心理干预对紧张型头痛患者心身症状及就医行为的影响

Influence of psychological intervention on the psychosomatic symptoms and treatment-seeking behavior of patients with tension-type headache

目的:探讨心理干预对紧张型头痛住院军人心身症状及就医行为的影响。方法:将2000-07/2003-07解放军第四六四医院诊断为紧张性头痛的109例住院军人随机分为两组,对照组55例给予常规单纯药物治疗,研究组54例与对照组予同样药物治疗外,还有针对性地进行认知行为等心理干预治疗。在治疗前后分别用症状自评量表评定患者的情绪变化程度,并比较两组的平均住院时间。出院1年后随访,比较出院后的就医行为及疾病归因方式。结果:109例均参加了治疗前后症状自评量表评定,1年后随访,研究组脱失12例,对照组脱失9例。①治疗后研究组在躯体化(1.39±0.56)人际敏感(1.37±0.39)、抑郁(1.36±0.42)、焦虑(1.23±0.36)、恐怖(1.43±0.29)、偏执(1.31±0.65)、精神病性(1.14±0.54)及其他因子分(1.21±0.30)均低于对照组(P<0.05),只有强迫及敌对两项因子分两组比较,差异无显著性意义(P<0.05)。②研究组42例平均住院时间为(21.54±4.31)d,对照组为(32.67±5.72)d,前者明显低于后者(P<0.01)。③1年后随访发现,研究组42例因头痛而经常服药的人、因头痛而门诊就诊的5人次、因头痛而再次住院的3人次、对头痛进行躯体归因的9人,而对照组46例上述指标分别为14人、14人次11人次、21人(P<0.05);在对头痛的心理归因人数上,研究组为2人,

AIM:To investigate the effect of psychological intervention on the psychosomatic symptoms and the treatment seeking behavior of hospitalized soldiers with tension type headache(TTH). METHODS:Totally 109 soldiers, who were diagnosed to have TTH and hospitalized in the 464 Hospital of Chinese PLA between July 2000 and July 2003,were randomly divided into control group(n=55) and study group(n=54).All the patients received regular simple drug treatment,besides,appropriate psychological interventions of cognition and behavior were given to those in the study group.The emotional changing degrees of the patients were assessed with symptom checklist 90(SCL 90)before and after treatment respectively,and the average stay of hospitalization was compared between the two groups.The patients were followed up for one year after discharge,their treatment seeking behavior and attributable methods of disease after discharge were compared. RESULTS:All the 109 cases participated in the evaluation of SCL 90 before and after treatment,and there were 12 cases and 9 cases missed after the one year follow up in the study group and control group respectively.①After treatment,patients in the study group had lower scores of somatization(1.39±0.56),interpersonal sensitivity(1.37±0.39),depression(1.36±0.42),anxiety(1.23±0.36),phobic anxiety(1.43±0.29),paranoid ideation(1.31±0.65),psychoticism(1.14±0.54) and additional items(1.21±0.30) than those in the control group(P< 0.05),and there were no significant differences in the scores of obsession compulsion and hostility between the two groups(P >0.05).②The average stay of hospitalization of the 42 cases in the study group[(21.54±4.31) days] was obviously shorter than that in the control group[(32.67±5.72) days](P< 0.01).③The follow up after one year showed that there were significant differences in the numbers of case,who often took medicine,who were treated in the outpatient clinic,who were rehospitalized because of headache,and who had somatic attribution to headache,between the study group(5,5,3,9) and control group(14,14,11,21)(P< 0.05).The number of cases,who had psychological attribution to headache in the study group(23) was significantly different from that in the control group(11)(P< 0.01). CONCLUSION:Psychological interventions can improve the emotions of anxiety and tension,psychosomatic symptoms and decrease the stay of hospitalization in TTH patients.The follow up after one year finds that in the study group,the number of cases for return visit and retreatment is reduced,more patients have psychological attribution to the symptoms of headache,while fewer patients have somatic attribution.