躯体症状自评量表的编制与试测研究

目的 编制“躯体症状自评量表（SSS）”筛查躯体形式障碍并量化地判断其严重度。方法 103例躯体形式障碍符合中国精神疾病分类方案与诊断标准（CCMD-3）有关躯体形式障碍诊断标准。选择的患者平均年龄39岁,平均病程2.8年。同期在本院职工中选择年龄、性别、教育程度匹配、躯体健康的对照组103例。躯体症状自评量表（SSS）的项目来源：“躯体形式症状筛查量表（SOMS）”的所有项目、WHO编制的“神经精神病学临床评估草案（SCAN）”的部分项目、认知和睡眠的项目分解以及基于文化背景差异的项目添加,SSS共有95项,每个项目分为5个级别,≥3为阳性。结果 项目的敏感性：躯体形式障碍组与正常对照组比较没有显著差异的项目共15项,其中12项来自SOMS项目;给出了SSS所有项目的发生频度;“全身乏力或易疲劳、头晕或眩晕、心慌或心悸、健忘、入睡很困难、头痛、后背痛、颈肩痛、口干或咽喉干燥、视力模糊”组成SSS简式,以19/20分为划界分,识别躯体形式障碍的敏感性88%,特异性82%。结论 SSS分别由10项、80项和95项组成3种版本,可以分别用于临床初步筛查、严重度判断和国际比较。     

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.     

躯体形式障碍患者的症状特点及性别差异

目的:探讨躯体形式障碍(SD)患者的症状特点及性别之间的差异。方法:采用躯体形式症状筛查量表(SOMS-7)中文版对326例SD患者进行调查和分析。结果:①SOMS-7测评均分最高的5种症状女性患者为:全身乏力或易疲劳、心慌或心里砰砰直跳、头痛、胸闷或心脏周围不适、气短(用力时除外);男性患者为:全身乏力或易疲劳、心慌或心里砰砰直跳、气短(用力时除外)、胸闷或心脏周围不适、呼吸困难或过度换气;②在腹痛或胃痛(t=2.218)、背痛(t=2.164)、关节痛(t=2.399)、经常便秘(t=4.077)、色斑或肤色改变(t=3.650)、性冷淡(t=3.678)条目上,女性患者得分高于男性(P0.05或P0.01);③出现频率最高的5种症状女性患者为:全身乏力或易疲劳、头痛、心慌或心里砰砰直跳、胸闷或心脏周围不适、气短(用力时除外);男性患者为:全身乏力或易疲劳、心慌或心里砰砰直跳、气短(用力时除外)、胸闷或心脏周围不适、口干;④在性交时痛(χ2=6.443)、经常便秘(χ2=7.383)、色斑或肤色改变(χ2=12.262)、性冷淡(χ2=15.832)、味觉或嗅觉丧失(χ2=3.942)条目上,女性患者的症状出现频率较男性为高(P0.05或P0.01);在小便时痛(χ2=5.58)、频繁大便或腹泻(χ2=3.954)、有尿却排不出(χ2=7.094)、肢体僵硬或强直(χ2=8.093)条目上,男性患者的症状出现频率较女性为高(P0.05或P0.01)。结论:SD患者"全身乏力或易疲劳"出现次数最多,程度最重;女性患者更常出现性、胃肠道抑制、外表、外部感觉等问题;男性患者更常出现泌尿道、胃肠道活跃、肌肉紧张等问题。     

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.     

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.     

