躯体化障碍与童年期的创伤

目的：探讨童年创伤与躯体化障碍形成的关系。方法：对象为一躯体化障碍女性患者，通过治疗性晤谈，收集其病史、阻抗、移植和反移植等材料，使用内省的、通情的和精神分析的 方法进行分析。结果：患者童年期有严重的创伤经历，其特征是丧母及长期的过度劳累性身体虐待，相应的表现有严重的压抑、分离、惊恐发作和生理应激反应。成年后突出的病征是躯体化障碍和惊恐发作，其发生和加重与分离和劳累联系在一起。这些情境类似于童年期的创伤情境，症状表现也类似过去的，提示其躯体化障碍是过去创伤性反应的再次唤起。结论：躯体化障碍可能起源于童年期不可逃避的持续性身体虐待所导致的生理应激反应。症状的形成机制涉及情绪的压抑、躯体反应的分离、继发性获益以及受虐性的客体关系内化，而后者导致对创伤主动的追寻倾向。     

躯体化障碍现实疗法的回访调查

目的评价现实疗法应用于躯体化障碍的远期疗效。方法将300例患者按随机原则分为两组,研究组(中西医病区)147例和对照组(心理病区)153例,研究组实施现实疗法,对照组进行传统护理。病人出院后电话回访治疗效果,采用生活质量综合评定问卷(GQOLI-74)、家庭功能评定量表(FAD)进行评分。结果两组疗效比较具有显著性差异(χ2=12.503,P0.05),研究组GQOLI-74(除外物质生活维度)、FAD明显优于对照组(P0.05)。结论现实疗法远期疗效显著,较传统护理更有利提高患者的生活质量。     

综合医院躯体形式障碍临床特点的初步研究

目的：了解综合医院门诊病人中符合ＩＣＤ－１０躯体形式障碍的比率及其临床症状特点。方法：采用躯体形式障碍筛选表和躯体形式障碍评定表检查内科和神经科门诊病人。结果：共筛查了３３４６位综合医院的门诊病人,ＩＣＤ－１０躯体形式障碍的估计比率为１８２％。躯体形式障碍各亚型之间重叠较多。１３５例患者在过去一年平均就医１３１次;经过治疗６０％的自感无变化或恶化。躯体化障碍患者的症状中以“对医生的诊断和治疗不信任”最为突出。结论：躯体形式障碍在综合医院内科、神经科门诊有较高的比率。其就医次数较多而治疗效果较差。ＩＣＤ－１０躯体形式障碍各亚型的诊断标准缺乏特异性     

躯体化障碍患者抑郁症状的对照研究

目的:了解躯体化障碍患者伴发抑郁症状的临床特征.方法:选取44例符合CCMD-3躯体化障碍诊断标准的患者(研究组)和 92例不伴躯体症状的抑郁症患者(对照组),分别用HAMD、SDS、SCL-90进行评定.结果:研究组HAMD认知障碍因子分及SCL-90人际关系、恐怖及偏执因子分低于对照组,临床以躯体性焦虑、胃肠道及疑病等症状为主,自罪、自杀、工作和兴趣减退、激越等症状较轻.结论:躯体化障碍的抑郁症状因躯体症状的掩盖而更易被忽视.     

躯体化障碍症状特征及治疗

目的了解躯体化障碍症状特征及氯米帕明对该病的疗效。方法对74例符合CCMD-3诊断标准的患者,于疗前及治疗第2、4、6周末分别进行SCL-90评定。口服氯米帕明治疗6周,疗效评定以减分率及有效率为评定指标。结果躯体化障碍者SCL-90总分及各项因子分明显高于常模,躯体化、焦虑、抑郁、偏执因子分升高明显,口服氯米帕明6周后总有效率为89．2％,治疗前与治疗后各因子分有显著性差异。结论氯米帕明对躯体化障碍患者躯体症状、焦虑、抑郁情绪有缓解作用。对躯体化障碍有较好疗效。     

不同性别躯体化障碍临床对照分析

目的了解不同性别躯体化障碍的临床特征。方法对我院2001年4月-2004年5月男女躯体化障碍的临床资料进行对照研究。结果女性患者住院次数多,住院前去其他科就诊者多,泌尿、生殖器、性症状及皮肤、软组织症状明显,紧张、焦虑突出;男性患者消极意念或行为者明显。使用抗抑郁剂方面,女性患者用SSRI类相对多见,而男性患者用TCA类较多。结论躯体化障碍男女患者在临床上存在某些差异。     

