Psychiatric and somatic diagnosis and treatment (hereinafter referred to as dual diagnosis and treatment) is the result of the joint research of Chinese and Western medicine and various humanities in neurological disorders, and has generally satisfactory efficacy and prognosis for neurological disorders. In 2000-07, we opened an open psychological ward in a general hospital. The purpose of this paper is to examine the efficacy of dichotomous diagnosis and treatment on neurasthenia in the open psychological ward of a general hospital.
1. Subjects and methods
Design: A controlled study was conducted based on the admission criteria, and the group was randomly divided into a study group (dual diagnosis and treatment group) and a control group (cognitive therapy + alprazolam, fluoxetine, etc.) according to the order of admission to the hospital.
Location and subjects: a total of 65 cases were selected from neurasthenia patients admitted to the psychology department of the Affiliated Hospital of Guangdong Medical College on 2001-03/2003-08.
Inclusion criteria.
(1) Complying with both the Chinese Classification of Mental Disorders scheme and diagnostic criteria CCMD-2-R and the rational diagnostic model of neurasthenia;
(2) No concomitant diseases: serious physical diseases, organic brain diseases, menopausal syndrome and other psychiatric disorders, etc.
(3) Willingness to cooperate with clinical research.
(4) Total score of 90-item symptom self-assessment scale (SCL-90) ≥ 180. There were 33 cases in the study group, 22 males and 11 females; age 16-45 years, mean (25.31±8.04) years; disease duration 3 months-17 years, mean (5.38±4.13) years; education level, 12 cases in university and 21 cases in secondary school. In the control group, there were 32 cases, 19 males and 13 females; age ranged from 16 to 46 years, mean (26.66±9.19) years; disease duration ranged from 3 months to 15 years, mean (4.73±3.35) years; education level, 11 cases in university and 21 cases in secondary school. The differences in age (p>0.5) and disease duration (p>0.5) between the two groups were not statistically significant.
Methods: Preparation for the study period: Patients in the study group, if they had not used before enrollment or had stopped using anxiolytics antidepressants antipsychotics half a month ago, could directly enter the formal study period; otherwise, they had to stop cleaning for half a month first. Patients in the control group can directly enter the formal study period.
Formal study period: 5 months in total, divided into two phases. The first 2 months were active treatment period and the last 3 months were free treatment period. The study group was treated with dichotomous discriminative treatment, specifically: discriminative psychotherapy, neurological gong, martial arts training, life coaching and training, diet and herbal therapy.
In addition, as a curative measure, albendazole tablets 400 mg/d were used for 3 d at the beginning and 3 d after half a month. detailed specific operations were carried out according to the relevant requirements, which are not repeated here. Active treatment period, exactly according to the above plan. In the free treatment period, patients stayed away from the open psychological ward of the general hospital, stopped relying on psychotherapy from the doctor himself, and adapted to life mainly by the psychological instincts learned in the active treatment period, and occasionally practiced neurological gong or martial arts by themselves.
The control group was treated with cognitive therapy + alprazolam, fluoxetine, etc., often combined with the Chinese medicine Xinxin, etc., as well as nutritional drugs. The dosage of alprazolam was 0.8-2.8mg/d, divided into 2-3 times; the initial daily dosage was 0.8mg, and later adjusted according to the condition. Fluoxetine dosage is 20mg/d, 1 time/d. Diet is self-regulated. During the active treatment period, the above plan was followed exactly. During the free treatment period, the patient is removed from the open psychiatric ward of the general hospital and stops relying on the doctor’s personal psychotherapy, on the one hand, with the psychological skills learned during the active treatment period and on the other hand, with the help of medication to adapt to life. The continued use of medication was self-determined, and 25 patients remained on alprazolam (and) or fluoxetine until the end of the free treatment period.
Clinical efficacy assessment criteria.
(1) Cured: complete or near-complete disappearance of symptoms and complete or near-complete recovery of function.
