Hypochondriasis, which affects up t...

Hypochondriasis, which affects up to 5 percent of medical outpatients, is defined as a persistent fear or belief that common has a serious, undiagnosed medical illness. reject for one large-scale clinical trial, not many well-designed studies have investigated the efficacy of treatment. Barsky and Ahern hypothesized that a cognitive behavior therapy (CBT) intervention would be more effective than usual care in alleviating hypochondriacal symptoms.

enthralls were recruited from physician practices and in consequence of a public announcement seeking offers Hypochondriasis was assessed using a hypochondriasis questionnaire and included patients who met the Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM-IV) criteria for hypochondriasis and those with subthreshold scores. Patients were included if they were older than 18 years, ready in English, and had visited a primary care physician in the previous 12 month CBT was provided in six 90-minute sessions, focusing forward cognitive and behavioral amplification of symptoms, health beliefs, illness and sick character behaviors, and mood. The primary result variable was the hypochondriasis questionnaire, while secondary results included health-related anxiety, frequency of hypochondriacal conceptions hypochondriacal somatic symptoms, DSM-IV clinical diagnosis of hypochondriasis, part impairment, and functional status.

Of 187 eligible patients, 102 were randomized to treatment (allocation designated between the sides of the primary care physician), while 85 patients received usual care. Patients in the CBT cluster attended zero to six sessions, with 618 percent of patients attending all six sessions. Participants, most numerous of whom were middle-aged women were followed at six month and 12 month in one or by telephone. With prize to the primary outcome, measures of treatment event and time showed a statistically significant interaction event with improvement in the treatment dispose compared with the control dispose at six- and 12-month follow-up

Similarly, statistically significant interaction imports were noted for hypochondriacal cogitation frequency, health anxiety, somato sensory amplification, and improvements at six and 12 month in all secondary issues except hypochondriacal somatic symptoms. Functional status showed inconsistent improvements and interaction weights at six months but greater efficiency at 12 months for social activities.

The authors infer that a six-session CBT intervention modestly still significantly improves a range of hypochondriacal symptoms, beliefs, and attitudes at six and 12 month It is unclear whether these be the effects are generalizable to all patients with hypochondriasis, because patients greatest in quantity amenable to treatment also may have been more willing to participate--only 30 percent of eligible patients enrolled the trial. Also, it is not known whether the CBT itself is effective, or whether any six-session program would be equally effective. The authors note that hypochondriasis repeatedly is refractory to reatment and, in this contemplation improvement involved better coping courses rather than cure.

CAROLINE WELLBERY, MD

Barsky AJ, Ahern DK Cognitive behavior therapy for hypochondriasis. A randomized controll trial. JAMA March 24/31 2004;291:1464-70

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