Objective.
To investigate the characteristics of life events, personality, and emotions of patients with panic disorder and to observe the efficacy of drug combined with cognitive psychotherapy on PD.
Methods.
Life events scale, Eysenck personality questionnaire and 90-item symptom self-rating scale psychological tests were administered to 60 patients with panic disorder and 60 healthy individuals who met the diagnostic criteria of the Chinese Classification and Diagnostic Criteria of Mental Disorders, 3rd edition, and 60 patients with panic disorder were randomly divided into two groups and given escitalopram 10-20 mg/d and escitalopram combined with cognitive-behavioral therapy for 12 weeks, respectively, at Before treatment and at the end of the 2nd, 4th, 8th and 12th week after treatment, the efficacy was assessed by the Total Clinical Efficacy Scale.
Results.
In the panic disorder group, the Life Events Scale negative life events score (13.33±6.91 vs. 4.56±2.67), the Eysenck Personality Questionnaire inward and outward factor score (53.13±10.88 vs. 49.20±11.72), the neuroticism factor score (61.27±9.37 vs. 51.02±11.75), and the total score of the 90-item symptom self-assessment scale ( 149.60±55.34 vs. 121.87±38.20), somatization (1.73±0.72 vs. 1.20±0.34), anxiety (1.92±0.71 vs. 1.44±0.53), hostility (1.82±0.60 vs. 1.28±0.44) and terror factor scores (2.17±0.47 vs. 1.27±0.48 ) were higher than those of the normal control group, and the difference was statistically significant; the total effective rate was 89.29% in the combined pharmacological-psychological treatment group and 77.78% in the single drug group, and the difference in efficacy between the two groups was statistically significant (t=2.267, P<0.05), and the total clinical efficacy rating scale in both groups decreased at the end of the 2nd, 4th, 8th and 12th week after treatment compared with that before treatment, and the difference was statistically significant (P< 0.05), and at the end of the 8th and 12th week, the total clinical efficacy rating scale was lower in the pharmacopsychological combination treatment group than in the single drug treatment group, and the difference was statistically significant (t=2.539, P<0.05).
Conclusion.
Patients with panic disorder have general characteristics of neurosis, patients often have life events as triggers for the onset of the disorder, patients are mostly extroverted or even overly extroverted, emotional and easily impatient, patients mostly have cognitive errors about somatic sensations and psychological experiences, pharmacotherapy mostly focuses on physical symptoms, single pharmacotherapy is difficult to control patients’ symptoms, making the condition recurrent, and poor efficacy is related to the presence of personality defects in patients. Cognitive-behavioral therapy can help patients correct their distorted cognition and get rid of the pain and social impairment of the disease, and the efficacy of cognitive-psychological therapy combined with medication is better than that of medication alone.
Panic Disorder (PD) is a neurological disorder with recurrent panic attacks as the main primary symptom, and severe patients have significant loss of social functioning, which can lead to social disability and affect career development and family life. Foreign community-based population epidemiological surveys have found that the lifetime prevalence of PD ranges from 1.8% to 3.7%. Data from domestic surveys show a point-in-time prevalence of 1.76% to 3.96%.
PD patients are mostly seen in general hospitals, complaining of various somatic discomforts, with a high rate of missed and misdiagnosis, and only 15% of PD patients can be identified by general practitioners. timely identification and effective treatment are important issues in clinical research of PD. treatment of PD is mostly based on anti-anxiety and antidepressant medication, but reduction and discontinuation difficulties and relapse are common, and some studies have suggested that it may be related to insufficient courses of treatment, insufficient dosage, presence of personality biases, and life events, emphasizing the importance of combined psychological interventions.
Therefore, it is of great clinical significance to analyze and compare the personality, life events and emotional characteristics of PD patients, to observe the efficacy of medication combined with psychological counseling in the treatment of PD, and to investigate the relationship between medication reduction and discontinuation difficulties in PD patients and their personality characteristics and life events, in order to improve the diagnostic accuracy and efficacy. In this study, we intend to investigate the differences between PD patients and normal healthy people using psychometric scales of life events, personality and emotion, and treat with escitalopram combined with cognitive psychological intervention to compare the differences between drug alone and combined treatment, and the treatment effect combined with the results of psychometric scales to analyze the relationship between the efficacy and patients’ personality.
I. Subjects and methods
1.Study subjects.
1.1 PD group: patients who attended the outpatient clinic of the Department of Clinical Psychology of Jiangsu Provincial People’s Hospital from February 2013 to November 2013 and were diagnosed with PD by two psychiatrists of attending or above, who met the diagnostic criteria of the Chinese Classification and Diagnostic Criteria of Mental Disorders, 3rd edition (CCMD-3) PD, excluding obvious somatic diseases, a total of 60 cases, aged 18-65 years, male 26 cases, female 34 cases. The random number method was used to divide them into single drug treatment group and combined drug-psychological treatment group, 30 in each group.
1.2 Normal control group: individuals with physical examination at the physical examination center of Jiangsu Provincial People’s Hospital from February 2013 to November 2013, excluding somatic diseases and mental diseases, a total of 60 cases, aged 20-65 years, 29 males and 31 females, were selected. The gender, age and years of education of both groups were statistically processed, and the differences were not statistically significant (P>0.05).
2. study methods.
