中国阴阳文化背景下的躯体症状障碍1例并文献复习

Somatic symptom disorder in the context of Chinese yin-yang culture:A case report and literature review

躯体症状障碍(somatic symptom disorder,SSD)的特征是患者长期对各种躯体症状感到过度的担忧,感到十分痛苦,明显影响其社会功能及个人生活。SSD患者的临床表现与其文化背景存在联系;本例SSD患者在躯体检查时未见任何异常,但受到我国传统阴阳文化的影响其临床表现具有显著的中华文化色彩,以与中华传统阴阳文化联系紧密的性功能障碍和心境障碍为主。笔者采用汉密尔顿焦虑量表、汉密尔顿抑郁量表及国际勃起功能问卷表分别对患者的焦虑情绪、抑郁情绪及性功能进行评价,分值分别为32,33及9。经5周的文拉法辛和米氮平联合用药治疗,临床症状得到显著改善。我国SSD患者的临床表现有时具有明显的中华阴阳文化色彩,在临床工作中很容易被误诊,临床医生应对此提高警惕。此外,文拉法辛和米氮平联合用药对以慢性疼痛及性功能障碍为主要表现的SSD患者可能具有较好的疗效。

Somatic symptom disorder(SSD)is a somatic disorder characterized by excessive anxiety over various somatic symptoms for a long time,which makes patients feel very painful and the quality of personal life significantly decreased.Previous studies have shown that there is a connection between the clinical manifestations of SSD patients and their cultural background.The patient in this case report was highly affected by Chinese yin-yang culture,displaying obvious Chinese characteristics.We report a patient with SSD,whose clinical manifestations were mainly sexual dysfunction and mood symptoms which were closely related to the Traditional Chinese culture of Yin and Yang.In this case,Hamilton Anxiety Scale,Hamilton Depression Scale,and International Erectile Function Questionnaire were used to evaluate the patients’anxiety,depression,and sexual function,and the scores were 32,33,and 9,respectively.The patient was treated with a combination of venlafaxine and mirtazapine.After 5 weeks of treatment,the patient’s clinical symptoms improved significantly.The clinical manifestations of some Chinese SSD patients have obvious characteristic relevance to Chinese theory of Yin and Yang,making SSD easily to be misdiagnosed.Therefore,clinicians should pay atlention to this situation.In addition,the combination of venlafaxine and mirtazapine may have a better effect on SSD patients with chronic pain and sexual dysfunction.