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1.
以躯体症状与情感症状为主诉的抑郁症比较   总被引:1,自引:0,他引:1  
目的:比较在综合医院就诊,分别以躯体症状或情感症状为主诉的抑郁症患者的区别.方法:将在内科普通门诊及心理咨询门诊确诊的抑郁症患者87例,采用汉密尔顿抑郁量表(HAMD),汉密尔顿焦虑量表(HAMA)和自编的深度调查问卷,对患者进行测评,分成情感症状组及躯体症状组.结果:两组在年龄、性别、婚姻、职业及HAMD和HAMA评分等无显著差异.两组在文化程度、性格特征、躯体不适出现频度、首诊求医方式、对自身疾病认识,以及对抑郁症诊断的接受程度有显著差异.在有关抑郁症知识、治疗及婚姻、工作影响等方面无显著差异.结论:以躯体症状或情感症状为主诉的抑郁症患者在某些方面有所不同.  相似文献   

2.
周艳  刘峰 《四川精神卫生》2003,16(4):239-239
报告 6 1例抑郁症均以躯体不适为突出症状 ,因误诊而久治无效 ,后经确诊后给予抗抑郁治疗取得了显著疗效。现将临床资料报告于后。1 对象和方法1 1 对象 为 1999年 6月~ 2 0 0 2年 6月首次就诊于我院的抑郁症患者 6 1例 (门诊 33例 ,住院 2 8例 ) ,按中国精神障碍分类与诊断标准第三版再诊断 ,均符合抑郁症的诊断标准 ,且汉密顿抑郁量表评分≥ 2 1分 ,排除其他精神疾病和躯体疾病导致躯体症状的患者。入组病例若首诊虽有躯体不适主诉 ,但躯体化症状≤ 3项者 ,则纳入精神症状组 (35例 ) ,若首诊也以各种躯体化症状为主诉 ,且躯体不适症状…  相似文献   

3.
影响精神分裂症首次门诊诊断的因素   总被引:1,自引:0,他引:1  
目的 调查门诊精神分裂症(包括分裂样精神病)患者首诊时影响确诊的相关因素。方法 对于1999年1月及2002年1月在上海市精神卫生中心门诊首次就诊的患者,进行回顾性调查后,分为三组:确诊组(首诊确诊为分裂症)、延迟诊断组(首诊未确诊为分裂症)和更改诊断组(首诊为分裂症,随访后诊断被更改),分析各组资料的差异。结果 诊断为分裂症的患者中有27.9%的需经一次以上随访才能确诊,6.7%的首诊为分裂症者在随访中被重新诊断。分裂性症状,情感性症状,Schneider一级症状,患者年龄,医师年资在组间存在显著性差异。结论 精神症状,患者年龄,医师经验是影响门诊精神分裂症首诊确诊的主要因素。  相似文献   

4.
抑郁症患者的躯体症状   总被引:4,自引:0,他引:4  
目的:了解抑郁症患者的躯体症状特征。方法:采用自制调查表对符合中国精神障碍分类与诊断标准第3版抑郁发作的119例门诊及住院患者进行调查。根据汉密尔顿抑郁量表(HAMD)评分,将119例患者分为轻度、重度抑郁症两组,比较两组的一般资料及躯体症状。结果:两组的一般资料差异无显著性,而重度抑郁组躯体症状与轻度抑郁组差异显著。结论:抑郁症的躯体症状非常突出,应引起足够重视。  相似文献   

5.
以躯体不适为主要症状的抑郁症误诊分析   总被引:13,自引:1,他引:13  
目的分析综合医院中伴有躯体不适的抑郁症误诊情况,提高早期诊治率.方法将各科以躯体不适就诊经多方治疗无效而转来我院精神科门诊的患者,进行汉密顿抑郁量表(HAMD)评分,分值≥18分,且符合CCMD-2-R抑郁症诊断标准者80例,给予氟西汀治疗8周,进行疗效评定.结果80例患者中,轻、中度抑郁占82.5%,重度抑郁占17.5%.有77.5%的初诊患者的第一主诉是躯体不适和睡眠障碍,而不是抑郁症状.氟西汀治疗8周后,HAMD评分明显下降.结论对综合医院抑郁症患者及时识别、诊断,适当应用抗抑郁剂可有效缓解抑郁症状和躯体症状,减少不必要的检查和治疗,有利于患者的早日康复.  相似文献   

