躯体化障碍与抑郁症的临床特征比较

目的：弄清躯体化障碍是否为一处陷匿形式的抑郁症。方法：按ＤＳＭ－Ⅳ诊断标准收集躯体化障碍５６例（Ａ组）、抑郁症５１例（Ｂ组）,对两级人列均用病史问卷及汉尔顿抑郁量表（ＨＡＭＤ）进行调查评定。结果：Ａ组躯体症状频率显著高于Ｂ组,抑郁症状频率和ＨＡＮＤ总分显著低于Ｂ组,两组在ＨＡＭＤ因子分析,疾病行为与态度、病程演变及发病背景方面存在显著差异。     

躯体化障碍与以躯体症状为主诉的抑郁症个性、躯体主诉、生活质量比较

目的探讨躯体化障碍与以躯体症状为主诉的抑郁症患者个性、躯体主诉、生活质量差异。方法对30例躯体化障碍和30例以躯体症状为主诉的抑郁症患者分别采用自编躯体症状主诉频数表,艾森克人格问卷（EPQ）、汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）、健康状况调查问卷（SF-36）等进行评定,对影响生活质量的某些因素进行多元回归分析。结果两组躯体主诉无显著性差异（P〉0．0．5）;躯体化障碍组E分显著低于抑郁症组,N分显著高于抑郁症组（P〈0．05）;两组HAMD总分无差异（P〉0．05）,躯体化障碍组焦虑／躯体化及认知障碍因子分显著高于抑郁症（P〈0．05）,躯体化障碍的HAMA总分及躯体性焦虑分显著高于抑郁症组（P〈0．05）;躯体化障碍组生理机能、生理职能、躯体疼痛分量表评分均显著低于抑郁症组（P〈0．05）;多元回归分析结果,影响两组患者生活质量的主要因素依次为HAMD总分、HAMA总分、EPQ精神质因子、病程。结论躯体化障碍与以躯体症状为主诉的抑郁症患者在个性、HAMA总分、躯体焦虑因子分、生活质量方面有差异,两者的个性、疾病严重程度、病程为影响生活质量的重要因素。     

综合性医院中抑郁症及其躯体体症状的研究

目的 比较综合性医院中有无躯体化症状抑郁症患者的临床特征。方法 采用半定式检查方法，对连续就诊并且符合ＣＣＭＤ－２－Ｒ和ＩＣＤ－１０抑郁症诊断标准的患者，采用ＨＡＭＤ、ＨＡＭＡ、ＳＣＬ－９０及自制的身体调查表进行评定。结果 躯体化组中ＨＡＭＤ总分及焦虑／躯体际关系、抑郁、焦虑和恐怖因子分均显著高于无躯体化组。结论 综合性医院中抑郁症的躯体化症状，不仅受抑郁症障碍影响，同时与焦虑障碍有关。     

综合性医院中抑郁症及其躯体化症状的研究

比较综合性医院中有无躯体化症状抑郁症患者的临床特征。方法采用半定式检查方法，对连续就诊并且符合ＣＣＭＤ—２—Ｒ和ＩＣＤ—１０抑郁症诊断标准的患者，采用ＨＡＭＤ、ＨＡＭＡ、ＳＣＬ—９０及自制的躯体调查表进行评定。结果躯体化组中ＨＡＭＤ总分以及焦虑／躯体化、阻滞和绝望感因子分，ＨＡＭＡ总分以及精神性焦虑、躯体性焦虑因子分，ＳＣＬ—９０中躯体化、人际关系、抑郁、焦虑和恐怖因子分均显著高于无躯体化组。结论综合性医院中抑郁症的躯体化症状，不仅受抑郁障碍影响，同时与焦虑障碍有关。     

抑郁症患者中的强迫症状

以自制的强迫症状调查表对８０例抑郁症患者进行强迫症状的调查，以ＨＡＭＤ量表及Ｙ－Ｂ量表对抑郁症状及强迫症状进行评分。结果发现，出现强迫症状者有３４例，占４２．５％，其中强迫性回已出现例数最多，无一例出现强迫性穷思竭虑，部分病人的强迫症状出现在疾病早期，抑郁症状的ＨＡＭＤ评分与强迫症状的Ｙ－Ｂ评分之间有显著的综合相关性。强迫症状与抑郁症状常共存，对强迫症状与抑郁症之间关系的研究，有助于对强迫症状精神     

