目的 探讨抽动障碍(TD)患儿系统化行为干预的方法,以期为TD患儿的行为治疗提供临床指导。方法 采用前瞻性病例对照研究方法,选取在福建医科大学协和临床学院儿童神经内科门诊就诊的慢性抽动障碍(CTD)和Tourette综合征(TS)患儿132人,随机分为行为干预组(n=47)、药物治疗组(n=47)及联合干预组(n=38)。1)干预方法:行为干预组采用自行设计的四阶段CHEN团体行为干预方法;药物治疗组采用可乐定缓释透皮贴剂干预;联合干预组在维持原药物治疗的同时加用行为干预治疗。2)抽动严重程度评估:根据耶鲁综合抽动严重程度量表(YGTSS)评定。 3)干预安全性采用治疗副反应量表系统(TESS)进行评定,并评估干预依从性。结果 1)干预后4周,8周,12周,联合干预组YGTSS减分率分别为(41.48±16.39,53.39±16.59,67.6±19.31)>行为干预组(33.35±17.84,43.69±22.27,55.59±22.44)>药物治疗组(24.79±19.94,34.49±30.79,44.13±26.57),差异有统计学意义(P<0.05或P<0.001);2)三组间安全性及依从性比较,差异无统计学意义(P均>0.05)。结论 结合抽动障碍患儿临床症状及其与家长的心理行为特点,实施针对性的团体心理行为干预对抽动障碍儿童的症状和心理健康有显著的改善作用。
Abstract
Objective To study the treatment of systematize group behavior intervention on tic disorders (TD) child patients,and provide clinical guideline of behavior therapy on TD child patients. Method sProspective case-control method was used.132 chronic chronic tic disorders (CTD) or Tourette's syndrome (TS) child patients were chosen as research objects from child neurology clinic in our hospital,which were randomly divided into three groups as behavior intervention group (n=47),medicine treatment group (n=47) and combined intervention group (n=38).1) Intervention methods:"CHEN four stages" group-behavior intervention was designed based on psychological behavior treatment principle.Behavior intervention group adopted the group-behavior intervention,medicine treatment group adopted clonidine slow-release patch treatment,and combined intervention group combined with the group-behavior intervention and the original therapeutic dose.2)Clinical curative effect:the clinically curative effect was assessed by Yale Global Tie Severity Scale (YGTSS).3) The treatment security was assessed by Treatment Emergent Symptom Scale(TESS),and the obedience was observed during the treatment. Results 1) Comparison of clinical curative effect:YGTSS reducing rate of combined intervention group at the 4th,8th and 12th week after intervention were 41.48±16.39,53.39±16.59,67.6±19.31,which were greater than those of behavior intervention group(33.35±17.84,43.69±22.27,55.59±22.44),and were greater than those of medicine treatment group(24.79±19.94,34.49±30.79,44.13±26.57),all the differences were statistically significant (P<0.05,or <0.001).2) There were no significant differences on security and obedience assessment among three groups(all P>0.05). Conclusion There are obvious improvement in the symptoms and psychological health of TD child patients by specific group behavior intervention treatment,basing on clinical symptoms of TD child patients and the psychology characteristics of their parents.
关键词
抽动障碍 /
团体行为干预 /
临床疗效 /
儿童
Key words
tic disorders /
group behavior intervention /
clinical effect /
child
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参考文献
[1] Piacentini J,Woods DW,Scahill L,et al.Behavior therapy for children with Tourette disorder:A randomized controlled trial[J].JAMA,2010,303(19):1929-1937.
[2] 刘智胜.儿童抽动障碍的研究现状与进展[J].临床儿科杂志,2009,27(11):1098-1100.
[3] Budman CL,Rockmori L,Stokes J,et al.Clinical phenomenology of episodic rage in children with Tourette's syndrome[J].J Psychosom Res,2003,55(1):59-65.
[4] Corbett BA,Mendoza SP,Baym CL,et al.Examining cortisol rhythmicity and responsivity to stress in children with Tourette syndrome[J].Psychoneuroendocrinology,2008,33(6):810-820.
[5] American Psychiatric Association.Diagnostic and statistical manual of mental disorders DSM-IV-TR ( Text Revision)[M].Washington DC:American Psychiatric Association,2000:1-943.
[6] Shana A,Franklin BA,Michael R,et al.Behavioral interven tions for tic disorders[J].Psychiatr Clin N Am,2010,33(3):641-655.
[7] 米尔腾伯格,石林.行为矫正-原理与方法[M].5版.北京:中国轻工业出版社,2015:1-493.
[8] 贝克,张怡,孙凌,等.认知疗法:基础与应用[M].2版.北京:中国轻工业出版社,2013:1-434.
[9] 庞爱莲,樊召锋.行为治疗[M].北京:开明出版社.2013:78.
[10] Scahill L,Erenberg G,Berlin CM,et al.Contemporary assessment and pharmacotherapy of Tourette syndrome[J].NeuroRx,2006,3(2):192-206.
[11] 陈颖萍,陈燕惠.抽动障碍患儿及家长心理状态调查[J].中国妇幼卫生杂志,2014,5(6):11-14.
[12] Wile DJ,Pringsheim TM.Behavior therapy for tourette syndrome:A systematic review and Meta-analysis[J].Current Treatment Options in Neurology,2013,15(4):385-395.
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