躯体化障碍的人格特征与应对方式的研究

目的:探讨躯体化障碍的人格特征及其应对方式。方法:56例躯体化障碍患者和56名正常对照者进行艾森克个性问卷(Eysenck's Personality Questionnaire,EPQ)和特质应对方式问卷(Trait Coping Style Questionnaire,TCSQ)测评。结果:①躯体化障碍组的EPQ-E和EPQ-N分、EPQ-L分均明显高于正常对照组(P<0.01),躯体化障碍患者主要表现为外向不稳定的性格特征;②躯体化障碍组的消极应对因子分高于正常对照组,积极应对因子分低于正常对照组(P=0.000);③相关分析结果为,EPQ-N、EPQ-L均与消极应对方式呈正相关(P<0.05)。结论:躯体化障碍患者表现为外向不稳定的人格特征,多采用消极应对方式。     

米氮平与多虑平治疗躯体化障碍的对照研究

目的观察米氮平对躯体化障碍的疗效和副反应。方法将60例躯体化障碍患者随机分成米氮平组和多虑平组,治疗8周,用症状自评量表（SCL-90）,临床疗效大体评定量表（CG I）评定疗效,用副反应量表（TESS）评定副反应。结果治疗8周后,米氮平和多虑平组的疗效相当（2χ=0.869,P〉0.05）,在治疗第2周末米氮平组的SCL-90总分,躯体化、抑郁及焦虑均低于治疗前,且躯体化、抑郁和焦虑同多虑平组同期比较均降低（t=2.876~6.246,P〈0.05或P〈0.01）。结论米氮平治疗躯体化障碍疗效确切,起效快,副反应小,可作为躯体化障碍治疗的首选药物之一。     

躯体变形障碍讨论

躯体变形障碍（BDD）与过去称谓的丑形恐惧（Dysmorphopbobia）是同一种病症．根据DSM－Ⅲ—R和DSM一Ⅳ草案，BDD被作为一种独立的疾病，而废用“丑形恐惧”病名．BDD定义为：身体外表正常，存在对身体想象的先占观念，或存在轻微的躯体缺陷而过分给予关注，并由此产生心理痛苦．1病因和发病机理1．1脑器质性损害神经机制是体象结构的最低水平．在亚急性硬化住全脑炎时出现的妄想性器质性障碍中，可发生巨作变形障碍症状；在重精神病时亦可出现理体变形障碍的相关症状，也不能排除脑器质性损害的存在．1．2人格偏离罹患BDD者往往过…     

小学生躯体化症状及其与述情障碍、心理虐待和忽视的关系

目的:了解小学生躯体化症状及其与述情障碍、心理虐待和忽视的关系。方法:采用儿童躯体化症状量表、多伦多述情障碍量表以及儿童心理虐待和忽视量表对长沙两所小学三至六年级的学生进行调查,收回有效问卷940份。结果:①儿童躯体化症状量表的平均得分为7.40±7.07,27.3%的儿童至少有一个经常出现或程度明显的症状,不同性别和不同年级儿童的躯体化症状检出率有显著差异;②述情障碍总分与躯体化总分的相关系数为0.32(P<0.01);③述情障碍对儿童躯体化症状的直接效应为0.39,心理虐待和忽视对儿童躯体化症状的间接效应分别为0.09和0.13。结论:①儿童躯体化症状的检出率为27.3%,其中疼痛/虚弱症状表现最为常见;②述情障碍与儿童躯体化症状之间存在低至中度相关;③述情障碍在心理虐待和忽视与儿童躯体化症状之间起完全中介作用。     

Histrionic personality disorder in women with somatization disorder

The clinical distinctions between histrionic personality disorder and somatization disorder have frequently been blurred. In this study, 60 women with somatization disorder were found to have histrionic personality disorder. A DSM-III diagnosis of histrionic personality disorder did not significantly help to improve the diagnosis of somatization disorder. A diagnosis of histrionic personality disorder should stimulate a search for better-validated Axis I diagnoses.     

Diagnostic concordance in primary care somatization disorder

A sample of 196 primary care patients with multiple unexplained complaints was used to examine diagnostic concordance between the Feighner criteria, the Research Diagnostic Criteria, DSM-III criteria, and DSM-III-R criteria for somatization disorder. The DSM-III-R diagnostic criteria for somatization disorder maintain a high concordance with the DSM-III criteria for somatization disorder (Kappa = 0.91), a moderate concordance with the Feighner criteria (Kappa = 0.66), but only a fair concordance with the Research Diagnostic Criteria (Kappa = 0.47). These results provide further evidence that DSM-III-R describes a slightly different sample of somatization disorder patients than does the Feighner and Research Diagnostic Criteria.     