度洛西汀与西酞普兰治疗不同症状抑郁症的对照研究

目的比较度洛西汀与西酞普兰治疗不同症状抑郁症的疗效。方法将126例符合CCMD-3抑郁痘诊断标准的患者,按不同主诉（精神症状或躯体症状）分为两组,每一组再随机分为两组,分别采用度洛西汀和西酞普兰治疗6周,用汉密尔顿抑郁量表（HAMD）评定疗效,用副反应量表（TESS）评定副反应。结果在以精神症状为主的患者中,度洛西汀组与西酞普兰组的有效率分别为84％和75％,两者比较差异无显著性（P〉0．05）,在以躯体症状为主的患者中,度洛西汀组与西酞普兰组的有效率分别为80％和55％,两者比较差异有显著性（P〈0．05）。结论与西酞普兰相比,度洛西汀治疗伴有躯体症状的抑郁症患者疗效更好．     

晚发与早发抑郁症的病例对照研究

为探讨晚发抑郁症的临床特点，对２８例晚发抑郁症和３６例早发抑郁症的临床有关因素进行病例对照研究。结果显示：晚发组家族史少于早发组（Ｘ＾２＝４．５５，Ｐ〈０．０５）；生理事件多于早发组（Ｘ＾２＝４．３４，Ｐ〈０．０５）；身体疾病与早发组相比比差异十分显著（Ｘ＾２＝２２．３７，Ｐ〈０．００１）；ＨＡＭＤ评分明显低于早发组（ｔ＝３．２３，Ｐ〈０．０１）；但焦虑／躯体化因子分高于早发组（ｔ＝２．０８，Ｐ〈     

曲唑酮与阿米替林治疗抑郁症的对照观察

为比较曲唑酮与阿米替林治疗抑郁症的疗效和副反应，将符合ＣＣＭＤ—３抑郁症诊断标准的患随机分为两组，分别给予曲唑酮和阿米替林治疗，并于治疗前及治疗后第１、２、４、６周分别用汉密尔顿抑郁量表（ＨＡＭＤ）、临床疗效总评量表（ＣＧＬ－ＳＩ）及副反应量表（ＴＥＳＳ）评定。结果，曲唑酮组显效率６２．５％，总有效率为８７．５％；阿米替林组分别为５７．２％和８６．７％。ＨＡＭＤ评分两组间疗效无显差（Ｐ＞０．０５）。不良反应：曲唑酮表现为镇静，阿米替林为抗胆碱能症状。结论：曲唑酮是一种疗效与阿米替林相当，而副作用较轻的抗抑郁药。     

舍曲林与氟西汀治疗抑郁症双盲对照研究

采用１０周随机双盲平行对照方法，研究舍曲林与氟西汀对抑郁症的治疗情况，对６３例病人采用ＨＡＭＤ、ＨＡＭＡ和ＳＥＣＬ评定。结果发现，两组药物治疗后ＨＡＭＤ评分均较疗前有明显下降，第１０周减分率舍曲林组为８１．８％，氟丁汀组为７８．１％，两组副反应均较小，组间无显著差异。作者就抑郁症病人的治疗问题提出讨论，认为ＳＳＲＩｓ类药物较好。     

抑郁症临床症状与P_(300)的相关研究

作者用听觉识别法测定１９例抑郁症病人的事件相关电位Ｐ＿（３００），对其与临床症状进行相关分析，并与２８名正常人的Ｐ＿（３００）进行对照研究。结果显示：抑郁症病人的Ｎ＿１、Ｐ＿２、Ｎ＿２、Ｐ＿３的潜伏期较对照组明显延长，观察组与对照组的年龄、Ｎ＿１、Ｐ＿２、Ｎ＿２、Ｐ＿３的潜伏期与波帽的综合取值有显著差异，汉米尔顿抑郁量表（ＨＡＭＤ）总分与Ｐ＿３波幅呈显著负相关，ＨＡＭＤ总分与Ｐ＿３波帽、潜伏期及发病次数无关。研究结果提示Ｐ＿（３００）作为抑郁症病人认知受损指标有一定意义，但不是唯一的指标。     

Liaison psychiatry and HIV infection (I): Avoidance coping responses associated with depressive symptoms accompanying somatic complaints

Abstract We examined the relationship of somatic complaints to coping behaviors and mood states among 50 HIV-positive patients without AIDS. Although no patients fulfilled the DSM-III-R criteria for mood disorders including major depression, scores for depressive symptoms were significantly higher in the HIV-positive patients than in healthy persons. Although depressive symptoms in HIV patients may not be strong enough to warrant a psychiatric diagnosis of mood disorders, these patients may be prone to depressive symptoms. The HIV patients indicated a tendency toward somatic complaints more frequently than their healthy counterparts. The scores for depressive symptoms were significantly and positively correlated with scores for avoidance coping responses. The presence or absence of six complaints (i.e., general fatigue, abdominal distress, chest pain or discomfort, and numbness or chills) could be discriminated based on the score of avoidance coping responses. The results of this study suggest that avoidance coping responses associated with depressive symptoms accompany several somatic complaints in HIV patients without AIDS.     