6.
目的探讨难治性抑郁症患者的临床特征及相关影响因素。方法采用自编一般情况量表、汉密顿抑郁量表、汉密顿焦虑量表、社会支持量表、及生活事件量表,对入组的难治性抑郁症和非难治性抑郁症进行调查和评定,并做相关统计分析。结果难治性抑郁症组在伴有其他慢性躯体疾病和慢性起病者的频率显著高于非难治性抑郁症组。两组在发作次数、住院次数、起病形式、绝望感、躯体焦虑方面有显著差异(P〈0.05)。多元逐步回归显示影响难治性抑郁症因素依次为:伴有其他慢性躯体疾病、首次发病年龄、慢性起病形式及躯体焦虑因子。结论发作次数频繁,病中绝望感重、躯体焦虑明显可能是难治性抑郁症的有效预测因子,临床上仅凭患者的症状严重程度不足以区分两组患者。抑郁症伴有其它慢性躯体疾病、首次发作年龄偏小、起病形式缓慢且躯体焦虑症状严重者,可能是导致抑郁症难治性的潜在危险因素。  相似文献   

7.
背景:双相情感障碍是一种高误诊率的精神疾病,常被误诊为抑郁症、精神分裂症、焦虑症、强迫症和人格障碍等精神疾病,导致临床症状不能有效控制,病情呈反复发作趋势,故近年来双相情感障碍的误诊问题越来越引起精神科医生的重视。目的:了解双相情感障碍在门诊的误诊情况,并分析其误诊原因,指导临床医师加强对双相情感障碍的识别,尽量避免或减少其误诊和漏诊。方法:纳入专家门诊确诊为双相情感障碍的患者,了解其在门诊的就诊及误诊和漏诊情况,通过比较误诊组(包含漏诊者)和确诊组的临床资料进一步分析导致误诊和漏诊的可能原因。结果:双相情感障碍在专家门诊就诊患者中占31.5%。符合本研究入组标准的共有177例,其中误诊组136例(76.8%),确诊组41例(23.2%),误诊为抑郁症者最多(70.6%)。误诊组患者首次发作更多的表现为抑郁发作(χ~2=5.206,p=0.023),并且病程中抑郁发作次数更多(Z=-2.268,p=0.023);误诊组起病至首次治疗的时间较短(Z=-2.612,p=0.009)、而起病至确诊时间更长(Z=-3.685,p0.001),总病程更长(Z=-3.274,p=0.001),并且住院治疗的患者更多(χ~2=4.539,p=0.033),住院次数也更多(Z=-2.164,p=0.031);误诊组伴有精神病性症状更多(χ~2=11.74,p=0.001),尤其抑郁发作时(χ~2=7.63,p=0.006),共病的发生率更高(χ~2=5.23,p=0.022);误诊组HCL-32评分更低(t=-2.564,p=0.011)。误诊组诊断为其他特定的双相及相关障碍的患者较确诊组多(11.0%v.4.9%),并且误诊组最近发作情况表现为抑郁发作的患者较多(78.7%v.65.9%)。结论:门诊双相情感障碍患者的误诊率高,常被误诊为抑郁症。误诊组患者首次发作更多的表现为抑郁发作,病程中抑郁发作次数更多,伴有精神病性症状更多,共病的发生率更高,并且患者对自身躁狂或轻躁狂发作情况明显认识不足,导致早期难以明确诊断,确诊所需时间更长,住院比率更高,住院次数更多。临床医生应提高对双相情感障碍的识别,避免或减少双相情感障碍的误诊和漏诊。  相似文献   

8.
目的:探讨门诊抑郁症患者抗抑郁药治疗现状及相关因素分析。方法:全国多中心调查1 503例抑郁症患者一般资料,并指导患者进行相关量表评定;比较抗抑郁药单药治疗组(单药组)和抗抑郁药联合治疗组(联合组)的一般资料,分析抗抑郁药联合治疗的相关因素。结果:1 503例抑郁症患者中,单药组1219例(81.1%),联合组284例(18.9%);最为常见的联合用药组合为文拉法辛和米氮平、艾司西酞普兰和米氮平。Logistic回归分析显示,就诊医院类型(OR=2.73)、是否共病躯体疾病(OR=1.66)、患者健康问卷躯体症状群量表(PHQ-15)得分(OR=0.55)与急性期是否换药(OR=2.09)是抗抑郁药联合治疗的相关因素(P均<0.01)。结论:就诊于综合医院、伴躯体疾病、PHQ-15<6分、急性期更换抗抑郁药是门诊抑郁症患者采用抗抑郁药联合治疗的因素。  相似文献   

9.
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122例符合国际疾病分类第10版抑郁症诊断标准的患者,按不同主诉(精神症状或躯体症状)分为精神症状组60例和躯体症状组62例,每组再随机分为度洛西汀组(30例/30例)和西酞普兰组(30例/32例),分别给予度洛西汀和西酞普兰治疗6周.用汉密尔顿抑郁量表17...  相似文献   

