心身疾病与神经症患者的述情障碍

“述情障碍”(Alexithymia)在国外已有不少报告,国内则较少见。本文观察各种心身疾病86例,神经症121例,以117例正常人为对照,以多伦多述情障碍量表(TAS)评定,结果发现心身疾病及神经症患者的TAS平均总分皆较对照组显著为高。因子分Ⅲ(缺乏幻想)均未见增加,男性神经症组较对照组显著为低。     

Alexithymia and somatization in agenesis of the corpus callosum

Deficient communication between the cerebral hemispheres is one of several prevailing neurobiological explanations for alexithymia and has been strongly supported by research on patients with commissurotomy. We examined self-reported symptoms of alexithymia in adults with agenesis of the corpus callosum (AgCC), a condition characterized by more subtle reductions in interhemispheric transfer than in commissurotomy. Sixteen adults with AgCC and full-scale intelligence quotient >80 were compared with 15 neurotypical controls group-matched for age and intelligence score. The AgCC group endorsed greater difficulty identifying and describing feelings and more vague physical symptoms than controls but similar levels of emotional experience and emotional coping. This finding of impaired emotional interpretation with intact emotional experience is consistent with findings in callosotomy patients, implicating the critical role of the corpus callosum in cognitive dimensions of emotion processing. Further study of alexithymia in AgCC using task-based measures may help clarify the nature of this relationship.     

A prospective DSM-III study of 100 consecutive somatization patients

In this study the authors defined somatization and prospectively studied the prevalence of somatizing patients referred to a psychiatric consultation service. Included are the demographic characteristics and five-axis DSM-III diagnoses of 100 consecutive somatizing patients. A comparison of these patients was made to a control group (N = 161) of nonsomatizing patients also referred for consultation. There were significantly more patients with depression, panic disorder, personality disorders and psychophysiologic illness in the somatization patient sample and significantly more patients with schizophrenia, manic depressive illness, organic brain syndromes, adjustment disorder and serious medical illness in the non-somatization control group. Age, sex, and DSM-III axes IV and V did not significantly differentiate the two groups. The role of somatization as a process as distinguished from a DSM-III somatoform disorder is discsssed, and the importance of somatic symptoms as they relate to an underlying mental disorder is reviewed.     

Mood variability: a study of four groups

OBJECTIVE: The authors' goal was to determine whether self-rated patterns of mood regulation differed among patients with major depression, patients with borderline personality disorder, patients with premenstrual syndrome (PMS), and normal subjects. METHOD: Fourteen days of morning and evening mood self-ratings on a visual analog scale were analyzed for 65 female subjects (10 with major depression, 16 with borderline personality disorder, 15 with PMS, and 24 without psychiatric diagnoses). For each individual, the mean and standard deviation of morning and evening ratings, the mean absolute change in mood from one day to the next, and the change from morning to evening were determined. RESULTS: The four groups differed significantly on every measure of mood and mood variability except diurnal variation. As expected, the group with major depression had the lowest global ratings and a low degree of variability. The group with borderline personality disorder was less depressed than the group with major depression and showed a high degree of mood variability. Autocorrelation analysis suggested that mood ratings in borderline personality disorder vary randomly from one day to the next. The mood variability over the 14 days of the patients with PMS was significantly greater than that of normal subjects. CONCLUSIONS: The visual analog scale can capture patterns of mood and mood variability thought to be typical of these diagnostic groups. Mood disorders differ not only in the degree of abnormal mood but also in the pattern of mood variability, suggesting that mechanisms regulating mood stability may differ from those regulating overall mood state.     

A test of delayed recovery following stressful stimulation in four psychosomatic disorders

Sternbach proposed a three component model to account for the emergence of psychosomatic symptoms. He hypothesized that if an individual exhibited (1) marked response stereotypy, and (2) inadequate homeostatic restraints, then (3) exposure to activating situations would result in psychosomatic episodes. The main purpose of the present study was to examine the second component of the Sternbach model, homeostatic inadequacy, as indicated by impaired rate of recovery from stressful stimulation. In addition, the presence of response stereotypy was investigated in this study.

