躯体形式障碍患者的述情障碍

目的：探讨躯体形式障碍患者的心理健康状况,以及与述情障碍的关系.方法：采用症状自评量表（SCL-90）及多伦多述情障碍量表（TAS）对60例躯体形式障碍患者（患者组）和60名健康自愿者（对照组）进行测评,并对躯体形式障碍患者的心理健康状况与述情障碍作相关分析.结果：患者组SCL-90总分及躯体化、人际关系敏感、抑郁、焦虑、偏执、精神病性6个因子评分均显著高于对照组（P＜0.05或P＜0.01）;其TAS总分及因子Ⅰ、Ⅱ、Ⅳ评分亦均显著高于对照组（P＜0.05或P＜0.01）,而因子Ⅲ评分两组间比较,差别则无统计学意义.躯体形式障碍患者的SCL-90总分与TAS总分及因子Ⅰ、Ⅱ、Ⅳ评分均呈显著性正相关;而与因子Ⅲ评分则无显著性相关.结论：躯体形式障碍患者的心理健康状况较差,并与述情障碍有关.     

躯体形式障碍患者生活质量调查

目的:调查躯体形式障碍患者的生活质量,分析影响生活质量的有关因素.方法:用生活质量综合评定问卷(CQOLI-74)、90项症状清单(SCL-90)对61例躯体形式障碍患者和64名正常者进行自评.结果:患者组GQOLI-74评分普遍显著较低;SCL-90评分普遍显著较高.影响生活质量的因素包括:年龄,性别,文化,职业,SCL-90的抑郁因子及躯体化因子.影响社会功能的因子还包括人际关系及精神病性因子.结论:躯体形式障碍患者的心理健康状态及生活质量明显低于正常人,改善抑郁状态和躯体化症状能提高躯体形式障碍患者的生活质量.     

躯体形式障碍患者心理防御方式调查

本研究通过对躯体形式障碍患者进行防御方式问卷和症状自评量表测评,探讨其心理防御方式特点,报告如下.     

躯体形式障碍患者的临床特征分析

<正>为了进一步认识躯体形式障碍,本研究对3例综合医院躯体形式障碍患者的临床资料进行分析,报告如下。1对象和方法为2005年至2012年期间经综合医院多科诊治2~5年后无效而就诊于我院心理科门诊患者3例,其中女2例,男1例;病程3~6年;经系统检查未发现任何器质性病变;符合ICD-10和CCMD-3的躯体形式障碍诊断标准;均给予药物辅     

躯体形式障碍的治疗

对躯体形式障碍的治疗作一综述.     

躯体化障碍和未分化躯体形式障碍患者辅助检查项目和费用调查

目的 了解躯体化障碍和未分化躯体形式障碍患者辅助检查项目和费用及其相关因素.方法 对115例躯体化障碍或未分化躯体形式障碍的患者,采用自编既往就诊检查情况调查表、自编躯体症状自评清单、症状自评量表、汉密尔顿焦虑量表和汉密尔顿抑郁量表进行评估.结果 患者就诊前辅助检查总费用为 72～10 948 元(中位数 1 068 元);检查频度为 1 ～ 53 次(中位数9.0次);检查项目数为 1～13 项(中位数6.0项).重复检查频度为 0～44 次(中位数 3 次),重复项目数为 0 ～ 9 项(中位数 2 项).检查频度及重复频度较高的项目为血常规、B超、CT、尿常规、摄片、生化常规、MRI、心电图、粪常规.检查频度与病程、就诊科室数及HAMD总分均呈正相关(P＜0.05),检查总费用与检查频度呈正相关(P＜0.01). 结论躯体化障碍和未分化躯体形式障碍患者辅助检查种类多,重复检查多,应引起重视.     