A nosological study of patients presenting with somatic complaints

The nosological status of patients presenting with multiple somatic complaints with reference to ICD-9 was examined in the present study. In 22% of the cases it was not possible to arrive at a single ICD-9 diagnosis. The majority of these cases had combinations of somatic, anxiety and depressive symptoms. Nine percent of the cases could not be given any psychiatric diagnosis using ICD-9. These cases had very few psychological symptoms and were not identified as psychiatric cases by the present state examination. The various possible factors responsible for this diagnostic uncertainty have been highlighted.     

Somatic manifestations of depressive patients in different psychiatric settings

The diagnostic and prognostic significance of somatic manifestations in various depressive conditions is discussed with special reference to the somatic complaints in masked depression. The experience presented is based on 788 depressive patients studied in three different psychiatric services of a Greek rural district--an inpatient, an outpatient and a mobile unit service. Headache was found to be on top of the symptom checklist in both outpatient and mobile unit population. Musculoskeletal complaints and dizziness had also a high incidence and to a lesser degree gastrointestinal, cardiovascular and genitourinary symptoms. Though the incidence of all other somatic complaints increased with age and was higher in inpatients, headache was a prominent symptom in younger patients, too, and in outpatients, proving to be also an early diagnostic phenomenon for an underlying depression. The mental health mobile unit saw the greatest percentage of neurotic depressives, who also presented the highest incidence of headache (62.63%). The efficacy of that service for tracing such cases and the need for cooperation with the primary health care for better preventive measures are stressed.     

Somatic symptoms in children and adolescents referred for emotional and behavioral disorders

Medically unexplained physical symptoms are frequently endorsed by children and adolescents in both clinical and community samples. The aim of this exploratory study is to examine the prevalence of somatic symptoms in a sample of 162 Italian children and adolescents consecutively referred to a Division of Child Neurology and Psychiatry from emotional and/or behavioral disorders. The role of age, gender, and psychiatric status was considered as a variable. Each patient received a DSM-IV assessment, including a diagnostic structured interview (DICA-R). The sample was divided according to gender (96 males, 66 females), age (70 children younger and 92 adolescents older than 12 years), and psychiatric diagnosis (Anxiety, Depression, Depression/Anxiety, Other). The presence of medically unexplained somatic symptoms was based on the responses to the DICA-R. Somatic complaints were reported in 69.2% of the patients. Headache was the most frequent somatic symptom (50.6%). Younger children showed higher rates of abdominal complaints than adolescents. No gender differences in frequency of somatic complaints were reported. Subjects with anxiety and/or depression reported significantly higher rates of somatic complaints, namely headache, than subjects with other mental disorders. No differences in frequency of somatic symptoms were evident between patients with anxiety, depression, and comorbid anxiety-depression. Our data suggest that an unexplained somatic symptom can be often considered as indicative of a neglected anxiety and/or depressive disorder. A collaboration between primary care physicians, pediatricians, and child psychiatrists may promote early diagnoses and timely treatments and prevent negative social and scholastic consequences.     

Disturbed sleep and somatic complaints

We investigated sleep patterns in 20 patients with multiple vague but persistent somatic complaints, not due to any identifiable medical or neurologic disorder, and in whom psychiatric consultations had failed to identify a psychiatric diagnosis. Afternoon naps were recorded in 20 patients and in 10 controls without medical or psychiatric problems. Three-hour postprandial nap recordings were made of submental electromyogram, electrooculogram, and EEG with drowsiness, stages 1-4 NREM, and REM sleep, sleep latency (minutes), sleep efficiency (percent), and number of arousals with return of alpha activity compared in patients and controls by one-tailed t-test. No stage IV or REM sleep occurred in naps. Patients with multiple somatic complaints had less stage III and stage II sleep, and more wakefulness. Arousals were more frequent in the patient group; sleep latency was shorter but sleep efficiency was reduced in patients with multiple somatic complaints compared with controls. The findings suggest that patients with multiple somatic complaints not otherwise explicable by medical or psychiatric problems may have disturbed sleep, improvement of which may ameliorate somatic complaints. Sleep histories should be elicited in such patients, and sleep recordings may be of value in their evaluation; afternoon naps may be a cost-effective way of screening for remediable sleep disturbances in patients with persistent physical complaints of undeterminable cause.     

