Sumathipala A, Hewege S, Hanwella R, Mann A H
Section of Epidemiology and General Practice, Institute of Psychiatry, King's College, University of London.
Psychol Med. 2000 Jul;30(4):747-57. doi: 10.1017/s0033291799002160.
Research on the management and the outcome of treatment of medically unexplained symptoms is very limited. Development of simple but effective techniques for treatment and demonstration of their effectiveness when applied in primary health care are needed.
A randomized controlled trial was carried out with follow-up assessments at 3 months after baseline assessments using the Short Explanatory Model Interview (SEMI), General Health Questionnaire (GHQ-30), Bradford Somatic Inventory (BSI) and patient satisfaction on a visual analogue scale. The study was carried out in a general out-patient clinic in Sri Lanka. The intervention group received six, 30 min sessions based on the principles of cognitive behavioural therapy over a period of 3 months. The control group received standard clinical care.
Eighty patients out of the 110 patients referred, were eligible. Sixty-eight were randomly allocated equally to the control and treatment groups. All 34 in the treatment group accepted the treatment offer and 22 completed between three and six sessions. At 3 months, 24 in the treatment and 21 in the control group completed follow-up assessments. Intention-to-treat analysis revealed significant differences in mean scores of outcome measures (adjusted for baseline scores) between control and intervention groups respectively--complaints 6.1 and 3.8 (P = 0.001), GHQ 10.4 and 6.3 (P = 0.04), BSI score 15.6 and 132 (P < 0-01), visits 7.9 and 3.1 (P = 0.004).
Intervention based on cognitive behavioural therapy is feasible and acceptable to patients with medically unexplained symptoms from a general out-patients clinic in Sri Lanka. It had a significant effective in reducing symptoms, visits and distress, and in increasing patient satisfaction.
关于医学上无法解释的症状的管理和治疗结果的研究非常有限。需要开发简单但有效的治疗技术，并证明其在初级卫生保健中的有效性。
进行了一项随机对照试验，在基线评估后3个月使用简短解释模型访谈（SEMI）、一般健康问卷（GHQ-30）、布拉德福德躯体量表（BSI）以及视觉模拟量表上的患者满意度进行随访评估。该研究在斯里兰卡的一家普通门诊诊所进行。干预组在3个月内接受了基于认知行为疗法原则的6次，每次30分钟的治疗。对照组接受标准临床护理。
转诊的110名患者中有80名符合条件。68名患者被随机平均分配到对照组和治疗组。治疗组的34名患者全部接受了治疗，22名患者完成了3至6次治疗。3个月时，治疗组的24名患者和对照组的21名患者完成了随访评估。意向性分析显示，对照组和干预组之间结局指标的平均得分（根据基线得分进行调整）存在显著差异——主诉分别为6.1和3.8（P = 0.001），GHQ分别为10.4和6.3（P = 0.04），BSI得分分别为15.6和13.2（P < 0.01），就诊次数分别为7.9和3.1（P = 0.004）。
基于认知行为疗法的干预对斯里兰卡一家普通门诊诊所中患有医学上无法解释的症状的患者是可行且可接受的。它在减轻症状、减少就诊次数和痛苦以及提高患者满意度方面具有显著效果。
