综合医院非精神科患者心理障碍诊断情况分析

Analysis of the diagnosis of mental disorders in non-psychiatric patients from general hospital

目的通过综合医院非精神科患者抗抑郁药物的使用情况分析心理障碍诊断的规范性。方法收集西安交通大学第一附属医院2014—2018年共5个年度全院使用抗抑郁药物的非精神科患者相关病历资料,分析使用抗抑郁药物的主要科室、相关诊断名称分布、主要诊断名称占比、无心理障碍相关诊断使用抗抑郁药物的患者所分布科室及年度数量变化等。结果使用抗抑郁药物患者主要分布于神经内科、心血管内科、老年科、风湿科、内分泌科、消化科,2014—2018年使用抗抑郁药物患者数量年平均增长率为22.8%,临床中与用抗抑郁药物相关的诊断主要有16种单病诊断及25种共病诊断,按诊断人数降序依次为焦虑状态、抑郁症、焦虑抑郁状态、抑郁状态、焦虑症、紧张型头痛,按疾病分类:焦虑状态、抑郁症、焦虑抑郁状态、紧张型头痛系各疾病分类主要诊断使用名称;出入院无心理障碍相关诊断但使用抗抑郁药的患者总占比69.1%(1818/2632);2017及2018年,在无心理障碍诊断患者分布科室中,消化内科、康复科和疼痛病房增幅显著。结论综合医院非精神科对心理障碍的临床识别有所提升,但诊断名称规范化、用药与诊断一致性需进一步提高。

Objective To analyze the standardization of the diagnosis of mental disorders through the use of antidepressants in non-psychiatric patients from general hospitals.Methods The related cases data of non-psychiatric patients who used antidepressants in First Affiliated Hospital of Xi’an Jiaotong University were collected from 2014 to 2018.The main departments using antidepressants,the distribution of related diagnosis names,the proportion of main diagnosis names,and the distribution of departments and annual changes in the number of patients using antidepressants without psychological disorders related diagnosis were analyzed.Results Patients using antidepressant were mainly distributed in the department of neurology,cardiovascular medicine,geriatrics,rheumatology,endocrinology and gastroenterology.From 2014 to 2018,the average annual growth rate of the number of patients using antidepressant was 22.8%.Diagnoses related to antidepressants mainly included 16 single disease diagnosis and 25 comorbid diagnosis.In descending order of diagnostic amount,the diagnosis names were anxiety state,depression,anxiety-depressive state,depression state,anxiety disorder,and tension headache.By disease classification,anxiety state,depression,anxiety-depression state,and tension headache were the main diagnostic names for each disease classification.The total proportion of patients admitted and discharged without a mental disorder related diagnosis but using antidepressants accounted for 69.1%(1818/2632).In 2017 and2018,gastroenterology,rehabilitation departments and pain ward increased significantly in the distribution departments of patients without diagnosis of psychological disorders.Conclusion The clinical recognition of mental disorders in the non-psychiatric department of general hospital has been improved,but the standardization of diagnosis names and the consistency of medication and diagnosis need to be further improved.