TREATMENT OF SOMATIZATION IN PRIMARY CARE

描述（申请人摘要）：躯体化患者--那些表现为 有多个医学上无法解释的身体不适的医生-构成 这是基层健康护理系统的一个重要而棘手的问题。患者 这种综合征广泛使用卫生保健资源，但很少收到 效益此外，这些患者经历了严重的痛苦， 残疾。迄今为止，没有任何医疗或精神干预措施， 在对照试验中证明， 这些患者的症状持续缓解或功能状态改善。 我们在此提出了一个认知行为的随机对照试验（N=240）， 治疗（CBT）与医疗护理一样，为初级保健患者高 医学上无法解释的躯体症状水平（符合DSM-IV的患者 躯体形式障碍的标准以及 Escobar的“简化躯体化”）。干预将发生在小学 护理场所作为躯体化者往往不愿意使用精神病服务， 甚至承认自己有精神问题在提出这项研究时，我们 几项CBT非对照试验的积极结果令人鼓舞， 躯体化，包括我们自己的手动干预的试点测试。 拟议工作的第二个目的是检查CBT的有效性 拉丁裔样本的协议，因为高水平的无法解释的物理 症状在拉丁美洲人的许多亚群中相当突出。此外，拉丁美洲人 是美国增长最快的少数民族，并预计将 到2050年占美国总人口的24.5%，从10.5% 目前（人口普查局，1996年）。尽管相对较高， 据我们所知，在这一组中， 对照试验的有效性治疗躯体化的 拉丁裔社区。

DESCRIPTION (Applicant's Abstract): Somatizing patients -- those presenting to physicians with multiple medically unexplained physical complaints - constitute an important and vexing problem for the primary health care system. Patients with this syndrome use health care resources extensively but receive little benefit. In addition, these patients experience significant distress and disability. To date, no medical or psychiatric intervention has been demonstrated in controlled trials, to produce clinically significant and lasting symptom relief or improved functional status in these patients. We propose herein a randomized controlled trial (N=240) of cognitive behavior therapy (CBT) versus medical care-as-usual for primary care patients with high levels of medically unexplained somatic symptoms (patients who meet DSM-IV criteria for a Somatoform Disorder as well as 'minimum symptom thresholds for Escobar's "abridged somatization"). The intervention will take place at primary care sites as somatizers are often reluctant to use psychiatric services or even admit to psychiatric problems. In proposing this research, we are encouraged by the positive results of several uncontrolled trials of CBT for somatization, including a pilot test of our own manualized intervention. A secondary aim of the proposed work is to examine the effectiveness of the CBT protocol for a Latino sample, because high levels of unexplained physical symptoms are quite prominent in many subgroups of Latinos. Moreover, Latinos are the fastest growing minority population in the U.S., and are projected to account for 24.5% of the total U.S. population by the year 2050, from 10.5% currently (Bureau of the Census, 1996). In spite of the relatively high prevalence of somatization in this group, to our knowledge, there are no controlled trials of the effectiveness of treatments for somatization in the Latino community.