心身医学实践与干预模式探讨

To study psychosomatic medicine and intervention model

探讨综合医院“筛查-诊治-会诊-康复-回归社会”的心身医学诊疗与干预模式。方法:筛查:门诊及住院病人的自评量表筛查;转介及诊治:筛查后共病精神障碍的患者,转介到心身医学门诊,由精神心理医生、心理工作者或医务社工进行治疗及干预;心身医学联合会诊:对疑难病例或治疗效果不理想的患者进行躯体、心理、社会因素等综合评估及综合干预;随访:医务社工、心理工作者跟踪随访,促进其康复及回归社会。结果:我院的门诊及住院患者共病精神障碍约30%左右,门诊病例HAD筛查符合焦虑、抑郁得分为24,01%(4744/19754),住院患者的SAS、SDS筛查符合焦虑、抑郁得分的分别为36.46%(35/96)和34.37%(33/96)。对于联合会诊的13例患者,通过综合干预后情绪、躯体感受、兴趣、家庭关系等均得到明显改善。13例患者在心身整体治疗前、后(部分病人为随访时)进行SAS、SDS评分,并进行t验,P〈0.01,具有显著差异。结论:在综合医院开展心身医学实践与干预的过程,提高了医务人员对患者躯体症状外的心理社会问题的关注,增强了医务工作者的心身医学理念。使患者得到多领域、多学科、多专业的工作人员对其躯体、心理及社会的全方位关注,达到心身同治的效果。医务社工及心理工作者的帮助促使患者回归社会、回归家庭,重返正常的社会生活。

Objective:To study the diagnosis and treatment and intervention model in psychosomatic medicine of "screeing- diagnosis and treat- ment - consultation - rehabilitation and return to society" in general hospital. Methods Screening: outpatient and inpatient self- report scale screening; After referral and diagnosis and treatment: screening patients with comorbid psychiatric disorders, referral to the psychosomatic medicine service, to re- ceive treatment and intervention by psychological doctors, psychological workers and medical social workers; Joint consultation of psychosomatic medi- cine : for patients with difficult cases or the treatment effect is not ideal, comprehensive evaluation and comprehensive intervention will be performed in- volving their physical, psychological and social factors; Follow -up: following up these patients by medical social workers and mental workers, to pro- mote them rehabilitation and return to society. Results There are about 30% of outpatient and hospital patients are sufferend from conmorbid mental dis- orders in our hospital. HAD screening in conformity with anxiety, depression score of outpatient cases was 24.01% (4744/19754) , SAS screening and SDS screening scores were 36. 46% (35/96) and 34. 37% ( 33/96 ) independently. For 13 cases of patients who had accepted comprehensive intervention, the mood, body feeling and interest and family relations were improved significantly( P 〈 0. 01 ). SAS and SDS score of these 13 cases were evaluated before or after the psychosomatic overall treatment (parts of them at the time of follow - up), and the T test was used to analyse the scores. Conclusion Development of psychosomatic medicine practice and intervention in general hospital, can promopt the medical staff to pay more attention to psychosocial problems except the somatic symptoms, and enhancing the concept of psychosomatic medicines to medical workers. In addition, patients will have chances to get comprehensive attention invovling their physica.