ABSTRACT
BACKGROUND: Medically unexplained symptoms are an important mental health problem in primary care and generate a high cost in health services.Cognitive behavioral therapy and psychodynamic therapy have proven effective in these patients. However, there are few studies on the effectiveness of psychosocial interventions by primary health care. The project aims to determine whether a cognitive-behavioral group intervention in patients with medically unexplained symptoms, is more effective than routine clinical practice to improve the quality of life measured by the SF-12 questionary at 12 month. METHODS/DESIGN: This study involves a community based cluster randomized trial in primary healthcare centres in Madrid (Spain). The number of patients required is 242 (121 in each arm), all between 18 and 65 of age with medically unexplained symptoms that had seeked medical attention in primary care at least 10 times during the previous year. The main outcome variable is the quality of life measured by the SF-12 questionnaire on Mental Healthcare. Secondary outcome variables include number of consultations, number of drug (prescriptions) and number of days of sick leave together with other prognosis and descriptive variables. Main effectiveness will be analyzed by comparing the percentage of patients that improve at least 4 points on the SF-12 questionnaire between intervention and control groups at 12 months. All statistical tests will be performed with intention to treat. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in this analysis. DISCUSSION: This study aims to provide more insight to address medically unexplained symptoms, highly prevalent in primary care, from a quantitative methodology. It involves intervention group conducted by previously trained nursing staff to diminish the progression to the chronicity of the symptoms, improve quality of life, and reduce frequency of medical consultations. TRIAL REGISTRATION: The trial was registered with ClinicalTrials.gov, number NCT01484223 [http://ClinicalTrials.gov].
Subject(s)
Cognitive Behavioral Therapy/methods , Primary Health Care/methods , Psychotherapy, Group/methods , Somatoform Disorders/therapy , Adolescent , Adult , Aged , Female , Humans , Logistic Models , Male , Middle Aged , Quality of Life , Referral and Consultation/statistics & numerical data , Sick Leave/statistics & numerical data , Spain , Surveys and Questionnaires , Treatment Outcome , Young AdultABSTRACT
Es un hecho reconocido que los problemas de comportamiento perturbador en la adolescencia y en la juventud, así como las conductas agresivas y delictivas, se ha incrementado notablemente en los últimos años, provocando una gran perocupación social por cómo revertir esta tendencia. Los trastornos del comportamiento perturbador suponen hoy en día uno de los diagnósticos más frecuentes en las unidades de salud mental infanto-juvenil, tanto en España, que supone algo más de la mitad de las consultas clínicas que se realizan, como fuera de nuestras fronteras. Loa programas de escuela de padres suponen el tratamiento de primera elección para los problemas cotidianos del comportamiento, lo que actuaría como prevención primaria de otros trastornos de conducta más graves. El objetivo principal de nuestro estudio experimental fue diseñar y probar la eficacia de un program protolizado y en grupo de escala de padres para el tratamiento de los trastornos del comportamiento perturbador de la infancia y la adolescencia, así como par mejorar lasatisfacción y el clima social dentro del contexto familiar. La muestra del estudio estubo compuesta por 31 familias (31 madres y 25 padres) que fueron derivadas a la Unidad de Salud Mental Infanto-Juvenil de Algeciras por problemas de comportamiento perturbador de sus hijos. Los resultados obtnidos mostraron que el programa EDUCA fue eficaz al producir una mejoría clínica y estadísticamente significativa en las variables: afgresividad (P<0,01), hiperactividad (p<0,05), Cohesión (P<0,02), Moral-Religiosidad (P<0,01), Organización (P<0,003) y Satisfacción familiar (P<0,01)(AU)
