人格状态对健康焦虑症认知行为疗法的疗效及成本的影响。
Impact of personality status on the outcomes and cost of cognitive-behavioural therapy for health anxiety.
作者信息
Sanatinia Rahil, Wang Duolao, Tyrer Peter, Tyrer Helen, Crawford Mike, Cooper Sylvia, Loebenberg Gemma, Barrett Barbara
机构信息
Rahil Sanatinia, MD, Centre for Mental Health, Imperial College, London; Duolao Wang, PhD, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool; Peter Tyrer, FMedSci, Helen Tyrer, MRCGP, PhD, Mike Crawford, FRCPsych, Sylvia Cooper, BSc, Centre for Mental Health, Imperial College, London; Gemma Loebenberg, MSc, North West London Clinical Research Network, Hammersmith Hospital, London; Barbara Barrett, PhD, King's Health Economics, King's College London, London, UK.
Rahil Sanatinia, MD, Centre for Mental Health, Imperial College, London; Duolao Wang, PhD, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool; Peter Tyrer, FMedSci, Helen Tyrer, MRCGP, PhD, Mike Crawford, FRCPsych, Sylvia Cooper, BSc, Centre for Mental Health, Imperial College, London; Gemma Loebenberg, MSc, North West London Clinical Research Network, Hammersmith Hospital, London; Barbara Barrett, PhD, King's Health Economics, King's College London, London, UK
出版信息
Br J Psychiatry. 2016 Sep;209(3):244-50. doi: 10.1192/bjp.bp.115.173526. Epub 2016 Jul 21.
BACKGROUND
Health anxiety, hypochondriasis and personality disturbance commonly coexist. The impact of personality status was assessed in a secondary analysis of a randomised controlled trial (RCT).
AIMS
To test the impact of personality status using ICD-11 criteria on the clinical and cost outcomes of treatment with cognitive-behavioural therapy for health anxiety (CBT-HA) and standard care over 2 years.
METHOD
Personality dysfunction was assessed at baseline in 444 patients before randomisation and independent assessment of costs and outcomes made on four occasions over 2 years.
RESULTS
In total, 381 patients (86%) had some personality dysfunction with 184 (41%) satisfying the ICD criteria for personality disorder. Those with no personality dysfunction showed no treatment differences (P = 0.90) and worse social function with CBT-HA compared with standard care (P<0.03) whereas all other personality groups showed greater improvement with CBT-HA maintained over 2 years (P<0.001). Less benefit was shown in those with more severe personality disorder (P<0.05). Costs were less with CBT-HA except for non-significant greater differences in those with moderate or severe personality disorder.
CONCLUSIONS
The results contradict the hypothesis that personality disorder impairs response to CBT in health anxiety in both the short and medium term.
背景
健康焦虑症、疑病症和人格障碍常并存。在一项随机对照试验（RCT）的二次分析中评估了人格状态的影响。
目的
使用国际疾病分类第11版（ICD-11）标准测试人格状态对健康焦虑症认知行为疗法（CBT-HA）和标准护理治疗2年的临床和成本结果的影响。
方法
在444例患者随机分组前的基线时评估人格功能障碍，并在2年中的4个时间点对成本和结果进行独立评估。
结果
总共381例患者（86%）存在某种人格功能障碍，其中184例（41%）符合人格障碍的ICD标准。无人格功能障碍的患者未显示出治疗差异（P = 0.90），与标准护理相比，CBT-HA组的社会功能更差（P<0.03），而所有其他人格组在2年期间接受CBT-HA治疗均显示出更大改善（P<0.001）。人格障碍更严重的患者获益较少（P<0.05）。除中度或重度人格障碍患者差异无统计学意义外，CBT-HA的成本较低。
结论
结果与人格障碍在短期和中期都会损害健康焦虑症患者对CBT反应的假设相矛盾。
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