躯体症状障碍患者临床特征分析

Clinical characters of the patients with somatic symptom disorder

目的探索躯体症状障碍(SSD)患者的临床特征。方法采用方便取样法选取北京协和医院精神科、中医科和消化科门诊患者作为研究对象。根据入排标准,共纳入210名被试完成自评问卷,并经过结构化诊断访谈得出SSD的诊断。分析SSD患者的临床特征,并与非SSD患者比较,同时比较来自3个科室SSD患者的临床特征。结果(1)被试中有27.1%(57/210)被诊断为SSD;患者年龄(43±13)岁,其中女性占61.4%(35/57),与非SSD患者各项人口学资料的对比差异均无统计学意义。(2)45.6%(26/57)的SSD患者躯体症状持续时间超过2年,29.9%(17/57)报告近1年就诊次数超过20次。过去6个月接受过治疗的SSD患者有46.8%(22/47)治疗满意度3~5分,44.7%(21/47)对治疗效果评分3~5分。(3)SSD患者较各科室非SSD患者各项自评量表得分差异均有统计学意义(P<0.05);与精神科非SSD相比,在躯体症状、焦虑相关量表及12项健康调查简表(SF-12)亚量表精神健康总评(MCS)间差异有统计学意义(P<0.05)。三个科室的SSD患者在诊治情况和各项自评量表得分的比较差异均无统计学意义。结论SSD患者的身心受疾病影响较为严重,应得到积极治疗。综合医院精神科,尤其会诊联络精神医学亚专科工作应重点关注该类患者并开展更深入研究。

Objective To explore the clinical characters of patients with somatic symptom disorder (SSD) in a tertiary general hospital.Methods 210 patients from the outpatient clinic of the mental health department,the traditional Chinese medicine department and the gastroenterology department,who fit the criteria after filling in a self-rating questionnaire,were evaluated by a diagnostic interview for somatic symptom disorder (SSD).The clinical characters of patients with SSD were compared among different departments,and with other patients without SSD.Results (1) 27.1%(57/210) were diagnosed as SSD,with the age of (43±13) years old,and 61.4%(35/57) were female.The differences of the demographic characteristics and the lifestyle between the SSD and the non-SSD were not statistically significant.(2) 45.6%(26/57) SSD patients had their duration of the somatic symptoms more than 2 years;29.2%(17/57) SSD patients went to see doctors more than 20 times within recent one year.46.8%(22/47) SSD patients who had received any treatment within the past 6 months evaluated it as effective,and 44.7%(21/47) SSD patients evaluated it as satisfactory.(3)The SSD patients reported more severe symptoms than those without SSD since the score of PHQ15 in SSD patients was 11 compared 7 in non-SSD patients (Z=4.876,P<0.001).The SSD patients were more disabled than those without SSD in all three departments with the DAS score 33,25,30 respectively (Z=5.429,P<0.001),and the disability of SSD patients was similar to those non-SSD in the mental health clinic (Z=0.894,P=0.371).There were no statistical differences in lifestyle,treatment evaluation and self-rating questionnaire in the SSD patients among the three departments.Conclusion SSD is quite prevalent in outpatient clinics in general hospitals and exerts substantial negative impact to their mental and physical health,as well as the daily functioning.SSD deserves more attention and effort to be managed in consultation-liaison psychiatry.