德国心身医学联络会诊中医学无法解释的躯体症状患者的诊断及转诊来源

Diagnosis and referral sources of patients with medically unexplained physical symptoms in consultation-li- aison psychosomatics in Germany

目的：考察德国心身医学联络会诊的转诊服务中医学无法解释的躯体症状（M U PS ）患者的诊断情况与转诊来源。方法以德国某综合性大学附属医学中心2006～2010年向心身医学与心理治疗科转诊的8722例住院患者为研究对象，采用联络会诊－基本资料记录表（CL －BaDo ）收集数据。结果（1）由综合性医院的临床科室向心身科转诊的 MUPS 患者的躯体疾病诊断中，在一般症状（22.0％）、神经系统（20．9％）、骨骼和肌肉组织（7．1％）方面的诊断比例明显高于当前的心理症状组（Current Psychological Symptoms ，CPS ）的患者和应对方式问题组（Problems of Coping ）的患者；而M U PS患者在精神疾病的诊断中，在躯体形式障碍（17．9％）、伴有生理紊乱及躯体因素的行为综合征（8．1％）、成人人格和行为障碍（2．2％）和其他神经症性障碍方面（3．6％）的诊断比例高于CPS和Cop‐ing的患者。（2）转诊患者的来源方面，心身科联络会诊服务中患者的转诊科室比例从高到低依次为内科、外科、神经科和皮肤科，与 CPS 及 Coping 的患者相比，MUPS 患者主要的转诊科室为神经科。结论德国心身医学联络会诊转诊服务中的MUPS患者的诊断情况与转诊来源与CPS和Coping患者不同，具有独特性，对于我国综合性医院识别及转诊M U PS患者具有参考意义。

Objective To assess the diagnosis and referral sources among patients with unex‐plained physical symptoms in consultation -liaison psychosomatics in Germany .current psychological symptoms（CPS）problems of coping .Methods A total number of 8 722 inpatients were referred between 2006 to 2010 to the department of psychosomatic medicine and psychotherapy in a University Hospital of Germany .These patients were investigated with CL -BaDo （a basis documentation form for C-L serv‐ice） .Results （1）As compared with the problems of coping group and current psychological symptoms （CPS） group ,the MUPS patients＇rates of the physical problems like general system （22 .0% ） ,nervous system （20 .9% ） ,skeleton and muscle （7 .1% ） were significantly higher .The MUPS patients＇rates of mental disorders like somatoform disorders （17 .9% ） ,behavioral syndromes associated with physiologi‐cal disturbances and physical factors （8 .1% ） ,disorders of adult personality and behavior （2 .2% ） and other neurotic disorders （3 .6% ） were also higher than the other two groups .（2）The main referral de‐partments were surgery （28 .7% ） ,internal medicine （42 .2% ） ,neurology （12 .6% ） and dermatology （5 .1% ） .Compared to the patients with CPS and the patients with coping problems ,the patients with MUPS were mainly referred from department of neurology （53 .9% ） .Conclusions There are differences of diagnosis and referral sources among patients with medically unexplained physical symptoms ,patients with CPS and patients with coping problems in consultation-liaison psychosomatics ,which is meaningful to the consultation-liaison service for MUPS patients in China .