I JMIR出版物认知行为疗法作为难治性抑郁症药物治疗的辅助:卡塔尔世界杯8强波胆分析随机对照试验%A Mantani,Akio %A Kato,Tadashi %A Furukawa,Toshi %A Horikoshi,Masaru %A Imai,Hissei %A Hiroe,Takahiro %A Chino,Bun %A Funayama,Tadashi %A Yonemoto,Naohiro %A Zhou,Qi %A Kawanishi,Nao %+京都，Sakyo-ku吉田河野町，日本，81 757538941，公共卫生学院健康促进与人类行为系，furukawa@kuhp.kyoto-u.ac.jp %K重度抑郁症%K药物治疗难治性抑郁症%K手机应用%K认知行为疗法%K eHealth %D 2017 %7 03.11.2017 %9原始论文%J J医学互联网Res %G英文%X背景:在治疗重度抑郁症时，抗抑郁药物有效但不能治愈。认知行为疗法(CBT)单独或与药物疗法联合使用也很有效，但可获得性是个问题。目的:目的是评估智能手机CBT应用程序作为抗抑郁药耐药性重性抑郁症患者辅助治疗的有效性。方法:在日本20家精神病诊所和医院进行了一项多地点、评估者蒙面、平行组随机对照试验。如果参与者被初步诊断为重度抑郁症，并且在服用一种或多种足够剂量的抗抑郁药4周或4周以上后出现抗抑郁难治性，他们就符合条件。在参与者开始用药切换并可以访问应用程序的欢迎会话的1周的试运行后，患者被随机分配到单独用药切换或通过集中式Web系统使用用药切换加智能手机CBT应用程序。这款智能手机应用名为kokoro -app(“kokoro”在日语中是“心灵”的意思)，包括由卡通人物呈现的自我监控、行为激活和认知重组课程。主要结局是抑郁症严重程度，由蒙面电话评估员在第9周使用患者健康问卷-9 (PHQ-9)评估。 The secondary outcomes included the Beck Depression Inventory-II (BDI-II) and Frequency, Intensity, and Burden of Side Effects Ratings (FIBSER). Results: In the total sample (N=164), 81 participants were allocated to the smartphone CBT in addition to medication change and 83 to medication change alone. In the former group, all but one participant (80/81, 99%) completed at least half, and 71 (88%) completed at least six of eight sessions. In the intention-to-treat analysis, patients allocated the CBT app scored 2.48 points (95% CI 1.23-3.72, P<.001; standardized mean difference 0.40) lower on PHQ-9 than the control at week 9. The former group also scored 4.1 points (95% CI 1.5-6.6, P=.002) lower on BDI-II and 0.76 points (95% CI –0.05 to 1.58, P=.07) lower on FIBSER. In the per-protocol sample (comfortable with the smartphone app, still symptomatic, and adherent to medication with mild or less side effects after run-in), the intervention group (n=60) scored 1.72 points (95% CI 0.25-3.18, P=.02) lower on PHQ-9, 3.2 points (95% CI –0.01 to 6.3, P=.05) lower on BDI-II, and 0.75 points (95% CI 0.03-1.47, P=.04) lower on FIBSER than the control (n=57). The treatment benefits were maintained up to week 17. Conclusions: This is the first study to demonstrate the effectiveness of a smartphone CBT in the treatment of clinically diagnosed depression. Given the merits of the mobile mental health intervention, including accessibility, affordability, quality control, and effectiveness, it is clinically worthwhile to consider adjunctive use of a smartphone CBT app when treating patients with antidepressant-resistant depression. Research into its effectiveness in wider clinical contexts is warranted. Trial Registration: Japanese Clinical Trials Registry UMIN CTR 000013693; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ ctr_view.cgi?recptno=R000015984 (Archived by WebCite at http://www.webcitation.org/6u6pxVwik) %M 29101095 %R 10.2196/jmir.8602 %U //www.mybigtv.com/2017/11/e373/ %U https://doi.org/10.2196/jmir.8602 %U http://www.ncbi.nlm.nih.gov/pubmed/29101095