اثر روان درمانی و آرام سازی بر روند روانی اجتماعی و جسمانی بیماری کرون: نتایج اصلی پژوهش آینده نگر چند مرکزی روان درمانی آلمانی بر روی بیماری کرون

Objective: Few studies have been published on the influence of psychotherapy on the physical and psychosocial course of Crohn's disease (CD). Methods: The present study, a prospective, randomized multicenter investigation conducted with 108 of 488 consecutive CD patients, was designed to investigate the influence of short-term psychodynamic therapy and relaxation in addition to a standardized glucocorticoid therapy on the somatic course of the disease as well as on patient psychosocial status. Based on the same standardized somatic treatment, the psychotherapy and control groups were compared after a 1-year treatment period and a follow-up of another year with regard to somatic course and psychosocial situation. Results: A total of 81 (75%) of 108 randomized patients completed the psychosocial follow-up. The comparison between the therapy groups after 1 year showed no significant differences in the four main target criteria of psychosocial status (depression, anxiety, psychosocial–communicative status and health-related quality of life). The mean Beck's Depression Inventory (BDI) score at admission was 12.3 in the psychotherapy group and 8.7 in the control group. At the 1-year follow-up, the scores for depression have been 7.8 (psychotherapy group) and 7.8 (control group). In the 2-year follow-up, 84 patients were classified into four groups on the basis of somatic course; 23% of the control group and 30% of the psychotherapy group showed episode-free courses, 29% and 17% respectively underwent surgery due to failure of immunosuppressive or medical therapy, and a further subranking showed no significant differences between the two groups (P=.125). At the 1-year follow-up, the scores for depression of patients with an active episode respective remission were 14.6 vs. 5.8. From the patient's point of view, at the end of the 2-year follow-up, the overall subjective evaluation of the effectiveness of psychotherapy was positive. Conclusion: The patients included showed no psychosocial disturbances of clinical relevance. Although a tendency toward fewer surgical interventions, fewer relapses and reduction of depression was noted, the analysis was unable to demonstrate any benefit from psychosocial intervention on hypothesized parameters of psychosocial status and somatic course. Further studies should be performed to identify patient subgroups that may benefit from psychosocial intervention.

Since Crohn's disease (CD) was first described, the role of psychosocial factors has been discussed in respect to both causation and progression of the disease [1], [2], [3], [4], [5], [6], [7] and [8]. However, the numerous studies addressing patient psychopathology or the importance of stressful life events have thus far not come up with any conclusive results [1], [5], [9], [10], [11], [12], [13], [14], [15] and [16]. The individual health status of patients with CD seems to be related more to psychological than to somatic factors [17]. One issue even more open is the effectiveness of psychotherapy on health status in CD, and very few studies have, in this connection, used assessments that include patient physical, psychological and social impairment. Positive effects of psychotherapeutic intervention have been reported in a few uncontrolled and retrospective studies [12], [13] and [14]. Only three controlled studies have been conducted on psychosocial intervention in CD, two of them restricted to a very limited sample and the larger study suffering from severe methodological shortcomings such as a complete lack of reference to the concomitant use of medical treatment [9], [10] and [11]. The present study therefore sought to examine the effectiveness of psychotherapy on the psychosocial and somatic course of CD in a prospective randomized multicenter study. Its aim was to assess the effectiveness of psychotherapy provided in combination with standardized medical treatment over a 2-year observation period. The main findings of the study are reported here, the focus being on the results relating to patient psychosocial status. The results focusing on the somatic course of the disease have been published elsewhere [18].