Sumathipala A, Siribaddana S, Abeysingha M R N, De Silva P, Dewey M, Prince M, Mann A H
Section of Epidemiology, Institute of Psychiatry, De Crespigny Park, London, UK.
Br J Psychiatry. 2008 Jul;193(1):51-9. doi: 10.1192/bjp.bp.107.043190.
A pilot trial in Sri Lanka among patients with medically unexplained symptoms revealed that cognitive-behavioural therapy (CBT) administered by a psychiatrist was efficacious.
To evaluate CBT provided by primary care physicians in a comparison with structured care.
A randomised control trial (n=75 in each arm) offered six 30 min sessions of structured care or therapy. The outcomes of the two interventions were compared at 3 months, 6 months, 9 months and 12 months.
In each arm, 64 patients (85%) completed the three mandatory sessions. No difference was observed between groups in mean scores on the General Health Questionnaire or the Bradford Somatic Inventory, or in number of complaints or patient-initiated consultations at 3 months. For both groups, all outcome measures improved at 3 months, and remained constant in the follow-up assessments.
Cognitive-behavioural therapy given by primary care physicians after a short course of training is no more efficacious than structured care. Natural remission is an unlikely explanation for improvements in people with chronic medically unexplained symptoms, but lack of a 'treatment as usual' arm limits further conclusions. Further research on enhanced structured care, medical assessment and structured care incorporating simple elements of CBT principles is worthy of consideration.
在斯里兰卡针对患有医学上无法解释症状的患者进行的一项试点试验表明，由精神科医生实施的认知行为疗法（CBT）是有效的。
评估初级保健医生提供的CBT与结构化护理相比的效果。
一项随机对照试验（每组75人）提供六次30分钟的结构化护理或治疗课程。在3个月、6个月、9个月和12个月时比较两种干预措施的结果。
每组中，64名患者（85%）完成了三次必修课程。在3个月时，两组在一般健康问卷或布拉德福德躯体量表的平均得分、投诉数量或患者发起的咨询次数方面均未观察到差异。两组的所有结局指标在3个月时均有所改善，且在后续评估中保持不变。
经过短期培训后由初级保健医生提供的认知行为疗法并不比结构化护理更有效。自然缓解不太可能是慢性医学上无法解释症状患者病情改善的原因，但缺乏“常规治疗”组限制了进一步得出结论。对强化结构化护理、医学评估以及纳入CBT原则简单要素的结构化护理的进一步研究值得考虑。
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