近日，德国LMU大学医院Jochen Gensichen团队研究了全科医生主导的简短叙事暴露干预对重症监护后创伤后应激障碍症状的影响。相关论文于2025年5月7日发表在《英国医学杂志》上。

为了确定一种新型的全科医生（GP）主导的叙述性暴露干预对重症监护后创伤后应激障碍（PTSD）症状的影响，研究组在德国319家全科诊所的初级保健进行了一项多中心、观察者盲、随机对照试验。319名成年人（18-85岁）在患有创伤后应激障碍症状的危重病中幸存下来，从重症监护室出院，并随机接受全科医生的干预（n=160）或改善的常规护理（n=159）。

干预组参与者与一名全科医生进行了三次叙述性接触咨询，并与一名护士进行了八次预约接触。对照组参与者根据德国创伤后应激障碍指南，像往常一样接受了改进的治疗。主要临床结局是在六个月时使用DSM-5创伤后诊断量表（PDS-5，范围0-80，得分越高表示症状越严重）自我报告的创伤后应激障碍症状。最小临床重要差异为6分。次要结局包括6个月和12个月时抑郁、焦虑、患者活动、健康相关生活质量和残疾的变化。

2018年10月21日至2023年1月18日，从重症监护室出院的1283名患者接受了创伤后应激障碍症状筛查。319名研究参与者被随机分配到对照组（n=159）或干预组（n=160）。患者的平均年龄为57.7岁（标准差（SD）12.7），61%的参与者是男性。两组的平均基线PDS-5评分为30.6（SD 13.3）。271名（85%）研究参与者在6个月后完成了随访评估，247名（77%）在12个月后完成了随访评估。干预效果显示，PDS-5评分的平均组间差异在6个月时为4.7分（95%置信区间1.6至7.8）；P=0.003，Cohen的d=0.37），12个月时为5.4分（1.8至9.0）；P=0.003，Cohen的d=0.41）。在次要结局中，干预组的患者在抑郁、健康相关生活质量和残疾方面有更大的改善。

研究结果表明，在重症后出现创伤后应激障碍症状的成年人中，简短的叙述性暴露干预是可行的，并显示出症状的减轻，这小于预定义的最小临床重要差异。随访12个月后发现效果持续。这些发现支持对初级保健干预措施的进一步评估。

附：英文原文

Title: Effects of a general practitioner-led brief narrative exposure intervention on symptoms of post-traumatic stress disorder after intensive care (PICTURE): multicentre, observer blind, randomised controlled trial

Author: Jochen Gensichen, Konrad F R Schmidt, Linda Sanftenberg, Robert P Kosilek, Chris M Friemel, Antina Beutel, Johanna Dohmann, Christoph Heintze, Hallie C Prescott, Ulf-Dietrich Reips, Maggie Schauer, Daniela Lindemann, Christian Brettschneider, Tobias Dreischulte, Bernhard Zwiler, Thomas Elbert

Issue&Volume: 2025/05/07

Abstract:

Objective

To determine the effect of a novel brief general practitioner (GP)-led narrative exposure intervention on post-traumatic stress disorder (PTSD) symptoms after intensive care.

Design

Multicentre, observer blind, randomised controlled trial (PICTURE).

Setting

Primary care in 319 general practices across Germany.

Participants

319 adults (18-85 years) who have survived critical illness with symptoms of PTSD, discharged from intensive care and randomised to receive the intervention (n=160) or improved usual care (n=159) from a general practitioner.

Interventions

Intervention group participants had three narrative exposure consultations with a general practitioner and eight scheduled contacts with a nurse. Control group participants received improved treatment as usual based on the German PTSD guideline.

Main outcome measures

The primary clinical outcome was self-reported PTSD symptoms using the Post-Traumatic Diagnostic Scale for DSM-5 (PDS-5, range 0-80, higher scores indicating more severe symptoms) at six months. The minimal clinically important difference was six points. Secondary outcomes included changes in depression, anxiety, patient activation, health related quality of life and disability at six and 12 months.

Results

Between 21 October 2018 and 18 January 2023, 1283 patients discharged from an intensive care unit were screened for PTSD symptoms. 319 study participants were randomly assigned either to the control group (n=159) or the intervention group (n=160). The mean patient age was 57.7 years (standard deviation (SD) 12.7), and 61% of participants were male. The mean baseline PDS-5 score was 30.6 (SD 13.3) in both groups. 271 (85%) study participants completed follow-up assessment after six months and 247 (77%) after 12 months. The intervention effect showed a mean between-group difference in the PDS-5 score of 4.7 points ((95% confidence interval 1.6 to 7.8); P=0.003, Cohen’s d=0.37)) at six months and 5.4 points ((1.8 to 9.0); P=0.003, Cohen’s d=0.41)) at 12 months. Among secondary outcomes, patients in the intervention group had greater improvements in depression, health related quality of life, and disability.

Conclusions

In adults with symptoms of PTSD after critical illness, a brief narrative exposure intervention was feasible and showed a reduction of symptoms, which was less than the predefined minimal clinically important difference. The effect was found to be sustained at 12 months’ follow-up. These findings support the further evaluation of this intervention in primary care.

DOI: 10.1136/bmj-2024-082092

Source: https://www.bmj.com/content/389/bmj-2024-082092