10.
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。  相似文献   

11.
神经症与抑郁症的躯体化症状及经济损失比较   总被引:1,自引:1,他引:0  
目的:比较神经症和抑郁症躯体症状的特点及经济损失。方法:对初次就诊的神经症和抑郁症患者,采用自编躯体症状的特点及经济负担调查问卷,调查躯体症状及经济损失状况。结果:二者躯体症状所占的比例差异无显著性,神经症组的病程显著长于抑郁症组,外院就诊次数也多于后组,从其他科至医学心理科就诊的时间间隔长。抑郁症组汉密尔顿焦虑量表(HAMA)精神焦虑因子分、汉密尔顿抑郁量表(HAMD)总分、体质量、认知障碍、日夜变化、阻滞、绝望感因子分均高于神经症组,焦虑/躯体化因子分低于神经症组。躯体症状组HAMA总分及躯体焦虑因子分、HAMD总分、焦虑/躯体化、体质量、睡眠障碍、绝望感因子分均高于无躯体症状组。神经症组的直接经济损失重于抑郁症组。结论:抑郁症、神经症的抑郁、焦虑、躯体症状的表现有各自特点,躯体症状会加重抑郁和焦虑症状,均造成很大的经济负担。  相似文献   

12.
OBJECTIVE: To assess the prevalence of anxiety and depressive symptoms among patients with somatic diseases in urban China. METHOD: A hospital-based cross-sectional study was carried out in four major cities of China from June to August in 2004. There were 2111 eligible subjects with Stroke, Parkinson's Disease, Epilepsy, Irritable Bowel Syndrome, Functional Dyspepsia, and Menopausal Syndrome, and 317 Post-natal women were recruited from general hospitals. Self-completed hospital anxiety and depression scale (HAD) questionnaire was used for screening anxiety and/or depressive symptoms. Subjects with a HAD score of > = 9 were further assessed with Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD) by certified psychologists or psychiatrists. RESULTS: The prevalence of "screened" depressive and anxiety symptoms using HAD were 11-19% and 11-22% respectively in patients with above somatic diseases and post-natal women. Assessed by HAMA/HAMD scale, the prevalence of "definite" depressive symptoms was 30%-59% in subjects with "screened" depressive symptoms, and 44%-84% in subjects with "screened" anxiety symptoms. About half of the subjects had co-morbidity depressive and anxiety symptoms. Less than one-fourth of these subjects had ever been diagnosed as depressive/anxiety disorders and been treated prior to the investigation. CONCLUSION: There is a high prevalence and low diagnosis and treatment rate of depressive and anxiety symptoms in patients with these somatic diseases in China.  相似文献   

13.
OBJECTIVE: To investigate differences in diagnostic subtypes of bipolar disorder as according to ICD-10 between patients whose first contact with psychiatric health care occurs late in life (over 50 years of age) and patients who have first contact earlier in life (50 years of age or below). METHODS: From 1994 to 2002 all patients who received a diagnosis of a manic episode or bipolar disorder at initial contact with the mental healthcare system, whether outpatient or inpatient, were identified in Denmark's nationwide register. RESULTS: A total of 852 (49.6%) patients, who were over age 50, and 867 patients, who were 50 or below, received a diagnosis of a manic episode or bipolar disorder at the first contact ever. Older inpatients presented with psychotic symptoms (35.4%) significantly less than younger inpatients (42.6%) due specifically to a lower prevalence of manic episodes with psychotic symptoms. Conversely, older inpatients more often presented with severe depressive episodes with psychotic symptoms than younger inpatients (32.0% versus 17.0%). Among outpatients, no significant differences were found between patients older than 50 years and patients 50 years of age or younger. However, a bimodal distribution of age at first outpatient contact was found with an intermode of 65 years and outpatients older than 65 years more often presented with severe depressive episodes with psychosis. CONCLUSIONS: Bipolar patients who are older at first psychiatric hospitalization (>50 years) present less with psychotic manic episodes and more with severe depressive episodes with psychosis than younger patients. The distribution of age at first outpatient contact is bimodal with an intermode of 65 years and outpatients older than 65 years more often present with severe depressive episodes with psychosis.  相似文献   

