Research on the indication of cognitive behavioral therapy and graded exercise in chronic fatigue syndrome

我们将大坂大学医院血液肿瘤科疲劳门诊就诊的患者分为四组，根据大坂大学医院精神科的SCID进行精神病学访谈。这四组包括一组无精神疾病（组I），一组随后精神疾病（组II），一组可以同时诊断为精神疾病的慢性疲劳综合征（CFS）首次发作时，和一组符合排除标准（排除组）。本研究主要包括I组患者。患者接受10次（45分钟/2周）的认知行为治疗（CBT）。分别于治疗前后进行评定、PDQ-R、SSAS、CISS、Holmes & Rahe’s量表、Jikakusho-Shirabe、JIBT、SDS、MOS-SF 36。CBT的内容包括认知扭曲的修正，这可能会延长疲劳（过度适应， ...更多信息 避免体力活动，对躯体症状的困扰等）通过访谈和活动图表，适当的计划和执行工作和休息，以及逐渐增加活动。虽然CBT对CFS患者的治疗效果较好，但在每个病例中的效果是不同的，这表明统一的评估可能无法检测CBT对CFS的有效性。在将CBT应用于日本CFS患者时，有几个要点。首先，我们强调医生，精神病学家和CBT心理学家合作的必要性。第二，作为第一次干预，行为技术似乎比认知技术更适合。第三，需要客观的方法来评估治疗效果。目前，我们发表了几篇关于日本CFS的精神病学筛查访谈和CBT概述的文章。我们现在正在准备一篇关于CFS预后的文章，表明第III组患者的医生治疗预后较差。少

We classified the patients who attended the Fatigue Clinic of the Department of Hematology and Oncology, Osaka University Hospital into four groups by a psychiatric interview based on SCID in the Department of Psychiatry, Osaka University Hospital. These four groups consisted of a group without psychiatric disorders (Group I), a group with subsequent psychiatric disorders (Group II), a group which could be simultaneously diagnosed as psychiatric disorders at the first onset of chronic fatigue syndrome (CFS), and a group which fulfilled the exclusion criteria (Exclusion Group). We mainly included patients in Group I in the present research. The patients received 10 sessions (45 minutes per 2week) of cognitive behavioral therapy (CBT). The assessment, PDQ-R, SSAS, CISS and Holmes & Rahe's Scale, Jikakusho-Shirabe, JIBT, SDS, MOS-SF36 were measured before and after the therapy. The contents of CBT comprised modification of cognitive distortions which could prolong fatigue (overadaptation, … More avoidance of physical activity, obsession on the somatic symptoms, etc.) by interviews and activity charts, appropriate planning and execution of work and rest, and gradual increase of activity. Although the therapy indicated preferable effects in the patients, the effects were different in each cases and it was suggested that uniformed evaluation could fail to detect the effectiveness of CBT for CFS. In applying CBT to Japanese patients with CFS, there were several important points. First, we emphasize necessity for cooperation of physician, psychiatrist and CBT psychologist. Second, as a first intervention, behavioral technique seemed more suitable than cognitive technique. Third, objective methods to evaluate therapeutic effects were required. At present, we published several articles on the psychiatric screening interview and overview of CBT for CFS in Japan. We are now preparing an article on the prognosis of CFS which indicates that patients in Group III showed poorer prognosis of medical treatment by physician. Less