躯体形式障碍与癔症性躯体障碍患者临床特征的对照研究

目的　探讨躯体形式障碍与癔症性躯体障碍患者临床特征的差异。方法　采用焦虑、抑郁症状自评量表 (SAS、SDS)以及自编临床特征调查表分别对 2 8例躯体形式障碍患者和 32例癔症性躯体障碍患者进行调查分析。结果　两组患者在起病形式、诱因、病程特点、精神病阳性家庭史、性别、主诉症状以及用药选择等方面均存在明显差异 (P <0 0 5 )。结论　躯体形式障碍与癔症性躯体障碍患者临床差异明显 ,这些差异有助于两者的鉴别。     

躯体变形障碍合并边缘型人格障碍的访谈与治疗

咨客,女性,25岁,经常感觉眼睛变小,反复为此纠结。个人情绪不稳定、易激动,在人际关系方面存在问题。在本次咨询中患者被诊断为躯体变形障碍合并边缘型人格障碍,建议采用生物-心理-社会的综合干预模式治疗。鼓励咨客规律运动,服用选择性5-羟色胺再摄取抑制剂(SSRIs)和第二代抗精神病药物联合治疗;采用辩证行为治疗(DBT)调整咨客认知、稳定情绪、改善人际技能;工作上建议选择人际压力小的工作环境,如影像学类临床辅助科室。     

躯体形式障碍患者就医行为研究

目的 探讨躯体形式障碍(SFD)患者就医行为及其影响因素.方法 采用自编的就医行为与躯体症状报告单对115例SFD患者进行评定.结果 完成研究的109例SFD中,首诊于综合性医院者73例(67％),私人诊所者10例(9％),药店购药者4例(4％),求助于巫医者2例(2％),精神病专科医院者19例(17％);曾经到非精神专科诊疗的98例患者中,仅有24例患者得到明确诊断.相关分析显示,非专科诊疗次数与患者年龄、对精神疾病相关信息了解程度、前后非专科诊疗的经济花费、运动系统、心血管系统、呼吸系统、感觉系统功能障碍及症状清单总分呈正相关(r =0.21 ～0.35,P＜0.05或0.01).患者对精神疾病相关信息了解程度、症状清单总分、经济花费、年龄依次进入非专科治疗次数的回归方程(P＜0.05).结论 SFD患者首诊于精神专科的比率较低,非精神专科对疾病的检出率较低.对精神疾病相关信息了解少、躯体化症状严重等可能为SFD患者就诊于非专科的重要影响因素.     

社会支持对躯体形式障碍患者疗效的影响

目的探讨社会支持对躯体形式障碍患者疗效的影响。方法采用自制的一般情况调查表、汉密尔顿抑郁量表（HAMD，17项）及社会支持评定量表对46例躯体形式障碍患者（研究组）以及正常志愿者（对照组）进行测查，用SSRIs类抗抑郁剂与非典型抗精神病药对患者进行治疗，三个月后再次用HAMD进行评定，分析社会支持对疗效的影响。结果研究组社会支持利用度显著低于对照组（P〈0．01），社会支持好的躯体形式障碍患者其HAMD减分率显著高于社会支持差的患者（P〈0．05）。结论躯体形式障碍患者社会支持利用度低，而社会支持程度影响疗效，在药物治疗的同时要加强心理治疗，提高患者的社会支持利用度。     

Study of stress and vulnerability in patients with somatoform and dissociative disorders in a psychiatric clinic in North India

The authors compared perceived stress in subgroups of patients defined by vulnerability (high and low) and disorder (somatoform and dissociative). A total of 30 patients each of somatoform and dissociative disorders diagnosed according to the classification of mental and behavioral disorders criteria were assessed with Presumptive Stressful Life Event Scale, The Hassles Scale, Psychoticism Extraversion Neuroticism Inventory, Dissociative Experience Scale, Twenty-Item Toronto Alexithyma Scale, and Illness Behavior Questionnaire. Somatoform and dissociative disorder groups had comparable scores on measures of perceived stress and vulnerability. Two-way anova showed significant main effect of neuroticism (F = 13.65, d.f. = 1.56, P < 0.01), psychoticism (F = 7.92, d.f. = 1.56, P < 0.01), illness behavior (F = 5.82, d.f. = 1.56, P < 0.05), and dissociative experience (F = 8.45, d.f. = 1.56, P < 0.01) on total hassles score, but no significant main effect of disorder groups or interaction effect for disorder and vulnerability was seen on total hassles score. No significant main or interaction effect was seen on life events score. Similarities were seen in stress and vulnerability factors in the two disorders. Neuroticism, psychoticism, dissociative experience, and abnormal illness behavior were significantly related to stress (daily hassles) perceived by the patient, irrespective of the disorder.     

Comorbid personality disorders and their impact on severe dissociative experiences in Mexican patients with borderline personality disorder

Abstract

Objective: To identify personality disorders comorbid with borderline personality disorder (BPD) that may confer greater risk for the presence of severe dissociative experiences.

