Whether medically unexplained or not, three or more concurrent somatic symptoms predict psychopathology and service use in community populations

Objectives

To examine the frequency of somatic symptoms in a community population of various ethnic backgrounds and to identify correlates of these symptoms such as psychopathology, use of services, and personal distress.

Methods

Using a 14-symptom inventory with interviewer probes for somatic symptoms, we determined the presence of general physical symptoms (GPS) in a sample of 4864 white, Latino, and Asian US community respondents. Medically “edited” verbatim interview responses were used to decide whether or not physical symptoms would qualify as medically unexplained physical symptoms (MUPS). We then assessed the association between GPS and MUPS and psychiatric disorders, psychological distress, and use of services, in both unadjusted and multivariate regression analyses.

Results

One-third (33.6%) of the respondents reported at least one GPS and 11.1% reported at least one MUPS within the last year. 10.7% of respondents had three or more GPS and 1.5% had three or more MUPS. Three or more GPS and MUPS were positively associated with depressive, anxiety, and substance use disorders; service use; and psychological distress in unadjusted comparisons. In multivariate regressions, GPS persisted as a significant predictor, but there was no significant independent effect of MUPS, after controlling for GPS and other covariates.

Conclusions

Regardless of the presence or absence of medical explanations, physical symptoms are an important component of common mental disorders such as depression and anxiety and predict service use in community populations. These results suggest that three or more current GPS can be used to designate a “case” and that detailed probes and procedures aimed at determining whether or not physical symptoms are medically unexplained may not be necessary for classification purposes.     

Causal symptom attributions in somatoform disorder and chronic pain

Objective

Somatoform disorders (SFD) are defined by symptoms that lack medical explanation. This study examined the type and pattern of patients' causal attributions using a new semistructured interview technique

Methods

The Causal Attributions Interview allows to assess and weigh 15 common explanations of physical symptoms. Attributions given by 79 patients with SFD were compared with those obtained from 187 chronic pain patients.

Results

The test-retest reliabilities of the interview-elicited attributions were satisfactory to good. SFD patients attributed most of their symptoms to mental/emotional problems (46.9%) and somatic disease (41.1%), while the pain sample preferred physical overloading/exhaustion (56.1%), daily hastiness/time pressure (41.7%), somatic disease (39.6%), and weather influence (39.0%). On average, SFD patients chose 2.57 and pain patients 3.86 different attributions for each symptom. These numbers were substantially larger than those of initial spontaneous attributions. Correspondence analysis revealed underlying dimensions with three groups labeled “environmental,” somatic,” and “psychological/stress.” While pure environmental attributions were rare (1.1%), somatic factors were chosen for 28.3% of the symptoms, psychological/stress for 22.1%, and the combination of both for 25.6%. Approximately 10% were attributed in a multicausal sense to all three groups. Depression was found to correlate positively with psychological/stress and negatively with somatic attributions.

Conclusion

The results do not support the perspective that SFDs generally result from poor acknowledgement of emotional factors. SFD and chronic pain showed distinguishable attributional patterns.     

西酞普兰治疗持续性躯体形式疼痛障碍对照研究

目的：观察西酞普兰治疗持续性躯体形式疼痛障碍的疗效。方法：将持续性躯体形式疼痛障碍门诊患者64例随机分为治疗组和对照组，两组分别给予西酞普兰（31人）和阿米替林（33人）治疗，总疗程6周。分别于治疗前及治疗后第2、4、6周评定疗效，阿米替林组有2例脱漏，最后完成疗程每组各31人。结果：治疗组和对照组完全缓解分别为9例和8例，明显缓解分别为10例和8例，轻度缓解分别为7例和9例，无效分别为5例和6例；有效率分别为83．87％，80．65％；两组间差异无显著性（P〉0．05）。但治疗组口干、便秘、视物模糊、心动过速、嗜睡等不良反应明显比对照组少（P〈0．01）。结论：西酞普兰对持续性躯体形式疼痛障碍与阿米替林疗效相当，但不良反应小。     