躯体形式障碍与躯体症状障碍患者临床特征比较

目的探索三甲综合医院门诊躯体形式障碍(somatoform disorder,SFD)和躯体症状障碍(somatic symptom disorder,SSD)患者临床特征的差异。方法采用方便取样法纳入消化内科、神经内科、中医科、精神科门诊候诊患者,完成患者健康问卷躯体症状群量表(Patient Health Questionnaire-15,PHQ-15),患者健康问卷抑郁量表(Patient Health Questionnare-9,PHQ-9),广泛性焦虑障碍量表(General Anxiey Disorder Scale,GAD-7),躯体症状障碍诊断B标准量表(Somatic Symptom Disorder-B Criteria Scale,SSD-12),世界卫生组织残疾评定方案2.0(WHO Disability Assessment Schedule 2.0,WHO DAS 2.0)等自评问卷,并经结构化访谈得出SSD和SFD诊断,采用独立样本t检验分析并比较SSD和SFD患者的临床特征及差异。结果699例受访者中,236例(33.8%)和431例(61.7%)分别被诊断为SSD和SFD,二者诊断一致性较低(Cohenκ=0.291 P<0.01)。SSD患者在PHQ-15[(12.01±5.54)分比(10.38±5.53)分,t=3.624]、PHQ-9[(11.84±6.76)分比(9.40±6.57)分,t=4.546]、GAD-7[(9.70±6.08)分比(7.34±5.92)分,t=4.871]、SSD-12[(23.60±11.43)分比(16.52±12.64)分,t=7.154]和WHO DAS 2.0[(22.65±8.52)分比(19.96±7.77)分,t=4.128]量表得分显著高于SFD患者,均P<0.01。结论SSD和SFD诊断一致性较低;相对于SFD患者,SSD患者在躯体症状负荷、焦虑抑郁情绪、与症状相关情绪、思维和行为问题、社会功能损害更严重。     

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.     

躯体形式障碍患者的人格障碍倾向调查

目的:探讨躯体形式障碍(SD)患者的人格障碍倾向。方法:对64例SD患者(SD组)和52名正常对照者(NC组)进行人格诊断问卷(PDQ-4)评估和比较。结果:SD组中,人格障碍筛查阳性为37例(57.81%),介于阳性与阴性间10例(15.6%);以C组人格障碍类型中的强迫型最常见。NC组中,人格障碍筛查阳性4例(7.7%),介于阳性与阴性间4例(7.7%)。SD组人格障碍筛查阳性率显著高于NC组(χ2=31.54,P0.001)。结论:SD患者人格障碍筛查阳性率较高,提示人格特质异常可能与SD的发病机制密切相关。     

The relationship between chronic fatigue and somatization syndrome: a general population survey

OBJECTIVE: The objective of this study was to assess the prevalence of chronic fatigue (CF) and its association with somatization syndrome [Somatization Syndrome Index (SSI) 4/6: >/=4 somatoform symptoms in men, 6 in women] in the general population. METHODS: A representative sample of the German population (N=2412) completed a fatigue questionnaire and a screening instrument for current somatoform symptoms (Screening for Somatoform Symptoms 7). RESULTS: The prevalence rate of CF was 6.1% (n=147). Females were affected significantly more often as compared with males (7% vs. 5.1%). The mean number of somatoform symptoms was higher in CF cases than in control subjects without CF (11 vs. 2; P<.001). Seventy-two percent of the subjects with CF fulfilled the SSI4/6 criterion for somatization syndrome. Quality of life (EUROHIS-QOL and 8-item Short-Form Health Survey) and well-being (5-item WHO Well-Being Index) were markedly decreased in CF and SSI4/6. The results of regression analyses suggest that fatigue and somatization severity had a similar impact on quality of life. CONCLUSIONS: The results suggest that CF is relevant in the general population. Its substantial overlap with somatization syndrome supports the hypothesis that the two syndromes are only partially different manifestations of the same underlying processes.     

躯体形式障碍患者述情障碍的相关因素分析

目的 探讨躯体形式障碍（SD）患者述情障碍的影响因素.方法 采用自编的躯体症状报告单、贝克抑郁问卷（BDI）、认知情绪调节问卷（CERQ-C）、多伦多述情量表（TASk0）、儿童期受虐经历问卷（CTQ-SF）对115例SD患者（研究组）进行评定,使用TASk0量表对101名健康志愿者（对照组）进行评定.结果 纳入研究的109例研究组患者TAS-20总分及各因子分均高于对照组（P＜0.01）.躯体症状报告单、CERQ-C、CTQ-SF及BDI多个因素中与TAS-20总分及TAS-20因子Ⅰ、Ⅱ、Ⅲ有相关性（P＜0.05,P＜0.01）.躯体症状报告单总分、躯体忽视、呼吸系统症状和睡眠障碍依次进入TAS-20总分的回归方程;BDI总分、泌尿生殖系统症状、积极重新关注依次进入TAS-20因子Ⅰ的回归方程;躯体症状报告单总分与情感虐待依次进入TAS-20因子Ⅱ的回归方程.结论 SD有明显的述情障碍.SD述情障碍的不同纬度影响因素不同,躯体化症状、抑郁情绪等为SD患者述情障碍的重要影响因素.     

