Department of Psychiatry, Dalhousie University, Halifax, Canada.
Department of Psychiatry, Dalhousie University, Halifax, Canada.
J Psychosom Res. 2024 Dec;187:111889. doi: 10.1016/j.jpsychores.2024.111889. Epub 2024 Aug 22.
Patients commonly present at hospital Emergency Departments (ED) with distress that meet criteria for a Somatic Symptom and Related Disorder (SSRD). Without access to effective treatment, risk of ongoing patient disability and further ED visits is high.
This pilot trial used a randomized parallel group design to test the efficacy of Intensive Short-Term Dynamic Psychotherapy (ISTDP). ED patients who met criteria for SSRD were recruited. The effects of ISTDP plus medical care as usual (MCAU) were judged through comparison against 8 weeks of MCAU plus wait-list symptom monitoring (WL-SM). The primary outcome was somatic symptom at 8 weeks. Patients allocated to WL-SM could cross-over to receive ISTDP and 6-month follow-up data was collected. Baseline measures of patient attachment style and alexithymia were collected to examine vulnerabilities to somatic symptoms.
gov: NCT02076867.
Thirty-seven patients were randomized to 2 groups (ISTDP = 19 and WL-SM = 18). Multi-level modelling showed that change over time on somatic symptoms was significantly greater in the ISTDP group. Between-group differences were large at 8 weeks (Cohen's d = 0.94) and increased by end of treatment (Cohen's d = 1.54). Observed differences in symptoms of depression and illness anxiety were also large, favoring ISTDP, and effects were maintained at follow-up. Patients receiving ISTDP had reduced ED service utilization at 2-year follow-up.
ISTDP appears an efficacious treatment for SSRD and a larger randomized trial is justified.
患者常因符合躯体症状及相关障碍（SSRD）标准的困扰而到医院急诊部（ED）就诊。如果无法获得有效治疗，患者持续残疾和进一步到 ED 就诊的风险很高。
本试验采用随机平行组设计，测试强化短期动力心理治疗（ISTDP）的疗效。符合 SSRD 标准的 ED 患者被纳入研究。通过与 8 周 MCAU 加等待名单症状监测（WL-SM）相比，判断 ISTDP 加 MCAU 的效果。主要结局为 8 周时的躯体症状。被分配到 WL-SM 的患者可以交叉接受 ISTDP 治疗，并收集 6 个月的随访数据。基线时评估患者的依恋风格和述情障碍，以检查躯体症状的脆弱性。
gov：NCT02076867。
37 名患者随机分为 2 组（ISTDP = 19 例，WL-SM = 18 例）。多层次模型显示，ISTDP 组躯体症状随时间的变化明显更大。8 周时组间差异较大（Cohen's d = 0.94），治疗结束时增加（Cohen's d = 1.54）。观察到的抑郁和疾病焦虑症状差异也较大，有利于 ISTDP，并且在随访时仍然存在。接受 ISTDP 的患者在 2 年随访时 ED 服务利用率降低。
ISTDP 似乎是 SSRD 的有效治疗方法，值得进行更大规模的随机试验。