Ten subjects from each of 5 diagnostic groups (rheumatoid arthritis, essential hypertension, migraine headache, tension headache, and healthy controls) were observed under conditions of unstructured relaxation, easement (exposure to stimuli intended to enhance relaxation), mild stress, and recovery from stress. Forearm and forehead muscle potential, peripheral temperature, electrodermal response, heart rate and systolic and diastolic blood pressure were monitored during these sessions.

Although evidence of symptom specific response stereotypy was regularly observed, slowness of recovery did not emerge as a robust phenomenon in the four psychosomatic disorders investigated. The phenomenon was consistently observed in the arthritic subjects, absent in hypertensives and tension headache subjects, and ambiguous for migraine subjects.     

Alexithymia and psychotherapy.

Alexithymia represents a disturbance in affective and cognitive function which overlaps diagnostic categories. Emotions are not differential, and are poor verbalized. Imagination related to drive fulfillment is limited. These and other problems seriously interfere with the patients' capacity to benefit from dynamic, uncovering or "anxiety-producing" psychotherapy. In order to consider possible remediation of the problem, we must explore the nature and causes of this disturbance.     

Comparison of four diagnostic systems for the diagnosis of somatization disorder

This article compares the Feighner criteria, the DSM-III criteria for somatization disorder and a modified version of the proposed ICD-10 criteria. Working with a data set collected from the charts of 250 patients considered likely to have unexplained somatic symptoms, the kappa statistic and percentage agreement was calculated. The kappa between the DSM-III and DSM-III-R criteria is 0.93. Between the modified ICD-10 and DSM-III it was 0.71, but between Feighner and the modified ICD-10 it was 0.44. However, the different criteria identify the same patient population based on mental co-morbidity and demographics. The authors suggest that the modified version of the proposed ICD-10 should be investigated further, as it can use data sets previously collected for assessments of somatization disorder.     

A prospective follow-up and family study of somatization in men and women

The authors evaluated alternative criteria for somatization disorder in 277 female and 129 male psychiatric outpatients. In women, the diagnosis of somatization disorder based on DSM-III criteria was highly concordant with the diagnosis of Briquet's syndrome based on Guze's original criteria. There was familial aggregation for Briquet's syndrome in women but none among individuals of either sex who had somatization disorder without the full Briquet's syndrome. In men, the diagnosis of somatization disorder was rarer and less stable than in women. The findings show that somatization usually has a different clinical picture and different familial antecedents in men than in women.     

Alexithymia in essential hypertensive and psychiatric outpatients: A comparative study

The purported association between alexithymia and essential hypertension was investigated in a sample of 114 hypertensive patients using the well-validated twenty-item Toronto Alexithymia Scale. Alexithymia was also assessed in a group of 113 general psychiatric outpatients and in a group of 130 normal adults. A rate of 55.3% of alexithymia was found in the hypertensive group compared with significantly lower rates of 32.7% in the psychiatric group and 16.3% in the normal controls. The results support the view that a high prevalence of alexithymia may be found among patients with disorders that were categorized in the past as “classical” psychosomatic diseases. It is hypothesized that a deficit in the cognitive processing and modulation of emotions may leave alexithymic individuals prone to states of heightened sympathetic arousal that are conducive to the development of essential hypertension.     

枣庄市403例老年人心身健康状况调查

目的：了解老年人心身健康状况。方法：采用整群随机抽样的方法对枣庄市４０３例６５岁以上老年人的整体功能（社会适应、躯体健康、卫生状况及心理需求）进行了调查和测试,并运用逐步回归分析法确定了影响老年人身心健康的若干因素。结果：我高老年人群整体经济状况相对较好,家庭稳定,自我保健识别及心理防卫能力总体水平高。但在相当一部分人中存在着不同程度的焦虑、换郁情绪。结论：影响老年人心身健康的主要因素为个人卫生习