Smith G R, Rost K, Kashner T M
Department of Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, Little Rock.
Arch Gen Psychiatry. 1995 Mar;52(3):238-43. doi: 10.1001/archpsyc.1995.03950150070012.
Patients who somatize but who do not meet criteria for somatization disorder are common in the community. Virtually no research has been conducted to determine how to treat these patients.
We conducted a randomized controlled clinical trial of a psychiatric consultation intervention we had previously shown to improve the management of somatization disorder. The study population included 51 physicians treating 56 somatizing patients who had a history of seeking help for six to 12 lifetime unexplained physical symptoms. At the onset of the experiment, physicians randomized to the treatment condition received a consultation letter recommending a specific management approach; physicians randomized to the control/crossover condition received the consultation letter after 12 months. Data on health outcomes and charges were collected every 4 months for 2 years after randomization for 96% of subjects who entered the study.
Patients of physicians who received the intervention reported significantly increased physical functioning, an improvement that remained stable during the year after the intervention. The intervention reduced annual medical care charges by $289 (95% confidence interval, $40 to $464) in 1990 constant dollars, which equates to a 32.9% reduction in the annual median cost of their medical care.
Somatizing patients with a lifetime history of six to 12 unexplained physical symptoms reported better physical functioning after their primary care physician was provided appropriate treatment recommendations via a psychiatric consultation. Such a consultation is cost-effective because it reduces subsequent charges for medical care, while improving health outcomes in a chronically impaired population.
在社区中，存在躯体化症状但不符合躯体化障碍标准的患者很常见。实际上，尚未开展任何研究来确定如何治疗这些患者。
我们对一种精神科会诊干预措施进行了随机对照临床试验，我们之前已证明该措施可改善躯体化障碍的管理。研究人群包括51名医生，他们治疗56名有躯体化症状的患者，这些患者一生中有6至12种无法解释的身体症状且有寻求帮助的历史。在实验开始时，被随机分配到治疗组的医生收到一封推荐特定管理方法的会诊信；被随机分配到对照组/交叉组的医生在12个月后收到这封会诊信。在随机分组后的2年里，每4个月收集一次96%进入研究的受试者的健康结局和费用数据。
接受干预的医生的患者报告身体功能显著改善，这种改善在干预后的一年中保持稳定。以1990年不变美元计算，该干预使年度医疗费用降低了289美元（95%置信区间，40美元至464美元），这相当于其年度医疗费用中位数降低了32.9%。
有6至12种一生无法解释的身体症状的躯体化患者，在其初级保健医生通过精神科会诊获得适当治疗建议后，身体功能有更好的改善。这样的会诊具有成本效益，因为它降低了后续的医疗费用，同时改善了长期受损人群的健康结局。