精神疾病住院患者幻觉属性分析

目的：了解幻觉属性的相互关系。方法：应用幻觉量表对83例精神疾病患者进行评定，并进行18项属性的相互的相关分析。结果；18个属性中的大多数属性之间都存在着统计学意义的相关性。结论：幻觉大多数属性相关性好，效应属性项目可能是幻觉的主要特征。     

复发性抑郁障碍发病与季节气象要素变化的关联分析

目的了解抑郁障碍的复发与季节气象要素变化的相关性,为复发性抑郁障碍的防治提供参考。方法收集2013年-2017年深圳市某精神病专科医院复发性抑郁障碍住院患者病历资料和同期气象资料,对复发性抑郁障碍月入院量与同期各气象要素进行相关分析,采用多元线性回归模型进一步分析季节气象因素对抑郁障碍复发的影响。结果复发性抑郁障碍月入院量最多的三个月份分别为5月[85例(10. 39%)]、7月[78例(9. 54%)]和8月[77例(9. 41%)];入院量最多的季节为秋季[226例(27. 6%)],其次为夏季[212例(25. 9%)]。不同性别的复发性抑郁障碍月入院量差异无统计学意义(χ~2=9. 947,P0. 05)。复发性抑郁障碍患者月入院量与月平均降水量、月平均相对湿度呈正相关(r=0. 292、0. 370,P0. 05),与月平均风速呈负相关(r=-0. 475,P0. 05)。多元线性回归分析表明,月均风速越慢、月均湿度越高,复发性抑郁障碍入院量越高(P0. 05)。结论复发性抑郁障碍发病具有季节性,气象要素变化与复发性抑郁障碍发病存在关联,尤其是湿度与风速变化。     

Factor analysis of the catatonia rating scale and catatonic symptom distribution across four diagnostic groups

Catatonia is a frequent psychomotor syndrome, which has received increasing recognition over the last decade. The assessment of the catatonic syndrome requires systematic rating scales that cover the complex spectrum of catatonic motor signs and behaviors. The Catatonia Rating Scale (CRS) is such an instrument, which has been validated and which has undergone extensive reliability testing. In the present study, to further validate the CRS, the items composing this scale were submitted to principal components factor extraction followed by a varimax rotation. An analysis of variance (ANOVA) was performed to assess group differences on the extracted factors in patients with schizophrenia, pure mania, mixed mania, and major depression (N=165). Four factors were extracted, which accounted for 71.5% of the variance. The factors corresponded to the clinical syndromes of (1) catatonic excitement, (2) abnormal involuntary movements/mannerisms, (3) disturbance of volition/catalepsy, and (4) catatonic inhibition. The ANOVA revealed that each of the groups showed a distinctive catatonic symptom pattern and that the overlap between diagnostic groups was minimal. We conclude that this four-factor symptom structure of catatonia challenges the current conceptualization, which proposes only two symptom subtypes.     

Association of costs with somatic symptom severity in patients with medically unexplained symptoms

Objective

To analyse the association of direct and indirect costs in patients with medically unexplained symptoms (MUS) with somatic symptom severity (SSS).

Methods

A cross-sectional cost analysis for retrospective 6 months was conducted in 294 primary care patients with MUS. Health care utilisation and loss of productivity were measured by questionnaires. SSS was measured using the “Patient Health Questionnaire 15” (PHQ-15). Direct and indirect costs and the association of costs with SSS were analysed via multiple linear regression analysis.