Method: Three hundred and one outpatients with a primary diagnosis of BPD were evaluated using the Structured Clinical Interview for DSM-IV Axis II personality disorders, the Borderline Evaluation of Severity Over Time (BEST) and the Dissociative Experiences Scale (DES).

Results: The most frequent personality disorders comorbid to BPD were paranoid (83.2%, n?=?263) and depressive (81.3%, n?=?257). The mean BEST and DES total score were 43.3 (SD?=?11.4, range 15–69) and 28.6 (SD?=?19.8, range 0–98), respectively. We categorized the sample into patients with and without severe dissociative experiences (41% were positive). A logistic regression model revealed that Schizotypal, Obsessive-compulsive and Antisocial personality disorders conferred greater risk for the presence of severe dissociative experiences.

Discussion: Our results suggest that a large proportion of patients with BPD present a high rate of severe dissociative experiences and that some clinical factors such as personality comorbidity confer greater risk for severe dissociation, which is related to greater dysfunction and suffering, as well as a worse progression of the BPD.     

Facial emotion recognition and alexithymia in adults with somatoform disorders

The primary aim of this study was to investigate facial emotion recognition (FER) in patients with somatoform disorders (SFD). Also of interest was the extent to which concurrent alexithymia contributed to any changes in emotion recognition accuracy. Twenty patients with SFD and 20 healthy, age, sex and education matched, controls were assessed with the Facially Expressed Emotion Labelling Test of FER and the 26-item Toronto Alexithymia Scale. Patients with SFD exhibited elevated alexithymia symptoms relative to healthy controls. Patients with SFD also recognized significantly fewer emotional expressions than did the healthy controls. However, the group difference in emotion recognition accuracy became nonsignificant once the influence of alexithymia was controlled for statistics. This suggests that the deficit in FER observed in the patients with SFD was most likely a consequence of concurrent alexithymia. It should be noted that neither depression nor anxiety was significantly related to emotion recognition accuracy, suggesting that these variables did not contribute the emotion recognition deficit. Impaired FER observed in the patients with SFD could plausibly have a negative influence on these individuals' social functioning.     

艾司西酞普兰对躯体形式障碍患者认知功能的影响

目的:探讨艾司西酞普兰对躯体形式障碍患者认知功能的影响。方法:60例躯体形式障碍患者(病例组)接受艾司西酞普兰治疗6周;治疗前后分别行瑞文标准推理测验、成人韦氏智力测验中数字广度及数字符号测验、以及事件相关电位P300检测;结果与60名健康者(对照组)比较。结果:病例组治疗前瑞文、数字广度及符号测验评分(84.78±13.85、11.22±1.61、10.95±2.45)明显低于对照组(96.52±18.18,12.63±2.66,12.83±1.49;P均0.01),P300 N1潜伏期[(101.96±9.38)ms]明显长于对照组[(90.17±7.99)ms](P0.001);治疗后瑞文及数字广度评分(91.25±14.87,11.98±1.89)明显增加,P300 P2及N2潜伏期[(194.64±65.31)ms,(240.60±41.41)ms]明显延长(P0.05或P0.01)。结论:艾司西酞普兰可改善躯体形式障碍患者的认知功能。     

Yoga-based intervention in patients with somatoform disorders: an open label trial

Abstract

Somatoform disorders are common mental disorders associated with impaired functioning and increased utilization of health resources. Yoga-based interventions have been used successfully for anxiety, depression, and chronic pain conditions. However, literature on the use of yoga in treatment of somatoform disorders is minimal. The current study assessed the effect of a specific yoga-based intervention in patients with somatoform disorders. Consenting patients meeting ICD-10 criteria for somatoform disorders were offered a specific yoga module (1?h per day) as a treatment. Assessments including Visual Analogue Scale (VAS), Brief Pain Inventory (BPI), and others were carried out at baseline and after 2, 6, and 12 weeks. Sixty-four subjects were included in the study and 34 completed 12 weeks follow-up. Significant improvement was noted in pain severity from baseline to 12 weeks after regular yoga sessions. The mean VAS score dropped from 7.24 to 2.88. Worst and average pain score in the last 24?h on BPI dropped from 7.71 to 3.26 and from 6.12 to 2.0,7 respectively. Results of the study suggest that yoga-based intervention can be one of the non-pharmacological treatment options in somatoform disorders. These preliminary findings need replication in larger controlled studies.     

