Comprehensive Intervention With Cognitive Behavioral Therapy, Anti-depressant Medication And Stellate Ganglion Block In Patients With Somatoform Disorders

Objective To evaluate the effectiveness of comprehensive intervention with cognitive behavioral therapy (CBT), antidepressant medication (ADM) and stellate ganglion block (SGB) in patients with somatoform disorders (SFD).MethodsAllocation of study groups:180 patients with SFD randomly allocated into three groups, n=60 each group:Group P (psychological treatment) received only CBT with a missing rate of 31.7%, Group B (biological treatment) received ADM and SGB with a missing rate of 18.4%, and Group C (psychosomatic combined treatment) received comprehensive intervention of CBT, ADM and SGB with a missing rate of 23.3%.Interventions:All patients received treatment for twelve consecutive weeks. CBT was provided once a week, each of 60 min duration, to correct cognitive distortions and improve the accompanying emotional symptoms. Fluoxetine 20 mg/d was commonly used in ADM, in particular, Paroxetine 20mg/d in patients with insomnia symptom. SGB was performed one time a week using paratracheal approach to reconstruct the balance of autonomic nervous tension.Measurements:The improvement of pain and somatic discomfort during treatment was assessed using the Visual Analogue Scale (VAS) once a week. All patients were evaluated using Symptom Checklist (SCL-90), Trait Anxiety Inventory (TAI), Beck Depression Inventory (BDI-13), short form health survey (SF-36) and Toronto Alexithymia Scale (TAS-20) before treatment, after treatment, at 3-month follow up and at 6-month follow up.ResultsPain and somatic discomfort:Pain and somatic discomfort was progressively improved during treatment in all three groups. The VAS scores of improvement of pain and somatic discomfort were higher in Group B and Group C than those in Group P since the end of the second week following treatment (P<0.05). The VAS scores of improvement of pain and somatic discomfort were higher in Group C than those in Group B since the end of the ninth week following treatment (P<0.05).Illness severity:In comparison with pretherapy, there was a significant decrease of SCL-90 factor scores of somatization, depression and anxiety, TAI score and BDI-13 score after treatment, at 3-month follow up and at 6-month follow up in all three groups (P<0.05); In comparison with Group P, SCL-90 factor scores of somatization scores and depression, and TAI score after treatment, at 3-month follow up and at 6-month follow up, and BDI-13 score after treatment and at 3-month follow up were lower in Group B and Group C (P<0.05); SCL-90 factor score of anxiety after treatment and at 3-month follow up, and BDI-13 score at 6-month follow up were lower in Group C (P<0.05). In comparison with Group B, SCL-90 factor scores of somatization and depression after treatment, at 3-month follow up and at 6-month follow up, TAI score after treatment and at 6-month follow up and BDI-13 score after treatment were lower (P<0.05).Health-related quality of life:In comparison with pretherapy, there was a significant increase of SF-36 factor scores of physical component summary (PCS) and mental component summary (MCS) after treatment, at 3-month follow up and at 6-month follow up in Group B and Group C (P<0.05), and SF-36 PCS score at 6-month follow up in Group P (P<0.05). In comparison with Group P, SF-36 scores of PCS and MCS after treatment, at 3-month follow up and at 6-month follow up were higher in Group C (P<0.05). In comparison with Group B, SF-36 PCS score at 6-month follow up was higher in Group C (P<0.05).Alexithymia:In comparison with pretherapy, there was a significant decrease of TAS-20 total score and factor scores of difficulty identifying feelings (DIF) and difficulty describing feelings (DDF) at 3-month follow up and at 6-month follow up in Group C (P<0.05), and TAS-20 total score and DIF score at 3-month follow up and at 6-month follow up in Group P (P<0.05). In comparison with Group P, TAS-20 total score and DIF score were lower in Group C (P<0.05).Conclusion Both CBT and ADM with SGB are effective in the treatment of SFD, and the therapeutic effects remain relatively stable at 3-month to 6-month follow up. ADM with SGB has a more rapid onset, while CBT is more helpful to improve alexithymia. The comprehensive intervention of CBT, ADM and SGB is more effective to alleviate illness severity and improve life quality and alexithymia in patients with SFD.