It is recognized that disruptive behavior problems in adolescence and youth, as well as aggressive and criminal behavior has increased dramatically in recent years, causing great social perocupación how to reverse this trend. The disruptive behavior disorders represent today one of the most common diagnoses in the units of child and adolescent mental health, in Spain, which involves more than half of clinical consultations taking place, and beyond our borders. Loa parents school programs involve the treatment of choice for the everyday problems of behavior, which act as primary prevention of other serious behavioral disorders. The main objective of our experimental study was to design and test the effectiveness of a program protolizado and scale group of parents in the treatment of disruptive behavior disorders of childhood and adolescence, and even improve lasatisfacción and social climate within the family context. The study sample was composed of 31 families (31 mothers and 25 fathers) who were referred to the Unit of Child and Adolescent Mental Health of Algeciras for disruptive behavior problems of their children. The results showed that the program obtnidos EDUCA was effective in producing a clinically and statistically significant variables: afgresividad (P <0.01), hyperactivity (p <0.05), Cohesion (P <0.02), Moral -religiosity (P <0.01), Organisation (P <0.003) and family satisfaction (P <0.01) (AU)
Subject(s)
Humans , Male , Female , Mental Disorders/psychology , Mental Disorders/therapy , Adolescent Behavior/psychology , Remedial Teaching/methods , Passive-Aggressive Personality Disorder/psychology , Psychology, Social/trendsABSTRACT
El objetivo del presente trabajo es comprobar si un programa protocolizado de tratamiento cognitivo conductual, diseñado específicamente para ser aplicado en formato grupal a pacientes de fibromialgia, puede ayudar a mitigar los problemas emocionales y mejorar el afrontamiento de la enfermedad. En el estudio participaron un total de 34 pacientes diagnosticados de fibromialgia, todos ellos pertenecientes a la Asociación de Fibromialgia de la Comunidad de Madrid (AFIBROM). El programa fue estructurado en 10 sesiones de dos horas de duración con una periodicidad semanal. En la evaluación pre y post-tratamiento, así como en el seguimiento realizado a los 3 meses, los participantes cumplimentaron los cuestionarios: Inventario de Depresión de Beck (BDI), Escala de Ansiedad y Depresión en Hospital (HAD), Escala de Autoeficacia (SES), Escala de Catastrofismo (PCS) y Auto-registro del Dolor. Los resultados mostraron una mejoría clínica y estadísticamente significativa entre el pre y el post-tratamiento, en la variable depresión medida tanto con el BDI como con el HAD-D, así como en la variable ansiedad según el HAD-A. Esta mejoría se mantiene en el seguimiento realizado a los 3 meses de finalizado el tratamiento. Asimismo, al final de la intervención se observa un incremento estadísticamente significativo en todas las medidas de Autoeficacia y una disminución significativa de los pensamientos de Rumiación y Magnificación, mejoría que no se mantiene uniformemente en el seguimiento. Finalmente señalar que aunque tras la intervención se produce una bajada en el dolor medio informado por los pacientes, esta disminución no resulta estadísticamente significativa. Por todo ello puede concluirse que este programa de tratamiento protocolizado y en grupo ha demostrado ser eficaz para mitigar los problemas emocionales asociados a la fibromialgia, disminuir los pensamientos rumiativos y mejorar su percepción de autoeficacia en el afrontamiento de su enfermedad. Finalmente señalar la conveniencia de realizar sesiones de seguimiento-mantenimiento para consolidar los resultados obtenidos (AU)
Fibromyalgia Association of Madrid (AFIBROM). The program was divided into 10 sessions of two hours duration on a weekly basis. The evaluation was pre- and post-treatment with follow-up after 3 months, and participants completed questionnaires: Beck Depression Inventory (BDI), Anxiety and Depression Scale Hospital (HAD) Self Efficacy Scale (SES), Pain Catastrophizing Scale (PCS) and Self-recording of pain. The results showed a clinically and statistically significant improvement between pre- and post-treatment depression with both the BDI and the HAD-D, as well as in the anxiety variable with HAD-A. This improvement was maintained at the follow-up 3 months after treatment ended. Also, at the end of the intervention a statistically significant increase is shown in all measures of self-efficacy and a significant decrease in the thoughts of rumination and magnification, though this is not maintained consistently at follow-up. Finally it is to be noted that even though after the intervention there was a reduction in average pain reported by the patients, this decrease is not statistically significant. Therefore, it can be concluded that this group treatment protocol has proven effective in alleviating the emotional problems associated with fibromyalgia, lowering ruminative thoughts and improving their self-perception in combating their disease. Finally, the desirability of conducting follow-up maintenance sessions to consolidate the results obtained should be noted (AU)
