综合医院心理门诊焦虑障碍10年就诊变迁的调查

Survey on 10-year vicissitude of consultation visit of outpatients with anxiety disorders in a psychological clinic in general hospital

目的了解综合医院门诊焦虑障碍患者在不同年代的诊治情况及复诊情况变迁。方法比较1992年度与2002年度就诊的、符合美国精神障碍诊断与统计手册(DSM)焦虑障碍诊断标准中的广泛性焦虑(GAD)、惊恐障碍(PD)和强迫症(OCD)三个亚型门诊初诊患者(1992年共69例,2002年共271例)的诊断治疗及复诊情况。结果随着随访时间推移,门诊焦虑障碍患者复诊比例逐步下降,GAD患者第一个月复诊比例为62.5%(1992年)与44.4%(2002年)、第五年分别为9.4%和15.6%;PD患者第一个月复诊比例为44.4%(1992年)与47.5%(2002年)、第五年分别为16.7%和20.0%;OCD患者第一个月复诊率为68.4%(1992年)与35.1%(2002年)、第五年分别为15.8%和8.1%。同一随访时点三个亚型间的复诊比例差异均无统计学意义(P>0.05);门诊焦虑障碍患者急性期就诊频度较高,但随着随访时间的延长,月平均就诊次数逐渐减少。结论2002年度的门诊焦虑障碍患者的就诊人数较10年前(1992年度)显著增加,但长期治疗患者依从性仍较差,因此需要重视提高患者治疗的依从性。

Objective： To understand 10-year vicissitudeof diagnosis,treatment and rate of return visit in outpatients with anxiety disorders between 1992 and 2002 in a general hospital.Methods： All cases should meet the DSM diagnostic criteria of anxiety disorders,including general anxiety disorder（GAD）,panic disorder（PD） and obsessive-compulsive disorder（OCD）.In 1992,only 69 outpatients were diagnosed as anxiety disorders（GAD,n=32;PD,n=18;OCD,n=19）,while after 10 years（2002）,there were 271 cases diagnosed as those（GAD,n=135;PD,n=99;OCD,n=37） in the same clinic.Results：Treatment adherence among these anxiety outpatients in 1992 and 2002 decreased progressively within the 5-year return visit after first visit.For GAD,62.5%（1992） and 44.4%（2002） of cases came back for a return visit in the first month,while only 9.4%（1992） and 15.6%（2002） of them maintained return visits 5 years later in the clinic.For panic disorder,44.4%（1992） and 47.8%（2002） of cases came back for a return visit in the first month,while only 16.7%（1992） and 20.0%（2002） of them maintained return visits 5 years later.For OCD,68.4%（1992） and 35.1%（2002） of cases came back for a return visit in the first month,while only 15.8%（1992） and 8.1%（2002） of them maintain a return visits 5 years later.No significant difference（P〉0.05）was found among three sub-groups in the rate of return visit and treatment adherence between 1992 and 2002.Conclusion：From 1992 to 2002,the anxiety outpatients in a clinic increased nearly 4 times,while treatment adherence was still lower than 2/3 in the first month and lower than 20% 5 years later.Attention should be paid to improve the treatment adherence of anxiety outpatients.