Halifax somatic symptom disorder trial: A pilot randomized controlled trial of intensive short-term dynamic psychotherapy in the emergency department.

Autor: Town JM; Department of Psychiatry, Dalhousie University, Halifax, Canada. Electronic address: joel.town@dal.ca., Abbass A; Department of Psychiatry, Dalhousie University, Halifax, Canada., Campbell S; Department of Emergency Medicine, Dalhousie University, Halifax, Canada.
Jazyk: angličtina
Zdroj: Journal of psychosomatic research [J Psychosom Res] 2024 Dec; Vol. 187, pp. 111889. Date of Electronic Publication: 2024 Aug 22.
DOI: 10.1016/j.jpsychores.2024.111889
Abstrakt: Background: Patients commonly present at hospital Emergency Departments (ED) with distress that meet criteria for a Somatic Symptom and Related Disorder (SSRD). Without access to effective treatment, risk of ongoing patient disability and further ED visits is high.
Method: This pilot trial used a randomized parallel group design to test the efficacy of Intensive Short-Term Dynamic Psychotherapy (ISTDP). ED patients who met criteria for SSRD were recruited. The effects of ISTDP plus medical care as usual (MCAU) were judged through comparison against 8 weeks of MCAU plus wait-list symptom monitoring (WL-SM). The primary outcome was somatic symptom at 8 weeks. Patients allocated to WL-SM could cross-over to receive ISTDP and 6-month follow-up data was collected. Baseline measures of patient attachment style and alexithymia were collected to examine vulnerabilities to somatic symptoms.
Clinicaltrials: gov: NCT02076867.
Results: Thirty-seven patients were randomized to 2 groups (ISTDP = 19 and WL-SM = 18). Multi-level modelling showed that change over time on somatic symptoms was significantly greater in the ISTDP group. Between-group differences were large at 8 weeks (Cohen's d = 0.94) and increased by end of treatment (Cohen's d = 1.54). Observed differences in symptoms of depression and illness anxiety were also large, favoring ISTDP, and effects were maintained at follow-up. Patients receiving ISTDP had reduced ED service utilization at 2-year follow-up.
Conclusions: ISTDP appears an efficacious treatment for SSRD and a larger randomized trial is justified.
Competing Interests: Declaration of competing interest We have no conflicts of interest to disclose. This research was supported by the Department of Psychiatry and Nova Scotia Health Authority.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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