柴胡桂枝汤治疗躯体形式疼痛障碍的疗效及对血清5-羟色胺与前列腺素E2的影响

  目的  探讨柴胡桂枝汤对躯体形式疼痛障碍患者的疗效及血清5-羟色胺(5-HT)、前列腺素E₂(PGE₂)的影响。   方法   选择2017年1月—2019年2月衢州市中医院及衢化医院门诊64例躯体形式疼痛障碍患者为观察对象, 数字表法随机分为研究组、对照组各32例。2组均给予心理治疗, 研究组口服柴胡桂枝汤煎剂, 对照组口服度洛西汀, 治疗周期均为8周。采用抑郁症状严重程度量表(PHQ-9)、广泛性焦虑量表(GAD-7)、McGill疼痛量表(SF-MPQ)及生活质量综合问卷(GQOLI-74)分别评价患者抑郁、焦虑、疼痛程度及生活质量改善情况, 有效率作为评定指标,并监测治疗前与治疗8周末血清5-HT、PGE₂水平, 随访6个月。   结果   2组患者治疗前及治疗8周末的疼痛分级指数(PRI)、视觉模拟评分法(VAS)、现在疼痛状况(PPI)、PHQ-9、GAD-7、GQOLI-74评分差异无统计学意义(均P＞0.05);6个月时, 研究组PRI、VAS、PPI评分、GQOLI-74总分优于对照组, 差异有统计学意义(均P＜0.05)。治疗8周末, 2组有效率比较差异无统计学意义(χ2=0.172, P=0.679), 且研究组未发生明显不良反应,其治疗后血清PGE₂水平与对照组比较差异有统计学意义, 而5-HT水平与治疗前比较差异无统计学意义。   结论   柴胡桂枝汤治疗躯体形式疼痛障碍具有与度洛西汀相当的近期效果, 远期效果显著。      

中西医结合治疗持续性躯体形式疼痛障碍临床研究

目的探讨针刺合用帕罗西汀治疗持续性躯体形式疼痛障碍的疗效及其安全性。方法将60例持续性躯体形式疼痛障碍患者随机分为治疗组(针刺加帕罗西汀)30例与对照组(单用帕罗西汀)30例,于治疗前及治疗后第2、4、6周末用简明McGill疼痛问卷表(SF-MPQ)的PPI总分、汉密尔顿抑郁量表(HAMD)评定疗效,抗抑郁药副反应量表(SERS)评定不良反应。结果治疗后2组PPI总分、HAMD总分较治疗前明显减少,差异有统计学意义(P<0.05)。第6周末治疗组有效率86.7%,对照组53.3%,两组比较,差异有统计学意义(P<0.05)。从第2周末开始,治疗组PPI总分即明显低于对照组(P<0.05)。第4周末开始,治疗组HAMD总分明显低于对照组(P<0.05)。在治疗第2、4、6周末时两组SERS评分比较差异无统计学意义(P>0.05)。结论针刺加帕罗西汀治疗持续性躯体形式疼痛障碍起效更快,疗效更好。     

综合医院躯体形式障碍患者三维人格特征及防御方式研究

目的 分析躯体形式障碍患者的三维人格特征、防御方式及其相互关系.方法 采用三维人格问卷(tridimensional personality questionnaire,TPQ)、防御方式问卷(defense styles questionnaire,DSQ)对60例门诊及住院躯体形式障碍患者及60名正常人进行人格评定及防御方式评定,并用独立样本的t检验对两组的(得分)结果进行比较,采用Pearson相关系数分析两者之间的相关性.结果 躯体形式障碍组在猎奇性得分高于正常对照组(P＜0.05);躯体形式障碍组在躲避伤害性维度上得分高于正常对照组(P＜0.01),躯体形式障碍组在奖赏依赖性维度上的得分低于正常对照组(P＜0.01);躯体形式障碍组在不成熟防御方式的得分高于正常对照组(P＜0.01),在成熟防御方式上的得分低于正常对照组(P＜0.01);三维人格特征中的躲避伤害性与成熟防御机制呈负相关(r=-0.612),奖赏依赖性与成熟防御机制呈正相关(r=0.350).结论 躯体形式障碍患者具有猎奇性、躲避伤害性以及依赖性等人格特征;躯体形式障碍患者较多使用不成熟防御方式,包括投射、抱怨、退缩、躯体化;人格特征与心理防御机制具有一定相关性.     

