Cognitive behaviour therapy in addition to antispasmodic treatment for irritable bowel syndrome in primary care: randomised controlled trial
Cognitive behaviour therapy in addition to antispasmodic treatment for irritable bowel syndrome in primary care: randomised controlled trial
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DOI：
10.1136/bmj.38545.505764.06
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发表时间：
2005-08-20
影响因子：
--
通讯作者：
Chalder, T
中科院分区：
文献类型：
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作者：
Kennedy, T;Jones, R;Chalder, T
目的评价认知行为疗法在初级保健中治疗肠易激综合征的疗效。设计随机对照试验。在伦敦设置10个一般做法。参与者149例对抗痉挛药美贝弗林有抵抗力的中度或重度肠易激综合征患者。干预措施由训练有素的初级保健护士提供认知行为治疗，加270毫克每日三次的甲比弗林，与单独服用甲比弗林相比。主要评价指标主要评价指标为肠易激综合征症状严重程度量表评分。次要测量是工作与社会适应量表和医院焦虑抑郁量表的得分。结果在334例转诊患者中，72例随机接受甲比弗林联合认知行为治疗，77例单独接受甲比弗林治疗。与单独使用mebeverine相比，认知行为疗法在症状严重程度方面具有相当大的初始益处，平均评分降低68分（95%置信区间103至33），益处持续到治疗后3个月和6个月（平均降低71分（109至32）和11分（20至3）），但之后就没有了。认知行为疗法在治疗后12个月仍存在的工作和社会适应量表上也显示出显著的益处（平均降低2.8分（5.2至0.4）），但在医院焦虑和抑郁量表上的效果不一致。结论：由初级保健护士提供的认知行为疗法比单独使用mebeverine提供了长达6个月的额外益处，尽管效果已经减弱了12个月。这种疗法可能对某些肠易激综合征患者在初级保健中有用。
Objective To assess the efficacy of cognitive behaviour therapy delivered in primary care for treating irritable bowel syndrome.Design Randomised controlled trial.Setting 10 general practices in London.Participants 149 patients with moderate or severe irritable bowel syndrome resistant to the antispasmodic mebeverine.Interventions Cognitive behaviour therapy delivered by trained primary care nurses plus 270 mg mebeverine taken thrice daily compared with mebeverine treatment alone.Main outcome measures Primary measures were patients' scores on the irritable bowel syndrome symptom severity scale. Secondary measures were scores on the work and social adjustment scale and the hospital anxiety and depression scale.Results Of 334 referred patients, 72 were randomised to mebeverine plus cognitive behaviour therapy and 77 to mebeverine alone. Cognitive behaviour therapy had considerable initial benefit on symptom severity compared with mebeverine alone, with a mean reduction in score of 68 points (95% confidence interval 103 to 33), with the benefit persisting at three months and six months after therapy (mean reductions 71 points (109 to 32) and 11 points (20 to 3)) but not later. Cognitive behaviour therapy also showed significant benefit on the work and social adjustment scale that was still present 12 months after therapy (mean reduction 2.8 points (5.2 to 0.4)), but had an inconsistent effect on the hospital anxiety and depression scale.Conclusion Cognitive behaviour therapy delivered by primary care nurses offered additional benefit over mebeverine alone up to six months, although the effect had waned by 12 months. Such therapy may be useful for certain patients with irritable bowel syndrome in primary care.