2.1 Psychological tests: The protocol was approved by the hospital ethics committee and the study subjects gave informed consent. The following psychological tests were performed in the psychological testing room using psychological testing software for the study subjects who met the inclusion criteria: Life Events Scale (LES): a 50-item version prepared by Dessen Yang and Yalin Zhang of Hunan Medical University; Eysenck Personality Questionnaire (EPQ); 90-item Symptom Self-Rating Scale (SCL-90 ).
2.2 Treatment methods
The monotherapy group was given escitalopram 10-20 mg/d, combined pharmacological-psychological treatment and cognitive-behavioral therapy, and there was no significant difference between the doses of the two groups (P>0.05), which were observed for 12 weeks. Cognitive-behavioral therapy: (1) psychotherapists and trained research assistants communicated with patients in the study group separately to understand patients’ automatic thinking, potential dysfunctional hypotheses and negative thinking patterns; (2) cognitive reconstruction: analysis of symptoms, explanation and psychological counseling to help patients eliminate distorted cognitive styles; (3) behavioral training: continuous exposure to panic-inducing situations, including relaxation training such as breathing training; Imagery training, meeting once a week for the first two months, then once every two weeks for 40 minutes [3,4].
2.3 Evaluation of efficacy: Patients were evaluated by a senior attending psychiatrist before treatment and at the end of 2, 4, 8 and 12 weeks of treatment, respectively, on the severity subscale of the CGI and the Hamilton Anxiety Inventory (HAMA), and the clinical efficacy was evaluated on the basis of patients’ self-report and physicians’ meeting findings. At the end of treatment, the clinical efficacy was evaluated according to the HAMA reduction rate, with a reduction rate of ≥75% being considered cured, 50%-74% being considered significant improvement, 30%-49% being considered improvement, and <30% being considered ineffective. < span=""> The clinical efficacy of the study was evaluated by the following methods
2.4 Statistical methods: SPSS11.5 software was used for statistical analysis, and statistical descriptions of measurement data were expressed as mean±standard deviation, and t-test was used for statistical extrapolation. The statistical narratives of the count data were expressed as percentages, and the χ2 test was used for statistical inference; multivariate correlation analysis was used for correlation analysis.
II. Results
1. Comparison of psychosocial factor characteristics
The scores of negative life events on the Life Events Scale and the scores of introversion factor and neuroticism factor on the Eysenck Personality Questionnaire were higher in the PD group than in the normal control group, and the differences were statistically significant (P<0.01).
2.Efficacy comparison
Case shedding: 3 cases in the single drug treatment group and 2 cases in the combined drug-psychological treatment group.
Clinical efficacy: 22 cases were cured, 3 cases were significantly better, 2 cases were improved, and 1 case was invalid in the combined drug-psychotherapy group, with a total effective rate of 89.29%, and 19 cases, 2 cases, 3 cases, 3 cases, and 77.78% in the single drug group, respectively, with statistically significant differences between the two groups (t=2.267, P<0.05). < span="">
There was a significant decrease in CGI in both groups at the end of the 2nd, 4th, 8th, and 12th week after treatment compared with the pre-treatment period (P<0.05). At the end of the 8th and 12th week, the cgi scores in the pharmacopsychological combination treatment group were lower than those in the single drug treatment group, and the difference was statistically significant (t=2.539, P<0.05).
3. Correlation between efficacy and psychosocial factors
The 12-weekend CGI scores of patients in the pharmacopsychological combination treatment group were positively correlated with the EPQ factor scores on the inward and outward scales and the neurological quality scale factor scores, which were statistically significant (r=0.348, P<0.05; r=0.390, P<0.01).
III. Discussion
The results suggest that PD has the general characteristics of neurosis, and patients often have life events as triggers for the onset of the disease, such as serious illness of a loved one, etc. It is also found clinically that the illness of a loved one or the stress encountered by the patient leads to sensitivity and suspicion, persistent anxiety and anxiety, causing sudden panic attacks. The results also suggest that PD patients tend to be extroverted or even too extroverted, but are moody and prone to impatience, in line with the pattern that extroverted personalities are prone to anxiety and introverted personalities are prone to depression. Similar studies also found that PD patients had higher total life event scores, neuroticism factors and anxiety than normals.
Although medication can significantly control panic attacks, it has no significant effect on anticipatory anxiety and situational avoidance. most PD patients have cognitive errors about somatic sensations and psychological experiences, and medication focuses on physical symptoms. single medication is difficult to control patients’ symptoms, making the condition recurrent. Cognitive-behavioral therapy can help patients to correct their distorted cognition and get rid of the pain and social impairment of the disease.
Most scholars believe that cognitive-behavioral therapy in PD maintenance treatment can at least increase patients’ compliance with treatment, promote the efficacy of medication, and be meaningful in stabilizing the disease. The results of this study also showed that cognitive-psychotherapy combined with medication was more effective than medication alone at 12 weeks of treatment, and several similar studies also supported this result. There are many reasons why some patients have difficulty stopping medication and relapse after combined medication and psychotherapy. Psychotherapy should be considered in combination with other psychological treatments.
In conclusion, patients with PD are relatively extroverted, easily emotional, commonly triggered by life events, and may have personality deviations; patients with significant psychosocial factors should pay attention to combined psychotherapy; the efficacy of cognitive psychotherapy combined with pharmacotherapy is better than that of pharmacotherapy alone; poor efficacy is associated with the presence of personality defects in patients.