Hypochondriasis responds to cognitive behavior therapy or paroxetine

Last Updated: 2007-02-07 15:02:38 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Cognitive behavior therapy and paroxetine are both effective short-term treatments for patients with hypochondriasis, according to findings reported by Dutch researchers.

In a multicenter trial, Dr. Philip Spinhoven, of Leiden University Medical Center, and colleagues randomized 112 patients who met the DSM-IV criteria for hypochondriasis to cognitive behavior therapy, paroxetine or placebo.

The primary outcome was determined using a 4-point Likert scale version of the Whiteley Index, a 14-item self-report questionnaire designed to assess the core features of hypochondriasis.

The patients were evaluated at baseline and at 16 weeks. Those who scored at least one standard deviation below the mean baseline Whiteley Index score were considered responders.

All analyses were conducted on intent-to-treat and completer basis. Thirty patients dropped out early, leaving 82 completers, researchers report in the January issue of the American Journal of Psychiatry.

Pooled analysis indicated that the treatment response of patients who received cognitive behavior therapy (p = 0.001) or paroxetine (p = 0.03) was significantly better than those assigned to placebo.

The responder analysis for the completers revealed that 54% of cognitive behavior therapy patients, 38% of paroxetine patients, and 12% of placebo patients responded.

The responder analysis for the intent-to-treat group showed that 45% of the patients in the cognitive behavior therapy group responded, compared with 30% of those in the paroxetine group and 14% of those in the placebo group. In this analysis only cognitive behavior therapy patients had a significantly better response than the placebo patients (p = 0.004).

"After these treatments, subjects appeared to be less frequently and intensively preoccupied with their fears of having a serious disease and also had less associated depressive, anxious, and psychoneurotic symptoms," Dr. Spinhoven's team reports.

The researchers suggest that further research investigate the durability of these responses to get a better picture of the effectiveness of the treatments, the researchers add.

Am J Psychiatry 2007;164:91-99.