多躯体症状患者的心理及行为特点

发布时间：2018-04-20 09:39

  本文选题：多躯体不适主诉 + 心理-行为特点　； 参考：《北京协和医学院》2013年博士论文

【摘要】：目的：有多个躯体不适主诉的患者普遍存在于各国各级医疗机构,又存在一定的文化差异,给医疗工作带来挑战。目前只有较少的资料对我国此类患者的临床特点进行直接研究,也缺乏他们对卫生资源的使用的系统描述。我们通过对综合医院不同科室的就诊者展开横断面调查,旨在回答：a)综合医院门诊的多躯体症状患者的临床特点,b)他们对医疗资源的使用及对疾病的归因。 方法：本研究是一项横断面调查性研究。为搜集具有多个躯体症状的患者的心理-行为相关的资料,研究者向就诊北京协和医院门诊消化科、中医科、心理医学科的符合入组条件的患者行知情同意并请患者填写自评问卷(包括人口学资料、躯体症状量表PHQ-15及其他临床心理学量表),之后对患者进行卫生资源的使用访谈及国际精神科简式访谈(M.I.N.I.)。 结果：a)共搜集的到多躯体症状患者(SOM+,PHQ-15≥10)的有效案例143例,平均年龄为44±15岁,女性占68.9%,调查过程中发现SOM+患者在被调查科室具有普遍性。b)临床特点方面：SOM+患者临床量表得分M(SD):PHQ-911.82[6.374]. GAD-78.51(6.02).WIT-74.04(2.26).SF-12MCS42.8[11.75].SF-12PCS42.13(8.48),各科室患者间过去12个月躯体疾病患病率不同(GI88.0%,TCM68.6%,PSY47.6%,p0.001),MINI阳性率没有明显统计学差异(GI54.5%,TCM48%,PSY48%,p=0.539)。c)就医行为方面：31.8%的患者在过去1年有10次以上的就诊经历,另43.8%看过3-10次医生,57.7%的患者症状持续大于1年,有81.6%的患者认为这些症状严重影响了日常生活。来自不同科室的被访者都接受“心理因素”疾病归因(GI52％,TCM40％,PSY68％). 结论：a)有多个躯体不适的受访者在被调查的各个科室具有普遍性,且多数为女性。b)临床特点上,有超过2/3的患者在过去一年内患有躯体疾病,1/2或更多的患者共病至少一种精神障碍(M.I.N.I.+)；大多数患者的不适趋于慢性化,并严重影响到他们的日常生活。c)对医疗资源的使用上,就诊于不同科室的被访者曾接受过的治疗及对治疗期望各有不同；在疾病归因上“心理因素”被来自不同科室的被访者普遍认同。
[Abstract]:Objective: patients with multiple complaints of physical discomfort generally exist in medical institutions at all levels of countries, and there are certain cultural differences, which brings challenges to medical work. At present, there are only a few data on the clinical characteristics of such patients in China, and lack of systematic description of their use of health resources. By conducting a cross-sectional survey on the patients in different departments of the General Hospital, we aim to answer the clinical characteristics of multi-somatic symptom patients in the General Hospital (A)) their use of medical resources and the attribution of diseases. Methods: this study is a cross-sectional investigation. In order to collect psycho-behavioral data of patients with multiple somatic symptoms, the researchers went to the Department of Digestive Medicine, the Department of traditional Chinese Medicine, the outpatient Department of Peking Union Hospital, and the Department of traditional Chinese Medicine. Patients eligible for admission in the Department of Psychiatry were given informed consent and were asked to fill out self-assessment questionnaires (including demographic data). The somatic symptom scale (PHQ-15) and other clinical psychological scales were followed by interviews on the use of health resources and international psychiatric interviews. Results one hundred and forty-three effective cases (mean age 44 卤15 years, female: 68.9%) of multiple somatic symptom patients (PHQ-15 鈮，

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