与药物过度使用所致慢性头痛解毒治疗失败相关的心理因素

Psychological factors associated with failure of detoxification treatment in chronic headache associated with medication overuse.

作者信息

Bottiroli S, Viana M, Sances G, Ghiotto N, Guaschino E, Galli F, Vegni E, Pazzi S, Nappi G, Tassorelli C

机构信息

Headache Science Center and Headache Unit, National Neurological Institute C. Mondino, Pavia, Italy

Headache Science Center and Headache Unit, National Neurological Institute C. Mondino, Pavia, Italy.

出版信息

Cephalalgia. 2016 Dec;36(14):1356-1365. doi: 10.1177/0333102416631960. Epub 2016 Feb 15.

DOI:10.1177/0333102416631960

PMID:26879321

Abstract

AIM

The aim of this study was to evaluate the psychological factors associated with a negative outcome following detoxification in a 2-month follow-up in medication-overuse headache.

METHODS

All consecutive patients entering the detoxification program were analysed in a prospective, non-randomised fashion. Psychiatric conditions and personality characteristics were assessed using the Structured Clinical Interview for DSM-IV Disorders (SCID-I) and the Minnesota Multiphasic Personality Inventory (MMPI)-2. χ tests, one-way analyses of variance, and odds ratios (ORs) were used.

RESULTS

A total of 248 patients completed the follow-up: 156 stopped overuse and their headaches reverted to an episodic pattern (Group A); 23 kept overusing without any benefit on headache frequency (Group B); and 51 stopped overuse without any benefit on headache frequency (Group C). The prognostic factors for the outcome of Group B were higher scores on the correction (OR 1.128; p = 0.036), depression (OR 1.071; p = 0.05), hysteria (OR 1.106; p = 0.023), and overcontrolled hostility (OR 1.182; p = 0.04) MMPI-2 scales, whereas those for Group C were psychiatric comorbidities (OR 1.502; p = 0.021) and higher scores on the hysteria scale (OR 1.125; p = 0.004).

CONCLUSIONS

The outcome of detoxification is influenced by psychological factors that should be considered when considering treatment strategies.

摘要

目的

本研究旨在评估药物过度使用性头痛患者在戒毒后2个月随访中与不良结局相关的心理因素。

方法

对所有连续进入戒毒项目的患者进行前瞻性、非随机分析。使用《精神疾病诊断与统计手册》第四版障碍的结构化临床访谈（SCID-I）和明尼苏达多相人格调查表（MMPI）-2评估精神状况和人格特征。采用χ检验、单因素方差分析和比值比（OR）。

结果

共有248例患者完成随访：156例停止过度使用，头痛恢复为发作性模式（A组）；23例继续过度使用，头痛频率无改善（B组）；51例停止过度使用，头痛频率无改善（C组）。B组结局的预后因素为MMPI-2量表中校正（OR 1.128；p = 0.036）、抑郁（OR 1.071；p = 0.05）、癔症（OR 1.106；p = .023）和过度控制敌意（OR 1.182；p = 0.04）得分较高，而C组的预后因素为精神共病（OR 1.502；p = 0.021）和癔症量表得分较高（OR 1.125；p = 0.004）。