抑郁症门诊患者躯体症状主诉及疗效比较

A comparing study between somatic complain and effectiveness among depressed outpatients

目的了解抑郁症患者常见躯体主诉,探讨不同求医主诉患者的临床症状特点及治疗疗效。方法连续门诊就诊、符合CCMD-3诊断标准的抑郁症患者,根据求医主诉不同(采用三级病诉法)分为躯体症状主诉组和精神症状主诉组,各30例。给予8周氟西汀(百优解)治疗,治疗前和治疗后1,4,8周分别予HAMD-17、CGI、TESS等量表评定。结果抑郁症患者最常见的三大类躯体主诉为疼痛(52%)、胃肠道症状(25%)、疲劳和精力缺乏(17%),并且75%的躯体症状主诉抑郁症患者在深入问诊时承认有精神症状。经8周氟西汀治疗,躯体症状主诉组有效率和临床治愈率分别为83%和51%,精神主诉组有效率和治愈率分别为86%和70%。结论两组患者都具有抑郁症核心症状,但躯体症状主诉抑郁症患者程度较重,并且急性期治疗时间可能需要更长。

Objective To classify the common somatic complains of depressed outpatients, and to compare the clinical characteristics and treatment effectiveness between somatic and mental complains among depressed cases. Methods 60 outpatients who met the CCMD-3 criteria of major depression are divided into two groups （somatic and mental complain groups）, and treated with Fluoxetine （Prozac） for 8 weeks, meanwhile rated with HAMD-17,CGI and TESS at baseline, after treatment 1, 4 and 8 weeks. Results The most common somatic complains are pain （52%）, gestro-intestinal symptoms （25%） and fatigue or lack of energy （ 16.7% ）. Threeforth of them will express their blue mood symptoms if the depressed patients with somatic complains are deeply interviewed with mental assessments. After 8 week-treatment with Fluoxetine, the response rate is over 80% between two groups, but the remission rate among somatic depressed group is lower than the group of mental complains （51% vs 70% ）. Conclusion The somatic complain and symptoms are not uncommon, and sometimes the severity in manifestations is more severe among the somatic depressed than the cases with low mood complains, as well as needed longer treatment for remission in the earlier group.