Markowitz J C
Department of Psychiatry, Cornell University Medical College, New York, NY 10021.
Am J Psychiatry. 1994 Aug;151(8):1114-21. doi: 10.1176/ajp.151.8.1114.
The author reviews empirical research on the psychotherapy of dysthymia. Dysthymia, a prevalent mood disorder, has been shown frequently to respond to antidepressant medication. The need for a treatment for dysthymic subjects unable or unwilling to take, or unresponsive to, medication still remains.
Studies were located by computerized search and the author's knowledge of the literature. All reports of studies on psychotherapy outcome for dysthymic patients, except studies of late-life chronic major depression, were included.
Psychotherapy research on dysthymia has been confined to small, usually uncontrolled studies with varying methods and limited follow-up. Cognitive approaches have been most frequently studied; the results have not been dramatic but do suggest that some dysthymic patients respond to brief cognitive therapies. Preliminary results of an ongoing study of interpersonal psychotherapy are promising.
Given the public health importance of dysthymia and the availability of treatments, the time is ripe for clinical trials of antidysthymic psychotherapy. The author proposes the following guidelines for such trials: time-limited, manual-based psychotherapy, interpersonal focus, serial design, continuation and maintenance treatment, combined treatments, and follow-up assessments.
作者回顾了关于心境恶劣障碍心理治疗的实证研究。心境恶劣障碍是一种常见的情绪障碍，已被证明对抗抑郁药物常常有反应。对于那些不能或不愿服用药物、或对药物无反应的心境恶劣障碍患者，仍然需要一种治疗方法。
通过计算机检索和作者对文献的了解来查找研究。除了关于老年慢性重度抑郁症的研究外，所有关于心境恶劣障碍患者心理治疗结果的研究报告均被纳入。
关于心境恶劣障碍的心理治疗研究局限于小型研究，通常是无对照的，方法各异且随访有限。认知疗法是研究最多的方法；结果虽不显著，但确实表明一些心境恶劣障碍患者对短期认知疗法有反应。一项正在进行的人际心理治疗研究的初步结果很有前景。
鉴于心境恶劣障碍对公众健康的重要性以及现有治疗方法，进行抗心境恶劣障碍心理治疗的临床试验时机已经成熟。作者为这类试验提出了以下指导原则：限时、基于手册的心理治疗、人际导向、系列设计、持续和维持治疗、联合治疗以及随访评估。
