05.011

摘要/Abstract

摘要：

目的:探讨甘麦大枣汤加减方联合认知行为干预（CBT）对精神分裂症超高危人群（UHR）的干预作用及对认知功能、生活质量及血清5-羟色胺（5-HT）、褪黑素（MT）、促甲状腺激素（TSH）的影响。方法:选取2015年1月到2016年12月在本院就诊的精神分裂症患者的一级亲属或符合UHR标准者110例作为研究对象，将所有研究对象随机分为研究组（35例）、对照1组（35例）和对照2组（40例）。研究组给予甘麦大枣汤加减方联合CBT，对照1组给予CBT，对照2组不进行任何干预，仅进行问卷随访。采用前驱期症状量表（SOPS）评估入组者的前驱症状，采用持续操作测验（CPT）、威斯康星卡片分类测验（WCST）评估入组者的认知功能，采用简明幸福与生活质量满意度问卷（Q-LES-Q）评估入组者的生活质量。比较各组不同时间点的前驱症状、精神疾病转化率、认知功能、生活质量以及血清5-HT、MT、TSH水平。结果:在第3个月、第6个月、第12个月、第18个月，研究组的SOPS阳性症状得分、SOPS瓦解症状得分、SOPS一般症状得分、SOPS总分明显低于对照1组和对照2组，对照1组的SOPS阳性症状得分、SOPS瓦解症状得分、SOPS一般症状得分、SOPS总分明显低于对照2组（P<0.05）；第6个月研究组和对照1组的精神疾病转化率低于对照2组，第12个月、第18个月研究组的精神疾病转化率低于对照2组（P<0.05）；第3个月、第6个月、第12个月、第18个月研究组和对照1组的CPT（反应时）、WCST（持续性错误数）低于对照2组（P<0.05）；在第3个月、第6个月、第12个月、第18个月，研究组的Q-LES-Q得分高于对照1组和对照2组，对照1组的Q-LES-Q得分高于对照2组（P<0.05）；在第3个月、第6个月、第12个月、第18个月，研究组的血清5-HT、MT、TSH水平高于对照1组和对照2组，在第3个月、第6个月、第12个月、第18个月，对照1组的血清MT水平高于对照2组，在第6个月、第12个月、第18个月，对照1组的血清5-HT、TSH水平高于对照2组（P均<0.05）。结论:甘麦大枣汤加减方联合CBT可有效改善UHR个体阳性症状、瓦解症状、一般症状及认知功能，降低精神疾病转化率，提升个体的生活质量，调节血清5-HT、MT、TSH水平。

关键词: 精神分裂症超高危人群, 甘麦大枣汤, 认知行为干预, 前驱症状, 认知功能, 生活质量

Abstract:

AIM: To investigate the intervention effect of modified Ganmaidazao Tang combined with cognitive behavioral intervention(CBT) on ultra-high risk for developing psychosis and the effects on cognitive function, quality of life and serum levels of 5-HT, MT and TSH. METHODS:A total of 110 patients of first-degree relatives of schizophrenia patients or who met the UHR criteria in our hospital from January 2015 to December 2016 were selected as the study subjects.All subjects were randomly divided into study group (35 cases), control group 1 (35 cases) and control group 2 (40 cases).The study group was given modified Ganmaidazao Tang combined with CBT, the control group 1 was given CBT, the control group 2 did not intervene, only questionnaire follow-up.The scale of prodromal symptoms (SOPS) was used to evaluate the prodromal symptoms,the Continuous perfomance test (CPT) and Wisconsin Card Sorting Test (WCST) was used to evaluate the cognitive function,the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) was used to evaluate the quality of life.Precursor symptoms, mental disease conversion rate, cognitive function, quality of life, and serum 5-HT, MT, and TSH levels were compared at different time points.RESULTS:At the 3th, 6th, 12th, and 18th months, the SOPS positive symptom score, SOPS disintegration symptom score, SOPS general symptom score, and SOPS total score of the study group were significantly lower than those of the control group 1 and the control group 2, the SOPS positive symptom score, the SOPS disintegration symptom score, the SOPS general symptom score, and the SOPS total score of the control group 1 were significantly lower than those of the control group 2 (P<0.05).The conversion rate of mental illness in the study group and the control group 1 was lower than that in the control group 2 at the 6th months, and the conversion rate of mental illness in the study group was lower than that in the control group 2 at the 12th and 18th months (P<0.05).At the 3rd, 6th, 12th, and 18th months, the CPT (reaction time) and WCST (number of persistent errors) in the study group and the control group 1 were lower than those in the control group 2 (P<0.05).At the 3th, 6th, 12th, and 18th months, the Q-LES-Q score of the study group was higher than that of the control group 1 and the control group 2, and the Q-LES-Q score of the control group 1 was higher than that of the control 2 groups (P<0.05);at the 3th, 6th, 12th, and 18th months, the serum 5-HT, MT, and TSH levels of the study group were higher than those of the control group 1 and the control group 2, and at the 3rd, 6th, 12th, and 18th months, the serum MT level of the control group 1 was higher than that of the control group 2, at the 6th, 12th, and 18th months. Serum 5-HT and TSH levels in control group 1 were higher than those in control group 2 (P<0.05).CONCLUSION:Modified Gan Mai Da Zao Tang combined with CBT can effectively improve the positive symptoms, disintegration symptoms, general symptoms and cognitive function of UHR, reduce the conversion rate of mental illness,improve quality of life,and regulate the levels of serum 5-HT, MT and TSH.

Key words: ultra-high risk for developing psychosis, Gan Mai Da Zao Tang, cognitive behavioral intervention, prodromal symptoms, cognitive function, quality of life

中图分类号:

R749

胡德凤，王轶虎，龙小宇，王广水. 甘麦大枣汤加减方联合认知行为干预对精神分裂症超高危人群的干预作用及对认知功能、生活质量及血清5-HT、MT、TSH水平的影响[J]. 中国临床药理学与治疗学, 2019, 24(5): 546-553.

HU Defeng, WANG Yihu, LONG Xiaoyu, WANG Guangshui. Intervention effect of modified Ganmaidazao Tang combined with cognitive behavioral intervention on ultra-high risk for developing psychosis and the effects on cognitive function, quality of life and serum levels of 5-HT, MT and TSH[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2019, 24(5): 546-553.

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