Facial emotion recognition and alexithymia in adults with somatoform disorders

Objective: The primary aim of this study was to investigate facial emotion recognition in patients with somatoform disorders (SFD). Also of interest was the extent to which concurrent alexithymia contributed to any changes in emotion recognition accuracy. Methods: Twenty patients with SFD and twenty healthy, age, sex and education matched, controls were assessed with the Facially Expressed Emotion Labelling Test of facial emotion recognition and the 26‐item Toronto Alexithymia Scale (TAS‐26). Results: Patients with SFD exhibited elevated alexithymia symptoms relative to healthy controls. Patients with SFD also recognized significantly fewer emotional expressions than did the healthy controls. However, the group difference in emotion recognition accuracy became nonsignificant once the influence of alexithymia was controlled for statistically. Conclusions: This suggests that the deficit in facial emotion recognition observed in the patients with SFD was most likely a consequence of concurrent alexithymia. Impaired facial emotion recognition observed in the patients with SFD could plausibly have a negative influence on these individuals' social functioning. Depression and Anxiety, 2009. © 2008 Wiley‐Liss, Inc.     

抗抑郁药合并阿立哌唑治疗躯体形式障碍临床分析

目的：探讨抗抑郁药联合小剂量阿立哌唑对躯体形式障碍的疗效。方法：将40例服用西酞普兰联合小剂量阿立哌唑患者（合用组）与38例单服西酞普兰患者（单用组），从药物的起效时间、症状改善时间，治疗后症状自评量表（SCL-90）评分、不良反应，服药依顺性及症状复燃，以及功能失调性态度问卷（DAS）进行评定。结果：合用组在治疗起效与症状改善时间上均较单用组快；治疗后SCL-90某些因子两组差异有显著性，合用组依顺性好，复燃者少，DAS评分明显较低。结论：抗抑郁药联合小剂量的阿立哌唑治疗躯体形式障碍疗效较好。     

度洛西汀联合奥氮平治疗躯体形式障碍患者的临床分析

目的:探讨度洛西汀联合小剂量奥氮平治疗躯体形式障碍患者的疗效和安全性。方法:120例躯体形式障碍患者随机分为研究组即度洛西汀联合小剂量奥氮平组和对照组即单用度洛西汀组,各60例疗程6周。治疗前后以汉密尔顿焦虑量表(HAMA)、密尔顿抑郁量表(HAMD)的疑病条目、阿森斯失眠量表(AIS),临床疗效总评量表(CGI)进行疗效评估,以治疗时出现的症状量表(TESS)评估用药的安全性。结果:治疗第2周,研究组HAMA和CGI-GI评分显著低于对照组(P均0.01)。治疗第6周,两组显效率基本接近,对照组的疑病观念的残留率高于研究组(P0.05)。两组第2、4、6周的HAMA评分均显著低于治疗前(P0.01)。第1周及第6周,对照组的治疗脱落率显著高于研究组(P均0.05)。治疗第1周末,对照组的恶心呕吐以及失眠的发生率显著高于研究组(P0.05)。结论:度洛西汀联合小剂量奥氮平治疗躯体形式障碍较单用度洛西汀,具有疗效好、起效快、恶心呕吐不良反应少,脱落率低的优点。     

Relationship between perfectionism,personality disorders and agoraphobia in patients with panic disorder

OBJECTIVE: In earlier reports, we found that perfectionism might be involved in the development and/or maintenance of agoraphobia in panic disorder. The present report extends this work by examining the relationship between perfectionism and comorbidity with personality disorders in panic disorder patients with agoraphobia (PDA) and those without agoraphobia (PD). METHOD: We examined comorbidity of personality disorders by Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and assessed perfectionism using multidimensional perfectionism scale in 56 PDA and 42 PD patients. RESULTS: The PDA group met criteria for at least one personality disorder significantly more often than the PD group. With stepwise regression analyses, avoidant and obsessive-compulsive personality disorders emerged as significant indicators of perfectionism in patients with panic disorder. CONCLUSION: These findings suggest that perfectionism in panic disorder patients may be more common in those with comorbid personality disorders, and may be an important target for preventive and therapeutic efforts.