PROSPECTIVE ASSESSMENT AND TREATMENT STUDY OF TMD

TMD 的前瞻性评估和治疗研究

• 批准号: 2430123
• 负责人: ROBERT Joseph GATCHEL
• 金额: $ 18.6万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 1994
• 资助国家: 美国
• 起止时间: 1994-06-01 至 1999-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2430123
• 关键词: alternative medicine; autogenic training; behavioral /social science research tag; chronic disease /disorder; cognitive behavior therapy; depression; diagnosis quality /standard; human subject; human therapy evaluation; longitudinal human study; medical complication; prognosis; temporomandibular joint syndrome

Although 80-90 percent of acute temporomandibular disorder (TMD) patients can be expected to improve with no long-term problems after standard, non- surgical treatment, the remaining 10-20 percent go on to experience chronic difficulties. Unfortunately, there has been very little systematic research attempting to isolate useful predictors of when acute TMD will likely develop into a more chronic and costly disability. The first major goal of the present proposed project is to evaluate whether use of the recently developed Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), along with DSM-III-R (American Psychiatric Association) Axis I and Axis II diagnoses derived from a structured interview format, will serve as useful predictors for those acute TMD patients who subsequently develop chronic TMD problems. In order to accomplish this goal, 1600 acute TMD patients (symptoms less than six months duration) will be prospectively followed over a one-year period in order to determine whether the presence of DSM-III-R disorders and certain RDC\TMD variables in the acute stage are predictive of the development of chronicity. Those acute TMD patients who subsequently develop chronic problems will participate in the second phase of this proposed project which will evaluate the relative efficacy of four techniques in treating these chronic TMD patients: (1) continuation of non-surgical treatment alone; (2) relaxation-biofeedback treatment; (3) behavioral-cognitive treatment; (4) combined relaxation-biofeedback and behavioral-cognitive treatment. These four groups will be balanced for type of patient: one subgroup of patients will have met diagnostic criteria for current major depression at the time of initial assessment during Phase 1; the other subgroup will have been diagnosed as not depressed and not having any major psychopathology. It is hypothesized that for those who have a major psychological overlay such as depression, a treatment program including procedures specifically directed at dealing with this disorder (i.e., behavioral-cognitive therapy) is necessary for therapeutic improvement of chronic TMD. For those who have significant psychological and physical concomitants, a combined treatment procedure will be most efficacious. Such results will further demonstrate that chronic TMD is a complex psychophysiological disorder involving both physical and psychological factors, with the relative contribution of these two factors depending upon premorbid characteristics of the particular individual.

尽管 80-90% 的急性颞下颌关节紊乱病 (TMD) 患者 在标准、非标准之后，预计会得到改善，不会出现长期问题 手术治疗，剩下的10-20%继续经历 慢性困难。不幸的是，系统性的研究还很少 试图找出急性 TMD 何时发生的有用预测因素的研究 可能会发展成更慢性且代价更高的残疾。 第一专业 目前拟议项目的目标是评估是否使用 最近制定的颞下颌关节研究诊断标准 疾病 (RDC/TMD) 以及 DSM-III-R（美国精神病学 关联）轴 I 和轴 II 诊断源自结构化 访谈形式，将作为那些急性 TMD 的有用预测因素 随后出现慢性 TMD 问题的患者。为了 为了实现这一目标，1600名急性TMD患者（症状少于6 几个月的持续时间）将前瞻性地跟踪一年的时间 以确定是否存在 DSM-III-R 疾病和某些 急性期的 RDC\TMD 变量可预测疾病的发展 慢性性。那些随后发展为慢性TMD的急性TMD患者 问题将参与该拟议项目的第二阶段 这将评估四种技术治疗的相对功效 这些慢性TMD患者：（1）继续非手术治疗 独自的; (2)放松-生物反馈治疗； (3)行为认知 治疗; (4)结合放松-生物反馈和行为-认知 治疗。这四组将根据患者类型进行平衡：一组 患者亚组将符合当前主要疾病的诊断标准 第一阶段初始评估时的抑郁症；另一个 亚组将被诊断为不抑郁并且没有任何症状 主要精神病理学。 据推测，对于那些拥有专业学位的人来说 心理叠加，例如抑郁症，治疗方案包括 专门针对处理这种疾病的程序（即 行为认知疗法）对于改善治疗效果是必要的 慢性TMD。对于那些有重大心理和身体负担的人 同时，联合治疗程序将是最有效的。 这些结果将进一步证明慢性TMD是一种复杂的疾病 涉及身体和心理的心理生理障碍 因素，这两个因素的相对贡献取决于 根据特定个体的病前特征。