Clinical case study: CBT for depression in a Puerto Rican adolescent: challenges and variability in treatment response.
Clinical case study: CBT for depression in a Puerto Rican adolescent: challenges and variability in treatment response.
复制标题
临床案例研究：波多黎各青少年抑郁症的 CBT：治疗反应的挑战和变化。
DOI：
10.1002/da.20457
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发表时间：
2009
影响因子：
7.4
通讯作者：
Rosselló,Jeannette
中科院分区：
文献类型：
--
作者：
JiménezChafey,MaríaI;Bernal,Guillermo;Rosselló,Jeannette
背景：有充分的证据表明认知行为疗法（CBT）对青少年抑郁症的疗效，包括波多黎各青少年。然而，仍然有很高比例的青少年对12次CBT的标准“剂量”没有反应。本临床病例研究探讨了波多黎各青少年治疗反应的相关特征，并说明了CBT治疗青少年重度抑郁症（MDD）的挑战和可变性。方法：患者是一名15岁的青春期女性，在治疗前被诊断为重度抑郁症，伴有严重抑郁症状、高自杀意念、低自我概念和高度功能失调态度。CBT治疗包括12次标准的个体治疗，外加4次额外的治疗和一次家庭干预。采用个案研究法。本病例的定性和定量数据均采用自我报告工具、临床病例记录和治疗过程记录。结果：她提出的与治疗部分或无反应相关的一些特征是：抑郁症状的严重程度增加，先前的重度抑郁症发作，与其他精神障碍共发病，以及显著的父母冲突。在终止治疗时，患者表现出抑郁症状、功能失调态度和自杀意念的减少，以及自我概念的改善。这些改善一直维持到治疗后1年。结论：文化问题讨论了潜在的父母冲突延续患者的抑郁症状。《抑郁与焦虑》，2009。©2008 Wiley‐Liss, Inc。
Background:There is ample evidence of the efficacy of cognitive‐behavioral therapy (CBT) for depression in adolescents, including Puerto Rican adolescents. However, there is still a high percentage of adolescents who do not respond to a standard “dose” of 12 sessions of CBT. This clinical case study explores the characteristics associated with treatment response in a Puerto Rican adolescent and illustrates the challenges and variability inherent in CBT treatment for major depressive disorder (MDD) in youth.Methods:The patient is a 15‐year‐old adolescent female who at pretreatment presented a diagnosis of MDD with severe depressive symptoms, high suicidal ideation, low self‐concept, and highly dysfunctional attitudes. CBT treatment consisted of 12 standard individual therapy sessions plus four additional sessions, and one family intervention. A case study method was used. Both qualitative and quantitative data for the case are presented using self‐report instruments, clinical case notes and recordings of therapy sessions.Results:Some of the characteristics she presented that have been associated with partial or no response to therapy were: increased severity of depressive symptoms, a prior MDD episode, co‐morbidity with other mental disorders, and significant parental conflict. At termination the patient presented decreases in depressive symptoms, dysfunctional attitudes, and suicidal ideation, as well as improvements in self‐concept. These improvements were maintained up to 1 year posttreatment.Conclusions: Cultural issues are discussed in terms of the potential for parental conflict to perpetuate the patient's depressive symptoms. Depression and Anxiety, 2009. © 2008 Wiley‐Liss, Inc.