Systematic review of meta-analyses evaluating the efficacy of therapies in somatoform and related disorders
Type de matériel :
8
Somatoform disorders are considered difficult to treat. Rarely taught, they are nevertheless frequent in primary care and responsible for great distress in patients. The objective of this work is to highlight therapies that have proven to be effective in the management of these disorders. Methods: A systematic review of meta-analyses was carried out using the Medline, Cochrane Library, and Embase databases, without date restriction. Meta-analyses focusing primarily on somatoform disorders or medically unexplained symptoms were included, with no age limit. Meta-analyses on organ-specific somatic syndromes (irritable bowel syndrome or fibromyalgia) or function, as well as hypochondriasis, dysmorphic syndrome, or conversion disorders were excluded. All types of therapeutic interventions were included. Results: Of the 412 studies selected, twelve meta-analyses were included. Seven meta-analyses evaluated the effectiveness of psychotherapies, one the effectiveness of pharmacological treatments, one the training of primary care practitioners in improved care, and three concerned different models of consultation in collaboration with a psychiatrist. Psychotherapies showed a significant effect on somatic symptoms, functional impairment, healthcare utilization, and symptoms of anxiety and depression. The various collaborative care models had a significant effect on somatic symptoms, functional impairment, and healthcare utilization. Newer generation antidepressants, selective serotonin inhibitors (SSRIs) alone (fluoxetine, venlafaxine, or escitalopram) or SSRIs plus an antipsychotic (citalopram and paliperidone, or paroxetine and quetiapine), and herbal treatments (St. John’s Wort or a combination of butterbur root, valerian root, passionflower, and lemon balm leaf) had a significant effect on somatic symptoms or symptoms of depression. Conclusions: Despite limited evidence and a small effect size, the results are interesting given the prevalence of these disorders. These therapies must be integrated into patient-centered care based on a biopsychosocial model.
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