Abdominal pain in children and symptoms of somatization disorder

Children seen in a multispecialty medical clinic for abdominalpain were divided into three groups: 21 with confirmed organicfindings related to the abdominal pain, 14 with confirmed organicfindings unrelated to the pain, and 108 whose physical examinationswere negative (the functional pain group). For children withfunctional abdominal pain (but not for the others) the numberof symptoms of somatization disorder (Briquet's syndrome) wassignificantly related to the chronicity of the child's condition.Children with functional pain and no prior complaint had a meanof 1.95 symptoms; those with complaints of less than 1 year'sduration, 2.21 symptoms; those with complaints of more thana year since age 6, 4.04 symptoms; and those with complaintsfor more than a year with onset prior to age 6 years, 4.55 symptomsfrom the Somatization Disorder list. Findings were interpretedas preliminary evidence for a distinct, chronic, polysymptomatichysterical disorder beginning in childhood.     

Psychiatric comorbidity in primary care somatization disorder

Lifetime prevalence rates were calculated for comorbid psychiatric disorders in 119 patients who were referred from primary care physicians for unexplained somatic complaints and who met DSM III-R criteria for somatization disorder. Comparisons were made with general population norms from the ECA study. Prevalence of nine comorbid conditions was significantly higher than in the general populations. The most prevalent comorbid diagnoses were major depression (54.6%), generalized anxiety disorder (33.6%), and phobic disorders (31.1%). The least common comorbid disorders were mania (4.2%) and drug abuse (4.9%); drug abuse prevalence rates did not significantly exceed general population estimates. Risk ratios were highest for panic disorder (16.25), major depression (9.41), schizophrenia (7.77), and obsessive-compulsive disorder (7.04).     

优势强化疗法治疗躯体形式障碍个案报告

优势强化疗法(strengths-centered Therapy,ST)[1]是将积极心理学的品格优势作为核心内容与社会建构主义心理学的理念、策略和框架整合于一体的一种新疗法.本文个案是一例持续性躯体形式疼痛障碍,属于躯体形式障碍的一个亚型,即不能用生理过程或躯体障碍予以合理解释的一种持续、严重的疼痛[2].本文拟结合此个案的治疗,具体展现优势强化疗法的治疗理念与策略,探讨ST在临床心理学中的实践意义.     

Functional upper airway obstruction: a possible somatization disorder

In this syndrome, severe upper airway obstruction with stridor and objective evidence of compromised ventilation occurs in the absence of evidence for any organic etiology. Psychiatric evaluation of four patients with the syndrome supports the hypothesis that the paradoxical adduction of vocal cords during inspiration derives in large part from psychological factors. There was a temporal association of stressful environmental stimuli and initiation of the symptom, and the patients had evidence of serious psychiatric disturbance.     

Evoked response potentials and regional cerebral blood flow in somatization disorder

Somatization disorder (SMD) is a chronic condition characterized by multiple complaints which are not due to any apparent organic illness but frequently involve pain. This study employs computer-aided imaging technologies to examine brain function in thousandths of a second (event-related brain potentials) and over a number of minutes (regional cerebral blood flow). Fourteen patients with SMD and 14 normal controls were investigated. Results from both studies suggest that patients with SMD have a dysfunction in the processes of attention, compared to normal controls.     

Psychiatric consultation in somatization disorder. A randomized controlled study

The per capita expenditure for health care of patients with multiple physical symptoms but no apparent physical disease (somatization disorder) is up to nine times the average per capita amount. We conducted a randomized controlled trial to determine whether psychiatric consultation would reduce the medical costs of these patients, without effecting a substantial change in patient outcome. Thirty-eight patients were randomly assigned to treatment or control groups and studied prospectively for 18 months. Treatment consisted of a psychiatric consultation and suggestions on management given to primary physicians. After nine months, the control group was crossed over to receive treatment with the same intervention. After the psychiatric consultation, the quarterly health care charges in the treatment group declined by 53 percent (P less than 0.05). In contrast, the charges in the control group showed wide variations but no overall change. The quarterly charges in the control group were significantly higher than those in the treatment group (P less than 0.05). After the control group was crossed over to receive treatment, their quarterly charges declined by 49 percent (P less than 0.05). The reductions in expenditures in both groups were due largely to decreases in hospitalization. We conclude that psychiatric consultation in the care of patients with somatization disorder reduced subsequent health care expenditures without inducing changes in health status or patients' satisfaction with their health care.