Departments of Psychosis Studies, King's College Hospital, London.
Neurology. 2013 Feb 26;80(9):792-9. doi: 10.1212/WNL.0b013e3182840678. Epub 2013 Jan 16.
To test the effects of a novel cognitive-behavioral therapy (CBT)-based intervention delivered by a nurse therapist to patients with Parkinson disease (PD) with clinically significant impulse control behaviors (ICB).
This was a randomized controlled trial comparing up to 12 sessions of a CBT-based intervention compared to a waiting list control condition with standard medical care (SMC). A total of 27 patients were randomized to the intervention and 17 to the waiting list. Patients with a Mini-Mental State Examination score of <24 were excluded. The coprimary outcomes were overall symptom severity and neuropsychiatric disturbances in the patients and carer burden and distress after 6 months. Secondary outcome measures included depression and anxiety, marital satisfaction, and work and social adjustment in patients plus general psychiatric morbidity and marital satisfaction in carers.
There was a significant improvement in global symptom severity in the CBT intervention group vs controls, from a mean score consistent with moderate to one of mild illness-related symptoms (χ(2) = 16.46, p < 0.001). Neuropsychiatric disturbances also improved significantly (p = 0.03), as did levels of anxiety and depression and adjustment. Measures of carer burden and distress showed changes in the desired direction in the intervention group but did not change significantly. General psychiatric morbidity did improve significantly in the carers of patients given CBT.
This CBT-based intervention is the first to show efficacy in ICB related to PD in terms of patient outcomes. The hoped-for alleviation of carer burden was not observed. The study demonstrates the feasibility and potential benefit of a psychosocial treatment approach for these disturbances at least in the short term, and encourages further larger-scale clinical trials.
The study provides Class IV evidence that CBT plus SMC is more effective than SMC alone in reducing the severity of ICB in PD, based upon Clinical Global Impression assessment (χ(2) = 16.46, p < 0.001): baseline to 6-month follow-up, reduction in symptom severity CBT group, 4.0-2.5; SMC alone group, 3.7-3.5.
测试由护士治疗师对患有临床显著冲动控制行为（ICB）的帕金森病（PD）患者进行新型认知行为疗法（CBT）干预的效果。
这是一项随机对照试验，比较了多达 12 次 CBT 干预与标准医疗保健（SMC）下的等待名单对照条件。共有 27 名患者被随机分配到干预组，17 名患者被分配到等待名单组。排除 Mini-Mental State Examination 评分<24 的患者。主要结果是 6 个月后患者和照顾者的整体症状严重程度和神经精神障碍、照顾者负担和痛苦。次要结果包括患者的抑郁和焦虑、婚姻满意度以及工作和社会调整，以及照顾者的一般精神疾病发病率和婚姻满意度。
与对照组相比，CBT 干预组的整体症状严重程度有显著改善，从中度到轻度与疾病相关症状的平均评分（χ(2) = 16.46，p < 0.001）。神经精神障碍也有显著改善（p = 0.03），焦虑和抑郁以及调整水平也有改善。干预组照顾者的负担和痛苦测量值朝着预期的方向变化，但没有显著变化。接受 CBT 的患者的照顾者的一般精神疾病发病率显著改善。
这是第一项在与 PD 相关的 ICB 方面显示出疗效的 CBT 干预研究，从患者结果来看。没有观察到减轻照顾者负担的希望。该研究证明了心理社会治疗方法对这些干扰的可行性和潜在益处，至少在短期内是如此，并鼓励进行更大规模的临床试验。
该研究提供了 IV 级证据，表明 CBT 加 SMC 在降低 PD 中 ICB 的严重程度方面比单独 SMC 更有效，这是基于临床总体印象评估（χ(2) = 16.46，p < 0.001）：从基线到 6 个月的随访，CBT 组的症状严重程度降低，4.0-2.5；SMC 单独组，3.7-3.5。
