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.     

躯体形式障碍患者躯体症状自评量表与SCL-90躯体化因子的相关性

目的探讨躯体症状自评量表(SSS)与症状自评量表(SCL-90)躯体化因子是否存在相关性。方法收集符合《精神障碍诊断与统计手册(第4版)》(DSM-IV)诊断标准的躯体化障碍和未分化型躯体形式障碍患者25例,采用自制一般情况调查表、SSS和SCL-90躯体化因子进行记录和评定,将受试者SCL-90躯体化因子评分与中国常模进行比较,分析SCL-90躯体化因子和SSS的相关性。结果受试者SCL-90躯体化因子评分高于中国常模水平[(12.28±7.63)分vs.(1.37±0.48)分,t=7.15,P0.01];躯体化严重程度指数(SSI)和症状数分别为(154.04±38.97)分和(18.0±13.0),SCL-90躯体化因子评分与SSS中的SSI和症状数均呈正相关(r=0.750,0.730,P均0.01)。结论 SSS可作为评估SFD的工具,是SCL-90躯体化因子的补充。     

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。     

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。     

综合医院常见躯体形式障碍临床特点及规律的横断面研究

躯体形式障碍患者以躯体症状为主要表现,因此常常于综合医院就诊,而相关检查并不能取得阳性的诊断证据.因此,如果接诊医生不能及时识别该病,往往导致患者因无法确诊而长期反复求医,不仅造成了巨大的医学资源的浪费,而且造成了家庭负担加重,家庭生活质量下降的后果,进一步影响患者的情绪,增加精神负担,加重病情,从而成为一种恶性循环[1].     

DSM-5躯体症状障碍与DSM-Ⅳ躯体形式障碍的 比较研究

目的 比较 DSM-5 躯体症状障碍（SSD）与 DSM-Ⅳ躯体形式障碍（SFD）一致性以及两标准 在躯体和心理维度的差异。方法 从中国地质大学（武汉）附属武汉心理医院的就诊患者中抽取 197 例, 采用临床面谈和定式工具收集病史和评估症状,依照 DSM-5 SSD 和 DSM-Ⅳ SFD 两标准将被试者分组, 并使用 SPSS 进行统计分析。结果 （1）根据 DSM-Ⅳ标准诊断为 SFD 患者 113 例（57.4%）,根据 DSM-5 标 准诊断为 SSD 患者 105 例（53.3%）。（2）DSM-5 中 SSD 与 DSM-Ⅳ中 SFD 诊断的一致性较低（Kappa=0.200）, 仅诊断为 SSD 但未诊断为 SFD 的患者表现出更严重的心理障碍。结论 与 DSM-Ⅳ中 SFD 诊断标准相 比,心理症状增强了 DSM-5 中 SSD 的预测有效性和临床实用性,采用 DSM-5 中 SSD 诊断标准比 DSM-Ⅳ 中 SFD 诊断标准更能识别出心理受损的患者。     

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.     

Readiness to change as a moderator of therapy outcome in patients with somatoform disorders

Objective: A considerable amount of patients with somatoform disorders do not benefit from psychotherapy as much as expected. Our aim was to explore whether readiness to change moderates the relationship between the intensity of symptoms and therapy outcome in the early stages of psychotherapy. Method: 144 patients with somatoform disorders received an outpatient cognitive-behavioural intervention. Symptom intensity was measured with the Screening for Somatoform Disorders (SOMS-7). For readiness to change, a German modification of the Pain Stages of Change Questionnaire (PSOCQ) was used, which comprises four subscales (FF-STABS). Regression analyses were carried out, with baseline symptoms and the readiness to change subscales as predictors and symptom reduction as the outcome variable. Results: Moderation analyses revealed significant interaction effects between baseline symptoms and the precontemplation subscale, as well as between baseline symptoms and the action subscale. For preparation and maintenance, no significant interaction effects were found. Conclusions: The results suggest that readiness to change is a variable that can be used to differentiate between patients, with low precontemplation and action scores indicating a better chance for positive outcome, even with high initial impairment. Rather than using readiness to change sum scores, the sub-aspects of this construct should be the subject of future research.     

文拉法辛与舍曲林治疗躯体形式障碍门诊病例对照研究

目的 评价文拉法辛与舍曲林对躯体化障碍和未分化躯体形式障碍的临床疗效和安全性. 方法文拉法辛组26例,剂量范围75～225mg/d;舍曲林组26例,剂量范围50～100mg/d,两组均以汉密尔顿焦虑量表(HAMA)、临床大体印象量表(CGI)、副反应量表(TESS)评定观察12周. 结果 47例完成研究(文拉法辛组22例,舍曲林组25例).研究终点,文拉法辛组和舍曲林组的HAMA-躯体性焦虑因子分均明显下降,文拉法辛组HAMA-躯体性焦虑因子分减分值平均为1.9±2.1,舍曲林组为3.2±2.5,差异无统计学意义(t=-1.961,P＞0.05).文拉法辛组临床总有效率为59.1%,舍曲林组为60.0%,差异无统计学意义(χ2=0.004,P＞0.05).文拉法辛组不良反应发生率为40.0%,舍曲林组为28.0%,差异无统计学意义(χ2=0.869, P＞0.05). 结论文拉法辛与舍曲林治疗躯体化障碍和未分化躯体形式障碍疗效相当,且均较为安全.     