Somatoform disorders: Perspectives from Pakistan

Somatoform disorders represent widespread and largely unsolved problems at the border between psychiatry and medicine. Patients with somatoform disorders often present difficult diagnostic and management problems. A series of three community-based epidemiological surveys of rural and urban populations in Pakistan found high prevalence of common mental disorders where the core presentations were somatic complaints. All the three epidemiological surveys used the Bradford Somatic Inventory (BSI), which was developed from symptom reports by psychiatric patients in Pakistan; these enquired about somatic symptoms in the local language, taking into account local cultural idioms of distress. At a conservative estimate, 66% of women and 25% men suffered from anxiety and depressive disorders whereby the complaints predominantly were somatic in nature. People in rural non-Western cultures are not psychologically minded and do not have abstract language or concepts of emotional distress and therefore communicate their emotions somatically. In Pakistan somatoform disorders possess a prominent diagnostic dilemma. The cornerstone of the management is a comprehensive medical, psychiatric and psychosocial evaluation of the patient. Patients with multiple somatic complaints not only present formidable management problems but also often have severe functional impairments that may outweigh those of patients with other so-called severe mental illnesses. Since somatoform disorders are the most common psychiatric disorders to present in non-psychiatric settings, it is important that training about them begin at undergraduate level. It should also be incorporated in the training of a wide variety of non-psychiatric specialists, both medical and non-medical.     

Major depression and somatic symptoms in a mind/body medicine clinic.

This study examined the prevalence of somatic symptoms and psychiatric characteristics of major depression in a Japanese psychosomatic outpatient clinic. A total of 2,215 outpatients referred for mind/body complaints were assessed by DSM-III-R or DSM-IV. Somatic symptoms were rated using the Cornell Medical Index Questionnaire. Ninety-one outpatients (4.1%) were diagnosed with major depression. Prevalence of fatigue (86%), insomnia (79%), nausea/vomiting (50%), and back pain (36%) as well as degrees of psychosocial stress (DSM-III-R axis IV) were higher (all p < 0.05) and scores of global assessment of psychosocial functioning (DSM-III-R/DSM-IV axis V) were lower (p < 0.001) in the major depressive patients compared to the remaining outpatients. Among the major depressive patients, the total number of somatic symptoms was larger (p < 0.05) in patients with 'severe' major depressive episodes than in those with 'mild' depressive episodes. These findings suggest that the level of depression is closely linked to the reporting of somatic symptoms in a psychosomatic medicine population.     

Somatoform disorders: perspectives from Pakistan

Somatoform disorders represent widespread and largely unsolved problems at the border between psychiatry and medicine. Patients with somatoform disorders often present difficult diagnostic and management problems. A series of three community-based epidemiological surveys of rural and urban populations in Pakistan found high prevalence of common mental disorders where the core presentations were somatic complaints. All the three epidemiological surveys used the Bradford Somatic Inventory (BSI), which was developed from symptom reports by psychiatric patients in Pakistan; these enquired about somatic symptoms in the local language, taking into account local cultural idioms of distress. At a conservative estimate, 66% of women and 25% men suffered from anxiety and depressive disorders whereby the complaints predominantly were somatic in nature. People in rural non-Western cultures are not psychologically minded and do not have abstract language or concepts of emotional distress and therefore communicate their emotions somatically. In Pakistan somatoform disorders possess a prominent diagnostic dilemma. The cornerstone of the management is a comprehensive medical, psychiatric and psychosocial evaluation of the patient. Patients with multiple somatic complaints not only present formidable management problems but also often have severe functional impairments that may outweigh those of patients with other so-called severe mental illnesses. Since somatoform disorders are the most common psychiatric disorders to present in non-psychiatric settings, it is important that training about them begin at undergraduate level. It should also be incorporated in the training of a wide variety of non-psychiatric specialists, both medical and non-medical.     

The body remembers: somatic symptoms in traumatized Khmer

Cambodians experienced genocide from 1975 to 1979 and ensuing civil war until 1993. Purpose: Are Khmer with a history of trauma who present to a general medical clinic with unexplained physical symptoms more likely than the general population to harbor psychiatric symptoms? Methods: Subjects were drawn from a Phnom Penh clinic and the surrounding neighborhood. All subjects completed the Stressful Life Events Screening Questionnaire (SLESQ) and the PRIMEMD. Clinic patients with unexplained physical complaints were compared with neighborhood nonpatients. All individuals reporting trauma during the Pol Pot regime were compared to those reporting no such trauma; and those reporting exposure to domestic violence were compared to those without such exposure. Findings: There is an increased incidence of traumatic events, depressive symptoms, general anxiety symptoms, and panic symptoms in the clinical group as compared to the control group. Survivors of genocide-associated trauma reported more somatic complaints and panic symptoms, while survivors of domestic violence had an increased incidence of depressive symptoms, general anxiety symptoms, and panic symptoms. Conclusion: Clinicians should consider the possibility of trauma-related psychological distress in patients who present with undiagnosable physical complaints.