“躯体不适感”在精神心理疾病症状学中的诊断意义

Diagnostic significance of"unwell sense of body" in the semiology of psychical and psychological disease

目的:提高以躯体不适感为主要症状的焦虑抑郁障碍的临床诊断率。方法:选择2001-11/2004-10贵阳医学院附属医院心理科住院治疗的焦虑抑郁障碍患者和精神分裂症患者为观察对象。纳入焦虑抑郁障碍患者(焦虑抑郁障碍组,包括五羟色胺再摄取抑制剂治疗有效的情感障碍)400例。纳入无理解障碍的精神分裂症患者(精神分裂者组)266例。自制躯体不适感症状调查表,内容为各种躯体症状。在调查前使用统一指导用语,要求患者根据近3年来自我实际情况如实填写,当场收回调查表。主要统计焦虑抑郁障碍组和精神分裂症组患者躯体不适感症状分布的情况,并对男女性焦虑抑郁障碍患者出现躯体症状的情况进行对比分析。同时对焦虑抑郁障碍组患者曾被诊断为其他疾病的情况进行统计。结果:发放调查表666份、收回有效调查表666份,有效率100%。①在焦虑抑郁障碍组患者中,女性出现躯体症状的比率显著高于男性,具有极显著统计学意义(176/287,22/133,χ2=21.46,P<0.005)。②精神分裂症患者中,4例出现身体有电流通过感;8例出现大脑里水流感;2例出现虫爬感;26例头昏感;18例心慌感。焦虑抑郁障碍出现躯体不适症状的情况为:胃区不适感133例;心慌126例;头昏111例;胸闷93例;出汗89例;头痛76例;发冷发热感58例;气短44例;浑身游走性疼痛感32例;浑身麻木感27例;濒死感21例;耳鸣14例;肛门坠胀感10例;四肢发抖5例;会阴部烧灼感4例;行走吃力3例;眩晕感2例;尿频尿急24例;眼胀或视物不清7例;咽喉异物感10例;肠胀气感25例。③焦虑抑郁障碍患者曾被诊断为更年期综合征177例;植物神经功能失调158例;胃肠功能紊乱122例;神经性头痛119例;胃炎80例;心脏病67例;甲状腺功能亢进64例;心肌炎15例;泌尿系感染2例。结论:焦虑抑郁障碍的躯体症状主要见于女性,可以表现多学科的症状,但较集中出现消化内科、心血管内科和神经内科疾病样的症状。容易误诊为其他疾病的科室主要集中于妇科、神经内科、消化内科、心血管内科和内分泌科。识别焦虑抑郁障碍患者可能出现的各种躯体不适表现,是减少以躯体不适感为主的焦虑抑郁障碍患者误诊率的关键。

AIM：To increase the rate of clinic diagnosis of the obstruction in anxiety and depression that mostly occurs on upset sense body. METHODS：The look-in objects were chosen from November 2001 to October 2004 in the inpatients with obstruction of anxiety and depression and patients with dementia praecox from the Department of Psychology, Affiliated Hospital of Guiyang Medical College.400 patients with the obstruction in anxiety and depression were included （obstruction in anxiety and depression group, including affective disorder effectively treated with serotonin re-uptake inhibitors）. 266 schizophrenes without disturbance of understandingwere included （schizophrenia group）. The questionnaire of the symptom with unwell sense of body was self-commanded,in which contained every symptom of body.The questionnaire was filled out faithfully according to the actual condition of the recent 3 years,and the questionnaire was taken back on the spot.The statistics was progressed in the distributing of unwell sense of body in the obstruction in anxiety and depression group and schizophrene group, and the parallel analysis was put up between male patients and female patients with obstruction in anxiety and depression. Meanwhile, the statistics was progressed in the patients, who had been diagnosed other disease in obstruction of anxiety and depression group. RESULTS：Totally 666 questionnaires were sent out, and 666 effective ones were collected, so the efficiency rate was 100%. ① In the obstruction with anxiety and depression group, the rate of body symptom was higher in the female patients than that in the male ones, and had statistically mighty marked significance （176/287, 22/133, X^2 =21.46,P 〈 0.005）. ② Among schizophrenes, 4 cases with the sense of electric current through the body, 8 cases with the sense of stream in the cerebra,2 cases with the sense of insect-creeping, 26 cases with the sense of faint, 18 cases with the sense of heart-confused.The situation of appearing unwell symptom of body in obstruction with anxiety and depression,133 cases with unwell in the section of stomach; 126 cases with the sense of heart-confused; 111 cases with the sense of faint;93 cases with the sense of stuffy in the chest; 89 cases with sweating;76 cases with headache;58 cases with the sense of algiaity and pyrexia; 44 cases with breathe hard; 32 cases with the sense of swimming stitch all over;27 cases with the sense of anaesthesia all over; 21 cases with the sense of being close to death;14 cases with tinnitus;10 cases with the sense of fall-swell in the anus; 5 cases with shiver in limbs; 4 cases with the sense of cauterization in the perineum;3 cases with difficulty tread; 2 cases with the sense of vertigo; 24 cases with micturiti0n and urgent emiction; 7 cases with the sense of bulge in the eye or unclear when watching matter;10 cases with the sense of eyewinker in the fauces; 25 cases with the sense of expanding-gas in the intestines. ③ In the patients with obstruction of anxiety and depression,177 cases were ever diagnosed menopause syndrome,158 cases with maladjustment of foliage nerve function,122 cases with turbulence of stomach-intestines function, 119 cases with nerve-headache,80 cases with gastritis, 67 cases with cardiopathy, 64 cases with hyperthyroidism, 15 cases with myocarditis, 2 cases with infect at urinary system. CONCLUSION：3he symptom of body in obstruction with anxiety and depression mostly catch sight of women,which may behaving many subjective symptoms, but rather focusing to occur the symptom of kind of disease in digest intemal medicine,department of cardiology and department of neurology. The section ofices of easy miss-examined other diseases mostly focus on department of gynecology,department of neurology,digest department,department of cardiologyand department of endocrinology. The identification of various kinds of unwell manifestation of body in patients with obstruction of anxiety and depression is the key of decreasing the rate of miss-examining in patients with obstruction in anxiety and depression which majors on the unwell sense of body.