神经内科门诊抑郁障碍患者的识别情况及其影响因素

Recognition and its influential factors of depressive disorder among outpatients in department of neurology

目的探讨神经内科门诊抑郁障碍患者的识别情况及其影响因素。方法采用中文版流调用的抑郁自评量表对神经内科门诊的全部初诊患者(654例)进行筛查,得分>16分者在其神经内科就诊完毕后征得患者的同意由精神科医师参照ICD-10进行诊断,对符合ICD-10抑郁障碍的78例患者进行汉密尔顿抑郁量表(HAMD)评分,及填写自制的一般情况调查问卷,并对识别抑郁的影响因素行单因素及Logistic多因素回归分析。结果(1)神经内科医师对78例抑郁障碍患者中识别14例(17.95%),识别为功能性疾病31例(39.74%)。(2)与未识别组相比,被识别组中躯体归因模式者多,家庭关系较差,病程较短。(3)被识别组主诉心理症状的比例(35.71%,5/14)高于未识别组(9.38%,6/64),而主诉躯体症状(包括头晕、头痛、乏力、失眠、纳差等)的比例(64.29%,9/14)低于未识别组(90.62%,58/64),差异有统计学意义(均P<0.01)。(4)伴有躯体疾病的抑郁障碍患者有89.18%(33/37)被漏诊;被识别组中伴有躯体疾病的比例(28.57%,4/14)明显低于未识别组(51.56%,33/64),差异有统计学意义(P<0.05)。(5)HAMD各因子分及总分比较,被识别组认知障碍、阻滞方面均重于未识别组(均P<0.001)。(6)Logistic回归分析显示,精神运动性迟滞、抑郁程度重,有利于被识别。结论神经内科门诊抑郁障碍患者的识别率低。伴有躯体疾病的抑郁障碍多被漏诊;主诉为心理症状的抑郁及严重抑郁易于被神经内科医师识别。

Objective To explore the recognition and its influential factors of depressive disorder among out-patients in department of neurology.Methods 654 outpatients at their preliminary visit in department of neurology were administered the Center for Epidemiological Servey-Depression Scale（CES-D）of Chinese edition for depressive disorder screening.Patients with score of CES-D≥16 were further interviewed by a psychiatrist,and were examed by ICD-10.Then 78 cases of them were diagnosed as depressive disorder.The depressive disorder patients were examed by Hamilton Depression Scale（HAMD）and a self-designed questionnaire,and the influencing factors of recognition on depressive disorder were analized by univariate analysis and multiplicity Logistic regression analysis.Results（1）14 cases（17.95%）of the 78 depressive disorder patients were recognized by neurologists,while 31 cases（39.74%）were recognized as functional diseases.（2）Compared with unrecognized group,there were less normalizing attributional style,poorer intimate relationship and shorter course of disease in recognized group.（3）The proportion of complain of psychologic symptoms was more in recognized group（35.71%,5/14）than in unrecognized group（9.38%,6/64）,while the proportion of complain of somatic symptoms was less in recognized group（64.29%,9/14）than in unrecognized group（90.62%,58/64）.The differences between the two groups were statistical significances（all P〈0.01）.（4）89.18%（33/37）of patients coexisting somatic disease were missed diagnosis.The proportion of somatic disease was less in recognized group（28.57%,4/14）than in unrecognized group（51.56%,33/64）,and the difference was statistical significance（P〈0.05）.（5）According to the comparison of score of HAMD,cognitive impairment and retardation were more severe in recognized group than in unrecognized group（all P〈0.001）.（6）Multiplicity Logistic regression analysis revealed that the more severe of psychomotor retardation and depression,the more simple to be recognized.Conclusions The recognition rate of depressive disorder patients among outpatients in department of neurology is not satisfied.Most depressive disorder patients coexisting somatic disease are missed diagnosis.Depressive disorder patients with complain of psychologic symptoms and severe depressive disorder are more simple to be recognized by neurologists.