全科医学中的心理健康病案研究(十一)--强迫性障碍

Case Studies of Mental Health in General Practice (11)——Obsessive Compulsive Disorder

强迫性障碍(强迫症)是一种常见的心理疾病。倪英等[1]对中国3个城市的9家综合性医院的非精神科和心理科门诊患者的调查表明,17.3%的门诊患者至少患有1种精神障碍,其中2.8%的门诊患者患有强迫性障碍。中国研究者在对各类社区人群的调查表明,强迫性障碍在各人群中普遍存在,且大中小学学生和特定职业工作者作为重点研究对象。刘媛等[2]的调查发现,32%的高中生有心理障碍倾向,其中10%的学生有强迫倾向。以往研究还表明,强迫性障碍患者的生活质量明显低于健康者。然而,中国患者对精神卫生服务的利用率很低,一方面与患者理解(mental health literacy)和耻感有关,另一方面与非精神或心理专业医生缺乏相关知识和技能有关。李飞等[3]的研究表明,人群对抑郁和焦虑的健康认知水平很低。张晶璟等[4]的研究表明,医学心理门诊患者复诊率低,依从性差。马丽华等[5]的调查结果表明,虽然70%的临床医生知道包括强迫障碍的神经症性障碍(neurotic disorders)的名词,但只有40%左右的医生能做出诊断和治疗,且医生的知识多来自非专业信息源(电视、报纸、杂志等)。本案例分析给中国的全科医生提供了一个理解和掌握强迫性障碍诊断和管理的好机会。

Obsessive compulsive disorder（OCD） is one of mental disorders which is found in the community and which sometimes presents in healthcare settings.Professor Ni Ying [1] and her colleagues of Peking University Institute of Mental Health found 17.3% of Chinese patients who seek non-psychiatric or non-psychological outpatient service in Chinese general hospitals suffer at least one mental disorder,and in fact 2.8% of these outpatient patients could be diagnosed as having OCD.Most recent studies of OCD prevalence in China have focused on specific population groups,especially children,adolescents and university students.For instance,Capital Medicine conducted a study which involved psychiatric screening of 1 000 high school students（year 10-12）,and found that 32% of the students had a tendency towards or symptoms of a mental problem,and 10% of the students had a tendency or symptoms of OCD [2].However,utilization of mental health service in China is still extremely low.The low rate could be attributed to a combination of client side factors（low mental health literacy and stigma） and supply side factors（shortage of related specialists as well as poor competency of mental health among health professionals other than psychiatrist or psychologist）.Li Fei [3] has reported than the general population has low literacy about depression,anxiety and neurotic disorders.Professor Zhang Jingjing [4] and colleagues has found poor follow up and poor compliance with treatment amongst patients with mental disorders,especially OCD patients.Ma Lihua [5] has reported 70% of general physicians have heard the term of OCD or neurotic disorders,however only one third of hospital doctors have some knowledge of OCD diagnosis and management.Surprisingly,Ma＇s study found doctor＇ s limited knowledge of OCD was commonly gained from ＇informal channels＇ such as TV programs,newspapers or magazines,instead of formal education or vocational training.Therefore,here is a good opportunity to share this case study about OCD with Chinese general practitioners,and with other clinicians who also need upgrade knowledge and skills of managing mental health problem.