Deary V, Chalder T, Sharpe M
Institute of Health and Society, University of Newcastle, 21 Claremont Place, Newcastle Upon Tyne NE2 4AA, UK.
Clin Psychol Rev. 2007 Oct;27(7):781-97. doi: 10.1016/j.cpr.2007.07.002. Epub 2007 Jul 17.
The article is a narrative review of the theoretical standing and empirical evidence for the cognitive behavioural model of medically unexplained symptoms (MUS) in general and for chronic fatigue syndrome (CFS) and irritable bowel syndrome (IBS) in particular. A literature search of Medline and Psychinfo from 1966 to the present day was conducted using MUS and related terms as search terms. All relevant articles were reviewed. The search was then limited in stages, by cognitive behavioural therapy (CBT), condition, treatment and type of trial. Evidence was found for genetic, neurological, psychophysiological, immunological, personality, attentional, attributional, affective, behavioural, social and inter-personal factors in the onset and maintenance of MUS. The evidence for the contribution of individual factors, and their autopoietic interaction in MUS (as hypothesised by the cognitive behavioural model) is examined. The evidence from the treatment trials of cognitive behavioural therapy for MUS, CFS and IBS is reviewed as an experimental test of the cognitive behavioural models. We conclude that a broadly conceptualized cognitive behavioural model of MUS suggests a novel and plausible mechanism of symptom generation and has heuristic value. We offer suggestions for further research.
本文是一篇叙述性综述，探讨了医学上无法解释的症状（MUS）的认知行为模型的理论地位和实证证据，特别是慢性疲劳综合征（CFS）和肠易激综合征（IBS）的认知行为模型。使用MUS及相关术语作为检索词，对1966年至今的Medline和Psychinfo数据库进行了文献检索。对所有相关文章进行了综述。然后按阶段进行限制检索，检索条件包括认知行为疗法（CBT）、疾病、治疗方法和试验类型。研究发现，遗传、神经、心理生理、免疫、人格、注意力、归因、情感、行为、社会和人际因素在MUS的发病和维持中发挥作用。本文还研究了个体因素的作用证据，以及它们在MUS中（如认知行为模型所假设的）自生互动的证据。作为对认知行为模型的实验检验，本文回顾了针对MUS、CFS和IBS的认知行为疗法治疗试验的证据。我们得出结论，广义概念化的MUS认知行为模型提出了一种新颖且合理的症状产生机制，具有启发价值。我们为进一步研究提供了建议。
