TREATMENT OF SOMATIZATION IN PRIMARY CARE

描述(申请者摘要)：对病人进行看护--那些向 医生有多种医学上无法解释的身体不适--构成 对于初级卫生保健系统来说，这是一个重要而令人头疼的问题。病人 对于这种综合症，广泛使用医疗资源，但收效甚微 利益。此外，这些患者还经历了严重的痛苦和 残疾。到目前为止，还没有医学或精神干预 在对照试验中证明，产生具有临床意义的和 这些患者的症状持续缓解或功能状态得到改善。 我们在此提出了一项关于认知行为的随机对照试验(N=240 治疗(CBT)与常规医疗照护对高血压病患者的比较 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最低症状阈值 埃斯科瓦尔的“简明的躯体化”)。干预将在初选阶段进行 作为躯体治疗者的护理场所通常不愿使用精神科服务或 甚至承认自己有精神问题。在提出这项研究时，我们是 对CBT的几项非对照试验的积极结果感到鼓舞 躯体化，包括对我们自己的人工干预进行试点测试。 拟议工作的次要目标是审查CBT的有效性 拉丁裔样本的协议，因为高水平的不明原因的物理 症状在拉丁裔的许多亚群中都相当突出。此外，拉丁裔 是美国增长最快的少数族裔人口，预计 到2050年，占美国总人口的比例从10.5%增加到24.5% 目前(人口普查局，1996年)。尽管相对较高， 据我们所知，在这一群体中，没有 躯体化治疗对精神分裂症患者疗效的对照试验 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.