社区糖尿病使用胰岛素后抑郁\焦虑的认知干预(1)
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【摘要】 目的 了解社区内2型糖尿病(T2DM)患者对使用胰岛素(INS)抑郁和焦虑的状况，探讨认知疗法干预对焦虑、抑郁情感的影响。方法 将使用INS的患者分为对照组和干预组，采用焦虑自评量表(SAS)、抑郁自评量表(SDS)对其进行评定，认知疗法干预6周后，再次对两组进行评定。结果 T2DM患者中使用INS抑郁、焦虑情绪评分显著高于我国国内常模；干预结束后，干预组患者抑郁、焦虑情绪得到明显改善，干预后与干预前比较，SAS、SDS评分有统计学意义(P<0.05)。结论 社区内T2DM患者对使用INS普遍存在心理障碍，社区干预是必需的。认知疗法干预可以减轻患者的焦虑、抑郁症状，纠正患者的认知曲解，提高治疗依从性及治疗效果。
【关键词】 糖尿病胰岛素应用；认知干预；抑郁；焦虑；社区
Effect of cognition-based intervention on state of depression and anxiety in type 2 diabetes acceptedinsulin-treatment in Community
LI Yong-kun,et al.Kunming yanan hospital，kunming 650051，China
【Abstract】 Objective Investigate the state of depression and anxiety in type 2 diabetesacceptedinsulin-treatment in community， as well as observation on the effect ofinterventionfor the patients before and after cognition-based intervention. Methods A investigation by general practitioners was carried out among 231 cases with diabetes， all the subjects were assessed by the Zung,s self-rating depression scale(SDS)，the Zung,sself-rating anxiety scale(SAS)， 71 patients acceptedinsulin-treatment were randomly divided into intervention group(n=36)and controlgroup(n=35), the two groups were compared by x2 test and t test.Results Patients with diabetes keep a mental dysfunction to insulin widespreadely. After 6 weeks of cognition-based intervention,self-rating scale values of anxiety and depression were significantly lower in the intervention group than that in the control group(P<0.05).ConclusionThe mental factor plays an important role in diabetes,the therapy of cognition-basedwas effective to depressive and anxious symptoms. It is very necessary to strengthen psychological education and eliminate misunderstand of the patients to insulin-treatment.
【Key words】 Type 2 diabetes accepted insulin-treatment； Cognition-basedintervention therapy；Depression；Anxiety；Community
T2DM患者中，部分有适应证的患者拒绝或推迟使用INS，或在使用INS治疗过程中，需要增加INS用量时，常常遇到患者反对或不理解。采用INS治疗可有效控制高血糖，延缓各种慢性并发症的发生，成为目前有效的治疗手段。在社区卫生工作中，常遇到不少患者在使用INS时都存在不同程度的以焦虑和抑郁为主要表现的情感障碍，在接受INS治疗时会出现多种心理反应。通过对231例社区T2DM患者的调查，发现患者对糖尿病和INS治疗普遍存在心理认知障碍。采用认知疗法干预，可消除患者对INS的误解，及早接受INS治疗，提高患者依从性。本文探讨了产生障碍的原因和消除的方法 ......
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