全科医生对躯体症状障碍的识别与处理

Identification and management of somatic symptoms disorder by general practitioners

以躯体不适为主诉就诊于全科门诊的躯体症状障碍(somatic symptoms disorder,SSD)患者越来越多,这些患者常年受痛苦的躯体症状所困扰而就诊于各个综合医院的专科或全科门诊,但却无法得到正确地识别与处理。在西方大多数国家,全科医生提供大多数精神心理卫生服务。全科医生对于此类疾病的识别具有重要意义,更早地发现和管理可以减轻患者和临床医生的负担。因此,如何正确地识别出以躯体不适为主诉的心理障碍患者,并为其提供持续性、综合性、个体化的管理,对全科医生来说是一种挑战。全科医生作为大多数患者医疗健康的“守门人”,如何采用“生物-心理-社会学”综合模式的角度来帮助躯体症状障碍患者了解其症状方面的重要性,并通过自身对精神疾病相关知识的学习,正确选择、利用各类心理量表等工具,提高对SSD患者的识别,针对患者的不适采取有效的缓解措施,并对患者在用药治疗过程中,辅以必要的心理治疗等是很重要的。随着我国医疗改革制度的不断深入,分级诊疗制度的推行,全科医生与精神心理专科医生之间共同协作,进而提升SSD的诊疗效果。因此,本篇文章从躯体症状障碍的流行病学及现状、病因学、临床表现与诊断、全科医生面对该类患者时的诊疗思路等方面做一综述,从而提高全科医生正确地识别出以躯体不适为主诉的心理障碍患者,并为其提供持续性、综合性、个体化的管理。

More and more patients with somatic symptoms disorder(SSD)with physical discomfort as the chief complaint are treated in general clinic.These patients are plagued by painful somatic symptoms for years and are treated in various specialties or general clinic of general hospitals,but they cannot be correctly identified and dealt with.In most western countries,general practitioners provide most mental health services.General practitioners have an important role to play in the identification of such diseases,and earlier detection and management can reduce the burden on patients and clinicians.Therefore,it is a challenge for general practitioners to correctly identify patients with psychological disorders who complain of physical discomfort and provide them with continuous,comprehensive and individualized management.General practitioners as"gatekeeper"of most of the patients health,how to use"biological-psychological-social"comprehensive model to help somatization disorder to understand the importance of its symptoms,and through their own learning knowledge about mental illness,correct selection and use of all kinds of tools,such as psychological scale to improve the recognition of SSD patients,in view of the patient's discomfort to take effective relief measures,and in the process of medication treatment,auxiliary necessary psychological treatment,etc.With the deepening of China's medical reform system and the implementation of the hierarchical diagnosis and treatment system,general practitioners and psychiatrists work together to improve the diagnosis and treatment effect of SSD.Therefore,this article from the body symptoms of disorders of the epidemiology and the present situation,the etiology,clinical manifestation and diagnosis,general practitioners in the face of such patients clinical thinking,to do a review,so as to improve the identify of general practitioners'right is complained of mental disorder patients with body discomfort,and provide a continuous,comprehensive,individualized management.