(2) Significant progress: most of the symptoms disappear, the degree is significantly reduced, and most of the functions are restored.
(3) Improvement: partial reduction of symptoms or slight reduction in degree, and some recovery of function.
(4) Ineffective: no change in symptoms or worsening of symptoms, and failure to restore function or worsening of functional impairment. The efficacy assessment was performed at the end of the active treatment period and the end of the free treatment period, respectively.
The 90-item symptom self-assessment scale (SCL-90) was used to assess the effectiveness of the treatment before the start of treatment, at the end of active treatment and at the end of free treatment, with a total of 5 levels from 1 to 5.
Main outcome observation indexes: The following indexes were used in both groups.
(1) The degree of symptom control.
(2) The degree of functional recovery.
(3) The 90-item symptom self-rating scale (SCL-90) score and subtraction.
In addition, the dichotomous treatment group was also able to use a unique, relatively insidious and centrally useful observation (which was not conditionally implemented in the control group): the ability to automatically control persistent distractions in the absence of antidepressant and anxiolytic drugs.
2. Results
2.1 Comparison of the clinical efficacy of the two groups at the end of the active treatment period: 33 cases in the study group, all healed, healing rate of 100%; 32 cases in the control group, healed 25 cases, significant progress in 2 cases, improvement in 5 cases, healing rate of 78%, efficiency rate of 100%. The difference in the healing rate between the two groups was significant (x2 = 5.97, P < 0.025).
Comparison of clinical efficacy at the end of the free treatment period The study group had 33 cases, all of which were cured, with a cure rate of 100%; the control group had 32 cases, 19 of which were cured, 2 were significantly improved, 4 were improved, and 7 were invalid, with a cure rate of 59.38% and an effective rate of 78.13%. The difference in the healing rate between the two groups was extremely significant ( x2=14.31, P < 0.005).
2.2 Comparison of SCL-90 assessment
The difference between the total scores of the two groups before treatment was not significant (t=0.201, p>0.5); at the end of the active treatment period, the total scores of both groups decreased significantly, and the scores of the study group were lower than those of the control group, and the difference between the two groups was highly significant (t=4.917, p<0.001); at the end of the free treatment period, the total scores of the study group continued to decrease, and the total scores of the control group rebounded, and the difference between the two groups was also highly significant (t=4.917, p<0.001). The difference between the two groups was also highly significant (t=4.409, p<0.001).
3.Discussion
Neurosis is a common type of neurosis. The key and trick of treatment is to eliminate the cause of persistent distractions and cultivate the essence of God, thus eliminating the symptoms.
The effect of dual diagnosis and treatment on neurasthenia is as follows: in the mental aspect, eliminating the cause of persistent distractions in order to calm the spirit, tranquilizing the void in order to nourish the spirit, calm and relaxed in order to protect the spirit, while cultivating good qualities such as perseverance, hard work, self-improvement, open-mindedness, ruggedness, boldness, roundness and harmony in order to adapt to the internal and external environment; in the physical aspect, nourishing the essence, blood and fluids internally to reduce consumption, restoring and In the body, the internal nourishment of essence, blood and fluid to reduce consumption, restore and strengthen the internal organs to promote regeneration, and the external strengthening of the body and bones to adapt to life. All of the above roles are synergistic and complementary, with the overall situation in mind for long-lasting peace. Attacking the evil and supporting the righteous, treating the disease and building the foundation together, the present and the long term should be taken care of, not only can precisely focus on eliminating the cause of the disease and lasting distractions and then disintegrate other symptoms, but also can widely improve the mental and physical qualities to ensure sustainable progress. The combination of attack and prevention, treatment and prevention promote each other, killing two birds with one stone.
Under the leadership and guidance of the doctor, the patient is cured through his or her own hard work, and has a thorough understanding of the principles, methods and processes of dual diagnosis and treatment. After curing neurasthenia, it is the patient’s own ability and is implicitly applied to many aspects of life, and can play a long-term role in improving, consolidating, preventing relapse and even curing. The way to heal and consolidate or even cure is to prevent the re-formation of persistent distractions of the cause of the disease, usually to be calm and empty, to strengthen the body, to improve the mind and body tolerance, when there are distractions to eliminate it in the bud.