Results

Patients with MUS had average 6-month direct costs of 1098 EUR and indirect costs of 7645 EUR. For direct costs, outpatient physician visits were the most expensive single cost category (36%), followed by pharmaceuticals (25%) and hospital stays (19%). Indirect costs were predominantly caused by productivity reduction at work (56%) followed by early retirement (29%) and acute sickness absence (14%). As compared to mild SSS, moderate SSS was not significantly associated with direct, but with indirect costs (+ 2948 EUR; p < .001); severe SSS was associated with increased direct cost (+ 658 EUR; p = .001) and increased indirect costs (+ 4630 EUR; p < .001). Age was positively associated with direct cost (+ 15 EUR for each additional year; p = .015) as well as indirect cost (+ 104 EUR for each additional year; p < .001).

Conclusions

MUS are associated with relevant direct and even much higher indirect costs that strongly depend on SSS.     

Hippocampus and amygdalar volumes in patients with somatization disorder

In regard to somatization disorder which covers an important section of our patient population, there is no systematic structural magnetic resonance imaging (MRI) study in the literature. Therefore, we aimed to use structural MRI to evaluate the hippocampus amygdalar complex which is associated with both stress and regulation of emotion that are main basis clinical presentation of somatization disorder in the patients with somatization disorder. Totally 40 subjects (20 patients with somatization disorder and 20 healthy controls) were enrolled. Intracranial volume (ICV), whole brain volume, gray and white matter volumes, and hippocampus and amygdalar volumes of the subjects were measured. In regard to unadjusted mean volumes of measured structures, the patients had significantly smaller mean volumes of the left and right amygdala. However, two groups did not differ significantly in terms of whole brain, total gray and white matter or hippocampus volumes. The repeated measures ANCOVA predicting left and right amygdala volumes demonstrated a significant main effect of diagnostic group. In conclusion, the findings of the present study revealed that the patients with somatization disorder had significantly smaller mean volumes of the left and right amygdala without any differences in regard to whole brain, total gray and white matter or hippocampus volumes. On the basis of the current findings, it seems reasonable to evaluate that abnormalities in connectivity and/or metabolism dimensions and to examine the effects of drugs or psychotherapeutic approaches could be especially informative.     

急性脑梗死患者脑血管异常与CT灌注成像参数的关联性研究

目的：探讨急性脑梗死患者脑血管异常与 CT 灌注成像（CTP）参数的相关性及其对临床预后的影响。方法临床纳入发病6 h 内颈内动脉系统急性脑梗死患者45例,所有患者均接受 CT 平扫、CTP 及 CT 血管造影（CTA）,分析 CTP 各个参数并评估患侧大血管情况。以血管情况分为血管正常组（17例）、血管狭窄组（10例）和血管闭塞组（18例）。另外,发病时、发病14 d 、发病90 d 分别采用美国国立卫生研究院卒中量表（NIHSS）、Barthel 指数（BI）、改良 Rankin 量表（mRS）评估患者的临床神经功能缺损、日常生活能力以及预后功能残疾水平。结果 CTA 检查显示：血管大致正常者17例,大脑中动脉狭窄者6例,大脑中动脉闭塞者8例,颈内动脉狭窄者4 例,颈内动脉闭塞者10例。3组患者在缺血区脑血流（CBF）面积、脑血容量（CBV）面积、梗死区相对 CBF（rCBF）、梗死区相对 CBV（rCBV）、局部灌注达峰时间（TTP）面积方面比较差异有统计学意义（P ＜0．05）;其中血管闭塞组以上参数均差于血管正常组,血管狭窄组仅 CBF 面积高于正常组,血管狭窄组与血管闭塞组比较,CBF 面积、CBV 面积、TTP 面积均较小,差异均有统计学意义（P ＜0．05）。发病时,各组间患者仅 NIHSS 评分差异有统计学意义（P ＜0．05）,血管正常组 NIHSS 评分明显低于血管狭窄组及血管闭塞组（P ＜0．05）。发病后14 d 、90 d ,各组患者 NIHSS 、BI 、mRS 评分差异均有统计学意义（P ＜0．05）,血管正常组各项评分均明显优于血管闭塞组（P ＜0．05）。结论急性脑梗死患者病灶侧血管异常与 CTP 显示的缺血范围存在密切的联系,能够作为患者临床预后的一个客观指标。