The relation between anger management style, mood and somatic symptoms in anxiety disorders and somatoform disorders

The objective of this study was to examine the relationship between anger management style, depression, anxiety and somatic symptoms in anxiety disorder and somatoform disorder patients. The subjects comprised 71 patients with anxiety disorders and 47 with somatoform disorders. The level of anger expression or anger suppression was assessed by the Anger Expression Scale, the severity of anxiety and depression by the Symptom Checklist-90-Revised (SCL-90-R) anxiety and depression subscales, and the severity of somatic symptoms by the Somatization Rating Scale and the SCL-90-R somatization subscale. The results of path analyses showed that anger suppression had only an indirect effect on somatic symptoms through depression and anxiety in each of the disorders. In addition, only anxiety had a direct effect on somatic symptoms in anxiety disorder patients, whereas both anxiety and depression had direct effects on somatic symptoms in somatoform disorder patients. However, the anxiety disorder group showed a significant negative correlation between anger expression and anger suppression in the path from anger-out to anger-in to depression to anxiety to somatic symptoms, unlike the somatoform disorder group. The results suggest that anger suppression, but not anger expression, is associated with mood, i.e. depression and anxiety, and somatic symptoms characterize anxiety disorder and somatoform disorder patients. Anxiety is likely to be an important source of somatic symptoms in anxiety disorders, whereas both anxiety and depression are likely to be important sources of somatic symptoms in somatoform disorders. In addition, anger suppression preceded by inhibited anger expression is associated with anxiety and somatic symptoms in anxiety disorders.     

Diagnostic classification and demographic features in 283 patients with somatoform disorder

A total of 283 patients with somatoform disorder (SFD) seen in a psychiatry clinic were surveyed and their diagnostic subtypes, demographic features, and comorbidities, analyzed. The results indicate that: (i) SFD comprises 5.8% of first-visit outpatients; (ii) undifferentiated SFD (USFD) and SFD not otherwise specified (SFD-NOS) account for the majority of patients; (iii) there are 1.7-fold more women than men; (iv) age of onset is lower in patients with somatization disorder or body dysmorphic disorder and higher in patients with hypochondriasis or pain disorder; (v) the mean number of years of education was 11.2 years; and (vi) comorbid illness were seen in 24.8% of patients, and included mood disorder, anxiety disorder, and personality disorder, as well as borderline intellectual functioning and mental retardation. The data indicate that the majority of patients with SFD are given a diagnosis of residual category, such as USFD or SFD-NOS, and that the age of onset varies depending on the diagnostic subtype. SFD was more frequently seen in women, associated with comorbidities.     

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.     

小组心理护理对躯体形式障碍患者述情障碍的影响

目的:研究小组心理护理对躯体形式障碍患者述情障碍的疗效. 方法:将符合入组标准的躯体形式障碍患者63例随机分为试验组32例和对照组31例,分别对两组患者进行常规药物治疗和护理,且对试验组进行小组心理护理.对完成研究的试验组30例患者和对照组30例患者进行多伦多述情障碍量表(TAS)和临床疗效总评量表(CGI)的测试. 结果:①重复测量的方差分析发现干预因素对TAS因子Ⅰ、因子Ⅱ和因子Ⅳ存在主效应(F=4.291 ～5.844,P＜0.05);时间因素对TAS因子Ⅰ、因子Ⅱ、因子Ⅲ和因子Ⅳ均存在主效应(F=31.283～99.974,P＜0.01);干预因素和时间因素对TAS因子Ⅰ、因子Ⅱ和因子Ⅳ存在交互作用(F =7.815～12.541,P＜0.01).②逐步回归分析显示干预前TAS各因子分数和小组心理护理对TAS因子Ⅰ、因子Ⅱ、因子Ⅳ减少值具有显著的预测作用(Beta值=4.572～13.199,P＜0.01).③试验组疗效(76.7％)优于对照组(50％);多因素Logistic回归分析显示,对躯体形式障碍患者临床疗效影响从大到小的因素分别是:小组心理护理、TAS因子Ⅰ、TAS因子Ⅱ和TAS因子Ⅳ(OR =9.721～1.237). 结论:小组心理护理能够改善躯体形式障碍患者的述情障碍和临床疗效.