PROSPECTIVE ASSESSMENT AND TREATMENT STUDY OF TMD

虽然80- 90%的急性颞下颌关节紊乱病（TMD）患者 可以预期在标准、非标准、非标准和非标准之后， 手术治疗，剩下的10- 20%继续体验 慢性困难不幸的是，很少有系统的 一项研究试图分离出急性TMD何时会 很可能会发展成一种更慢性、更昂贵的残疾。 第一主 本拟议项目的目标是评估是否使用 最近制定的颞下颌关节炎研究诊断标准 疾病（RDC/TMD），沿着DSM-III-R（美国精神病学 轴I和轴II诊断源自结构化的 访谈格式，将作为有用的预测，为那些急性TMD 随后发展为慢性TMD问题的患者。为了 完成这一目标，1600急性TMD患者（症状小于6 持续时间）将前瞻性随访一年， 为了确定是否存在DSM-III-R疾病和某些 急性期RDC\TMD变量可预测 慢性病那些急性TMD患者随后发展为慢性TMD， 问题将参与该拟议项目的第二阶段 这将评估四种技术在治疗 这些慢性TMD患者：（1）继续非手术治疗 单独治疗;（2）放松-生物反馈治疗;（3）行为-认知治疗 治疗;（4）放松-生物反馈和行为-认知相结合 治疗这四个组将根据患者类型进行平衡： 患者亚组将符合当前主要 第1阶段初始评估时的抑郁症;其他 亚组将被诊断为没有抑郁症， 主要精神病理学 据推测，对于那些谁拥有一个主要的 心理覆盖，如抑郁症，治疗计划，包括 专门针对处理这种病症的程序（即， 行为认知疗法）对于治疗性改善 慢性TMD对于那些有重大心理和身体 伴随的，联合治疗程序将是最有效的。 这些结果将进一步证明慢性TMD是一个复杂的 涉及身体和心理的心理生理障碍 因素，这两个因素的相对贡献取决于 基于特定个体的发病前特征。

Although 80-90 percent of acute temporomandibular disorder (TMD) patients can be expected to improve with no long-term problems after standard, non- surgical treatment, the remaining 10-20 percent go on to experience chronic difficulties. Unfortunately, there has been very little systematic research attempting to isolate useful predictors of when acute TMD will likely develop into a more chronic and costly disability. The first major goal of the present proposed project is to evaluate whether use of the recently developed Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), along with DSM-III-R (American Psychiatric Association) Axis I and Axis II diagnoses derived from a structured interview format, will serve as useful predictors for those acute TMD patients who subsequently develop chronic TMD problems. In order to accomplish this goal, 1600 acute TMD patients (symptoms less than six months duration) will be prospectively followed over a one-year period in order to determine whether the presence of DSM-III-R disorders and certain RDC\TMD variables in the acute stage are predictive of the development of chronicity. Those acute TMD patients who subsequently develop chronic problems will participate in the second phase of this proposed project which will evaluate the relative efficacy of four techniques in treating these chronic TMD patients: (1) continuation of non-surgical treatment alone; (2) relaxation-biofeedback treatment; (3) behavioral-cognitive treatment; (4) combined relaxation-biofeedback and behavioral-cognitive treatment. These four groups will be balanced for type of patient: one subgroup of patients will have met diagnostic criteria for current major depression at the time of initial assessment during Phase 1; the other subgroup will have been diagnosed as not depressed and not having any major psychopathology. It is hypothesized that for those who have a major psychological overlay such as depression, a treatment program including procedures specifically directed at dealing with this disorder (i.e., behavioral-cognitive therapy) is necessary for therapeutic improvement of chronic TMD. For those who have significant psychological and physical concomitants, a combined treatment procedure will be most efficacious. Such results will further demonstrate that chronic TMD is a complex psychophysiological disorder involving both physical and psychological factors, with the relative contribution of these two factors depending upon premorbid characteristics of the particular individual.