14.
OBJECTIVE: To explore the relationships between sociodemographic and clinical factors and quality of life (QOL) in a cohort of Chinese schizophrenia outpatients. METHOD: Two hundred subjects with a diagnosis of DSM-IV schizophrenia aged 18-60 years were randomly selected, and their sociodemographic and clinical characteristics including psychotic and depressive symptoms, extrapyramidal symptoms (EPS), and quality of life were assessed. Correlation and multiple regression analyses were used to evaluate the relationships of sociodemographic, clinical data and QOL. RESULTS: Compared to normative data obtained for the general population in Hong Kong, significantly lower scores in physical, psychological, and social QOL domains were found in the patient group. History of suicidal attempts and the presence of positive, negative, depressive, anxiety and EPS symptoms were all significantly correlated with QOL in schizophrenia patients. After controlling for the effects of variables that were significantly correlated with QOL in the correlation analysis, however, only depressive symptoms were still significantly correlated with each QOL domain. Multiple regression analysis showed that depressive symptoms predicted all QOL domains, while positive symptoms predicted overall and physical QOL domains. CONCLUSIONS: Chinese outpatients with schizophrenia had poorer QOL than the general population. In this patient population, QOL was more strongly related to the severity of depressive symptoms and was independent of sociodemographic factors.  相似文献   

15.
Major depression and somatic symptoms in a mind/body medicine clinic.   总被引:7,自引:0,他引:7  
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.  相似文献   

16.
目的:探讨以躯体化症状为主抑郁症患者和以情绪症状为主抑郁症患者述情障碍的差异。方法:50例以躯体化症状为主抑郁症患者(躯体症状组)、50例以情绪症状为主抑郁症患者(情绪症状组)和50名正常健康者(正常对照组)参加研究,采用90项症状自评量表(SCL-90)、汉密尔顿抑郁量表(HAMD)和多伦多述情障碍量表进行评定。结果:躯体症状组SCL-90总分、躯体化、焦虑、人际敏感、恐怖、偏执因子分及HAMD的焦虑/躯体化因子评分均高于情绪症状组(P<0.01或P<0.05),情绪症状组在强迫、抑郁因子评分及HAMD的认知障碍、阻滞、日夜变化、睡眠障碍及绝望因子分高于躯体症状组(P<0.05或P<0.01)。躯体症状组与情绪症状组仅在述情障碍因子II评分差异有统计学意义(P<0.05),而在述情障碍总分及因子分上均高于正常对照组(P<0.05或P<0.001)。结论:以躯体化症状为主和以情绪症状为主抑郁症患者均存在述情障碍,以前者更缺乏识别情绪和躯体感受能力。  相似文献   

17.
Psychological correlates of functional status in chronic fatigue syndrome   总被引:1,自引:0,他引:1  
Background: The present study was designed to test a cognitive model of impairment in chronic fatigue syndrome (CFS) in which disability is a function of severity of fatigue and depressive symptoms, generalized somatic symptom attributions and generalized illness worry. Methods: We compared 45 CFS and 40 multiple sclerosis (MS) outpatients on measures of functional ability, fatigue severity, depressive symptoms, somatic symptom attribution and illness worry. Results: The results confirmed previous findings of lower levels of functional status and greater fatigue among CFS patients compared to a group of patients with MS. Fatigue severity was found to be a significant predictor of physical functioning but not of psychosocial functioning in both groups. In CFS, when level of fatigue was controlled, making more somatic attributions was associated with worse physical functioning, and both illness worry and depressive symptoms were associated with worse psychosocial functioning. Conclusions: Our findings support the role of depression and illness cognitions in disability in CFS sufferers. Different cognitive factors account for physical and psychosocial disability in CFS and MS. The SF-36 may be sensitive to symptom attributions, suggesting caution in its interpretation when used with patients with ill-defined medical conditions.  相似文献   

18.
Patients with somatization disorder (SD) endorse high rates of psychiatric symptoms. However, prior studies have not addressed whether these endorsed symptoms reflect underlying psychiatric illness or whether they represent symptom overendorsement mirroring somatic complaints in patients with SD. Thirty-two female outpatients with SD and 101 with other psychiatric disorders completed a checklist of current and lifetime psychiatric symptoms. These findings were analyzed with respect to the diagnoses given by their treating psychiatrists. Patients with SD displayed significantly more current and lifetime psychiatric symptoms than did patients without either SD or cluster B personality disorder. Patients with SD endorsed a large number of psychotic, manic, depressive, and anxiety symptoms; however, they endorsed few alcohol use disorder symptoms. Psychotic and manic symptoms endorsed by patients with SD did not reflect their clinical diagnoses: only two patients with SD carried an additional clinician diagnosis of either schizophrenia or bipolar disorder, despite high rates of endorsed symptoms by the group. Patients with cluster B personality disorders but without SD showed a symptom profile similar to that of patients with SD. Psychiatric outpatients with SD endorse many more psychiatric symptoms than do other psychiatric patients. Patients with SD in the psychiatric treatment setting may mimic other psychiatric illnesses; therefore, SD should be considered in the differential diagnosis for a wide variety of psychiatric illness, including psychotic and mood disorders  相似文献   

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