Sumathipala Athula
Department of Health Services Research, Kings College, University of London, London, UK.
Psychosom Med. 2007 Dec;69(9):889-900. doi: 10.1097/PSY.0b013e31815b5cf6.
To review published literature for the highest level of evidence on the efficacy of treatment for patients with medically unexplained symptoms.
A comprehensive literature search was carried out in Cochrane library, Medline (1971-2007), PsychINFO (1974-2006), and EMBASE (1980-2007) to identify pharmacological, nonpharmacological, psychological, and other interventions, using the search terms "medically unexplained symptoms," "somatisation," "somatization," "somatoform disorders," "psychological therapies," "cognitive behavior therapy," "pharmacological therapies," "management," "therapy," "drug therapy," and "anti-depressants" with Boolean operators AND and OR on the entire text. Searches were confined to literature in English.
Studies were carried out in primary, secondary, and tertiary care settings. The therapists ranged from medical specialists, psychiatrists, and psychologists to primary care physicians. Three types of interventions (antidepressant medication, cognitive behavioral therapy (CBT), and other nonspecific interventions) were supported by evidence on the efficacy of treatment for patients with medically unexplained symptoms. There is more level I evidence for CBT compared with the amount for other approaches. There was only one study reported from the developing world.
CBT is efficacious for either symptom syndromes or for the broader category of medically unexplained symptoms, reducing physical symptoms, psychological distress, and disability. A relatively small number of studies were carried out in primary care, but the trend has been changing over the last decade. No studies have compared pharmacological and psychological treatments. Most trials assessed only short-term outcomes. Use of divergent selection procedures, interventions, outcome measures, and instruments, and other methodological differences observed in these studies hamper the ability to compare treatment effects across studies.
回顾已发表文献，以获取关于医学上无法解释症状患者治疗效果的最高级别证据。
在Cochrane图书馆、Medline（1971 - 2007年）、PsychINFO（1974 - 2006年）和EMBASE（1980 - 2007年）中进行全面的文献检索，以识别药物、非药物、心理及其他干预措施，使用检索词“医学上无法解释的症状”、“躯体化”、“躯体形式障碍”、“心理治疗”、“认知行为疗法”、“药物治疗”、“管理”、“治疗”、“药物疗法”和“抗抑郁药”，并在全文中使用布尔运算符AND和OR。检索限于英文文献。
研究在初级、二级和三级护理环境中开展。治疗师包括医学专家、精神科医生、心理学家以及初级保健医生。有证据支持针对医学上无法解释症状患者的三种干预措施（抗抑郁药物、认知行为疗法（CBT）和其他非特异性干预措施）的治疗效果。与其他方法相比，CBT有更多的I级证据。发展中世界仅报告了一项研究。
CBT对于症状综合征或更广泛的医学上无法解释症状类别有效，可减轻身体症状、心理困扰和残疾。在初级保健中开展的研究相对较少，但在过去十年中趋势一直在变化。没有研究比较药物治疗和心理治疗。大多数试验仅评估短期结果。这些研究中观察到的不同选择程序、干预措施、结果测量和工具以及其他方法学差异，妨碍了跨研究比较治疗效果的能力。
