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系统评估和心理教育在重度功能性躯体障碍青少年专科治疗中的临床影响:AHEAD研究结果

Clinical Impact of Systematic Assessment and Psychoeducation in Specialized Treatment of Adolescents with Severe Functional Somatic Disorders: Results from the AHEAD Study.

作者信息

Kallesøe Karen Hansen, Wellnitz Kaare Bro, Ørnbøl Eva, Rask Charlotte Ulrikka

机构信息

Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 175, 8200 Aarhus, Denmark.

The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Palle Juul Jensens Boulevard 11, 8200 Aarhus, Denmark.

出版信息

Children (Basel). 2023 Jun 22;10(7):1101. doi: 10.3390/children10071101.

Abstract

Functional somatic disorders (FSD), characterized by persistent and disabling physical symptoms, are common in adolescents. Diagnostic uncertainty and insufficient illness explanations are proposed perpetuating factors that may constitute barriers for treatment engagement. This study describes the impact of manualized assessment and psychoeducation on diagnostic certainty and various clinical outcomes in adolescents with multi-system FSD. Ninety-one adolescents (15-19 years) received systematic assessment (4 h) and a subsequent psychiatric consultation (1.5 h). Clinical characteristics included self-reported physical health, symptom severity, illness perception, illness-related behavior, and psychological flexibility assessed before and approximately two months after assessment, prior to specialized treatment. Data were analyzed using -tests. Immediately following assessment, 71 (80.7%) adolescents out of 88 reported a higher diagnostic certainty and 74 (84.1%) reported that attending assessment gave them positive expectations for future treatment. A clinically relevant improvement of physical health was not observed at two months but considerable reductions were seen in symptom severity, illness worry, negative illness perceptions, illness-related limiting behavior, and psychological inflexibility. The results emphasize that systematic assessment and psychoeducation are important in their own right in the specialized treatment of adolescents with severe FSD.

摘要

功能性躯体障碍(FSD)以持续且致残的躯体症状为特征,在青少年中很常见。诊断不确定性和对疾病解释不足被认为是持续存在的因素,可能构成治疗参与的障碍。本研究描述了手册化评估和心理教育对多系统FSD青少年诊断确定性和各种临床结局的影响。91名青少年(15 - 19岁)接受了系统评估(4小时)以及随后的精神科会诊(1.5小时)。临床特征包括自我报告的身体健康状况、症状严重程度、疾病认知、疾病相关行为以及在评估前和评估后约两个月、专门治疗前评估的心理灵活性。使用t检验分析数据。在评估后立即进行报告的88名青少年中,71名(80.7%)报告诊断确定性更高,74名(84.1%)报告参加评估让他们对未来治疗产生了积极期望。在两个月时未观察到身体健康状况有临床相关的改善,但症状严重程度、疾病担忧、负面疾病认知、疾病相关的限制行为和心理僵化有显著降低。结果强调,系统评估和心理教育本身在重度FSD青少年的专科治疗中很重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aad2/10378561/e2fe62d6f640/children-10-01101-g001.jpg

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