PROSPECTIVE ASSESSMENT AND TREATMENT STUDY OF TMD

尽管80%-90%的急性颞颌关节紊乱(TMD)患者 可以预期改进后不会出现长期问题，标准、非 手术治疗，剩下的10%-20%继续经历 长期的困难。不幸的是，几乎没有系统化的 试图分离急性TMD何时将出现的有用预测因素的研究 很可能发展成一种更慢性和代价更高的残疾。第一大调 本拟议项目的目标是评价是否使用 新近发展起来的颞下颌关节研究诊断标准 精神障碍(RDC/TMD)以及DSM-III-R(美国精神病学 关联)Axis I和Axis II诊断源自结构化 访谈形式，可作为预测急性TMD的有用指标 随后出现慢性TMD问题的患者。为了 实现这一目标，1600名急性TMD患者(症状少于6 个月的持续时间)将在一年内进行前瞻性跟踪 以确定是否存在DSM-III-R障碍和某些 急性期RDC-TMD变量可预测糖尿病的发生 慢性病。这些急性TMD患者随后发展为慢性 问题将参与这一拟议项目的第二阶段 它将评估四种治疗方法的相对疗效 这些慢性TMD患者：(1)继续非手术治疗 (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。这四组将根据患者类型进行平衡：一 患者亚组将符合当前主要疾病的诊断标准 在第一阶段进行初步评估时的抑郁；其他 亚组将被诊断为没有抑郁，也没有任何 主修精神变态。据推测，对于那些拥有专业知识的人来说 心理覆盖，如抑郁症，一个治疗计划，包括 专门针对处理这种紊乱的程序(即， 行为-认知疗法)对提高治疗效果是必要的 慢性TMD。对于那些有重大心理和生理问题的人来说 随之而来的是，综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 心理生理障碍，涉及生理和心理两方面 因素，这两个因素的相对贡献取决于 根据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.