综合医院心理门诊患者躯体化症状的临床分析

Somatized symptoms in patients of psychological clinic service in general hospital

目的探讨综合性医院医学心理科门诊患者躯体化症状的临床特征以及抗抑郁药物对伴发躯体化症状的抑郁症的临床疗效。方法以躯体化症状为主诉至南京大学医学院附属鼓楼医院医学心理科门诊就诊的188例患者,分析其症状分布的特征、精神障碍的诊断构成,并对被诊断为抑郁症的患者中的39例给以帕罗西汀治疗,应用17项汉密尔顿抑郁量表(HAMD17)、汉密尔顿焦虑量表(HAMA)进行评分,在治疗前后进行比较。结果睡眠障碍、心、肺部不适、头部不适以及胃肠道不适为最常见的躯体化症状,而临床上常常会被诊断为抑郁症、焦虑障碍、躯体形式障碍以及精神分裂症等其他精神障碍。其中39例以躯体化症状就诊的被诊断为抑郁症的患者在给予帕罗西汀治疗四周以后,HAMD17、HAMA的平均分在治疗后较治疗前显著降低(P<0.01)。结论躯体化症状临床表现多种多样,可涉及全身各个系统,几乎所有的精神障碍都有可能伴发躯体化症状,帕罗西汀对以躯体化症状为主诉的抑郁症患者的疗效肯定。

Objective To investigate the clinical features of somatized symptoms in patients of psychological clinic service in general hospital and the therapeutic effects of antidepressants in treatment of depression with somatized symptoms. Methods A total of 188 patients with somatized symptoms consulted by psychiatrists in general hospital were analyzed for the distribution of characteristics and psychiatric diagnosis. Thirty - nine patients with depression were treated by paroxetine,and the therpeutic effects were assessed with HAMD17 and HAMA . Results The extremely frequent somatized symptoms were sleep disorder, complaint of the heart and lung, complaint of the cephalosume and complaint of the gastrointestinal. The patients were diagnosed as depression, anxiety disorder, somatoform disorder, schizophrenia and other mental disorders. The scores of HAMD17 and HAMA in patients with paroxetine significantly diereased after treatment. Conclusion The clinical features of the somatized symptoms are miscellaneous and involve nearly all systems. Nearly all the mental disorders possibly are accompanied by somatized symptoms. Paroxetine is effective in treatment of depression with somatized symptoms.