躯体形式障碍患者定量感觉检查的研究

目的 用定量感觉检查的方法了解躯体形式障碍患者的感觉改变.方法 用定量感觉仪对27名躯体形式障碍患者,分别用Limit法和Level法测定四肢的冷觉(CS)、温觉(WS)、热痛觉(HP)、冷痛觉(CP)、振动觉(WT)阈值,并与19名正常人的CS、WS、HP、CP、WT阈值进行对比.结果 Limits法显示躯体形式障碍组与对照组间除左上肢的冷痛觉、振动觉、右上肢的冷痛觉、右下肢的冷觉、冷痛觉阈值差异无显著性外,其余15项定量感觉值均差异有显著性[左上肢的热痛觉分别为(39.79±1.29)℃,(43.17±1.10)℃],t=9.2835,P＜0.01,左下肢的热痛觉分别为[(16.46±3.41)℃,(14.72±1.10)℃,t=2.1410,P＜0.05].其中11个定量感觉阈值为躯体形式障碍组明显低于正常对照组,而仅4个定量感觉阈值为躯体形式障碍组明显高于正常对照组,躯体形式障碍组的阈值降低率为55%,高于20%的升高率,差异有显著性(x2=5.2267,P＜0.05).Levels法显示2组间除右下肢的冷觉差异无显著性外,其余各定量感觉阈值亦差异有显著性[右下肢的振动觉分别为(1.07±0.13)Hz,(1.33±0.03)Hz,t=8.5327,P＜0.01]左下肢的冷觉分别为[(28.73±0.69)Hz,(28.08±0.63)Hz,t=3.2587,P＜0.01].且其中8个定量感觉阈值为躯体形式障碍组明显低于正常对照组,而仅3个定量感觉阈值为躯体形式障碍组明显高于正常对照组,躯体形式障碍组的阈值降低率为67%,高于25%的升高率,差异有显著性(x2=4.1958,P＜0.05).Limits法和Levels法阈值降低或升高率差异无显著性(P＞0.05).结论 Limits和Level法的定量感觉检查均提示躯体形式障碍出现感觉阈值下降、感觉敏感性增加的可能性较大;躯体形式障碍所产生的感觉障碍可能与周围和中枢神经敏感性均增高有关.     

126例男性脑卒中患者勃起功能障碍及影响因素分析

目的：探讨男性脑卒中患者勃起功能障碍（ED ）发生情况及影响因素。方法选取126例男性脑卒中患者,采用国际勃起功能指数‐5（IIEF‐5）量表判定入选患者有无ED ,根据评分结果将患者分为ED组和非ED组。采用NIHSS评分量表及改良Rankin （mRS）评分量表评估患者神经功能缺损情况;采用抑郁自评量表（HAMD）评估患者抑郁状态;采用简易智能状态检查量表（MMSE）评估患者认知功能。比较ED组与非ED组临床因素及心理因素组间的差异,应用Logistic回归模型分析ED的影响因素。结果共有38例（30．2％）患者患有ED。单因素分析显示高血压、糖尿病、血管紧张素转化酶抑制剂（ACEI）药物使用及抑郁与ED显著相关,而多因素分析提示ACEI药物使用及抑郁与ED独立相关。结论男性脑卒中患者的 ED较为常见,患者使用ACEI药物及抑郁是ED主要影响因素。     

躯体形式障碍患者临床特征的对照研究

目的分析对比躯体形式障碍患者情绪和个性特征,提高对躯体形式障碍的识别敏感性与临床诊治水平。方法综合性医院门诊收集131例躯体形式障碍患者、94例抑郁症患者、97例焦虑症患者和95例健康志愿者,采用心理测试软件进行90项症状自评量表和艾森克人格问卷测试,对情绪和个性特征进行分析。结果躯体形式障碍组躯体化因子分（2.47±0.65VS2.05±0.58）高于焦虑组,躯体形式障碍组人际关系敏感（2.18±0.75VS2.67±0.68）、抑郁（2.53±0.70VS3.20±0.60）、敌对因子分（2.23±0.64VS2.71±0.55）低于抑郁症组,躯体形式障碍组精神质（54.26±11.18VS39.69±10.11）和神经质因子（62.55±9.88VS53.07±11.35）分高于正常对照组,差别有统计学意义（P〈0.05）;躯体形式障碍组神经质因子分与强迫、人际关系敏感、抑郁、焦虑、敌对、偏执、精神病性和其他因子分呈正相关。结论躯体形式障碍患者存在多种躯体不适和负面情绪,躯体化症状高于焦虑症,但抑郁程度低于抑郁症,神经质特征与躯体化症状、负面情绪严重程度呈正相关。     

肌电生物反馈对躯体形式障碍的心理与生理指标的影响

目的:探讨肌电生物反馈对躯体形式障碍患者的生理和心理指标的影响。方法:将160例患者随机分为2组,在药物治疗的基础上,1组加生物反馈治疗,1组加模拟生物反馈治疗,治疗每天1次,治疗4周。采用症状自评量表(SCL-90)评定疗效,每次生物反馈治疗前后测额肌电值、心率、血压,以观察患者生理指标的变化。结果:(1)SCL-90评分,2组比较治疗4周末各因子分均较治疗前有显著下降(P<0.05);(2)额肌电值:入组时2组患者无显著性差异(P<0.05),治疗后2组患者肌电值差异具有统计学差异(P<0.01)。结论:肌电生物反馈治疗躯体形式障碍起效快,可迅速缓解焦虑症状。