The control group was treated with cognitive therapy + alprazolam, fluoxetine, etc., which was set up based on the still recognized form of superior treatment. Cognitive therapy is based on rational analysis and preaching to change the patient’s cognitive style and perception, thus improving their emotional, behavioral and physical symptoms; alprazolam and fluoxetine can directly improve physical symptoms and symptoms of depression and anxiety; if combined with herbal medicine, they can calm the mind and improve the physical condition. However, their own inherent defects are also obvious. Cognitive therapy for patients with pathological cognitive patterns of persistence, complexity and involuntary lack of understanding and methods to deal with, so it is not easy to terminate the patient’s cause of persistent distractions, the result is often just to get the right cognition is soon disturbed by persistent distractions or denial and the previous work is not guaranteed or even lost.
In addition, cognitive therapy is far inferior to dual diagnosis and treatment in reshaping good personality and rebuilding physical constitution, as a result, the defective personality base and inferior physical constitution base hinder the comprehension, acceptance, implementation and improvement of cognitive therapy. Alprazolam has anxiolytic-hypnotic and other effects, but the more it is used, the more resistant and large amounts, with certain toxic side effects, and addictive, and finally become a barrier to further treatment. Although fluoxetine has antidepressant and anxiolytic effects, it is ultimately a passive therapy. Although nutritional injections can temporarily improve physical fitness, but often rely on unconventional ways, seems very passive and difficult to last.
According to Li Genqi’s report: neurasthenia, using self-designed brain nourishing soup, the initial combined with a small amount of Western drugs (hydroxycodone, alprazolam, Teldene), the middle of the reduction of Western drugs, the late addition of psychotherapy, acupuncture, meridian oxygen, but stop using Western drugs. After several courses of treatment (14d for 1 course), the total effective rate was 93.1%. We achieved a higher cure rate and effective rate for neurasthenia by using cognitive therapy + alprazolam and fluoxetine in the open psychological ward of the general hospital. This indicates that the open psychological ward of the general hospital provides more convenient conditions for neurasthenia.
However, in the open psychological ward of the general hospital, dichotomous discriminative treatment was superior to cognitive therapy + alprazolam and fluoxetine for neurasthenia. The clinical efficacy of the two groups was compared as described above. Although the control group also had a high recovery rate at the end of the active treatment period, when compared with the study group, the disadvantages were evident.
(a) Cognitive therapy is not yet unique for neurological disorders and has to rely on drugs;
(ii) Long-term reliance on medication hinders the further role of cognitive therapy;
(c) Based on symptom control, it is difficult to maintain the efficacy for a long time, and to consolidate the efficacy at the cost of long-term treatment, if the drugs are discontinued, more patients will relapse, so the recovery rate at the end of the free treatment period will inevitably decline;
(iv) Stopping the use of drugs will cause the disease to rebound and even complicate withdrawal symptoms or dependence symptoms;
(e) The external conditions of dependence are higher and the medical costs required are greater, making it difficult to implement long-term follow-up treatment due to the economic pressure on patients and society in the long run. Unlike the study group, the relevant herbal treatments were only used or could be dispensed with in their first 5 d. What was involved was the essential nature of the etiology of the disease such as lasting distractions, pathological changes in the disease mechanism of the gods and essence and all kinds of internal relationships, while the realm reached was already the overall treatment goal. It can be seen that the level of the disease and the treatment goal pursued by the two groups are no longer at the same level, and the research group is superior.
CONCLUSION: Dual discriminative treatment has generally superior healing efficacy and healing consolidation efficacy for neurasthenia and should be actively promoted. The open psychological ward of a general hospital can be used as a medical platform for dual diagnosis and treatment of neurasthenia.