躯体形式障碍患者的心理健康状况及其与心理社会因素的相关性研究

发布时间：2018-05-17 16:28

本文选题：躯体形式障碍 + 抑郁　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的躯体形式障碍(Somatoform Disorders,SFD),是一种很常见的精神心理疾病。患者因躯体各种不适反复就诊,尽管各种医学检查的结果都是阴性或者正常的,尽管医生反复告知和解释,都不能使患者减轻疑虑。该疾病患者首诊多在初级医疗机构或综合医院,但是这些医院的非精神科医生对该病种识别率较低,且容易忽视患者的焦虑和抑郁情况,不能对疾病正确的诊治,不能共情患者的心理苦恼,导致降低患者就诊的满意度,降低治疗的依从性,增大了医疗纠纷的发生率,同时患者本人的痛苦和经济负担也随之增大。本文旨在通过全面的研究分析,探究综合医院就诊的SFD患者心理健康状况以及该病的发生发展与心理社会因素的关系,以期提高综合医院非精神科医生对该病的重视,同时为躯体形式障碍的综合治疗提供一定的参考。方法依据国际疾病分类第十次修订版(ICD-10)的精神与行为障碍分类的诊断标准,选取2015-2016年就诊于天津港口医院的躯体形式障碍患者120例作为观察组,同期选取志愿者120例作为健康对照组。两组分别填写症状自评量表(SCL-90)、艾森克人格问卷(EPQ)、防御方式问卷(DSQ)以及社会支持评定量表(SSRS)。分别比较两组心理健康水平以及社会心理特质,并检验观察组的心理健康水平和社会心理因素的相关性。统计上采用常用的SPSS软件19.0进行统计与分析,计数资料比较采用χ2检验,计量资料比较采用t检验及方差分析,对相应数据做相关分析,P0.05为差异有统计学意义,将SCL-90分值是否高于160分作为因变量,将单因素分析中有显著意义的因素作为自变量,进行Logistic回归分析。结果心理健康方面,观察组SCL-90总分以及躯体化、焦虑、抑郁、偏执得分均高于对照组,差异均有显著性(P0.05);人格特征方面观察组内外向得分低于对照组,神经质得分高于对照组,差异有显著性(P0.05);防御方式方面,观察组不成熟的防御机制得分高于对照组,成熟的防御机制低于对照组,差异均有显著性(P0.05);社会支持方面,观察组在客观社会支持、主观社会支持和社会支持利用度总分均显著低于对照组(P0.05)。躯体化障碍、未分化的躯体形式障碍、躯体形式的植物功能紊乱患者的社会心理特性不尽相同,躯体形式障碍患者的心理健康状况和神经质值、不成熟的防御机制呈负相关,与社会支持呈正相关,与神经质因子、掩饰因子、主观支持、年龄、性别、受教育年限有回归关系。结论躯体形式障碍患者更容易出现躯体化、焦虑、抑郁等心理健康问题,应该重视综合医院中SFD患者的正确诊断和正规治疗。SFD患者性格多为情绪不稳定型,患者的防御方式以及患者的社会支持系统与疾病的发展密切相关,这些情况可以纳入心理治疗的干预范畴,应该对SFD患者进行综合治疗。
[Abstract]:Objective somatoform Disorders (SFDD) is a common mental and psychological disorder. Although the results of various medical examinations are negative or normal, despite repeated notification and explanation by the doctor, they cannot allay the patient's doubts. Most of the patients were first diagnosed in primary medical institutions or general hospitals, but the non-psychiatrists in these hospitals had a low recognition rate of the disease, and were prone to ignore the anxiety and depression of the patients, and could not correctly treat the disease. The psychological distress of unsympathetic patients leads to the decrease of patients' satisfaction and compliance, which increases the incidence of medical disputes, and the pain and economic burden of the patients themselves are also increased. The purpose of this paper is to explore the mental health status of SFD patients in general hospitals and the relationship between the occurrence and development of the disease and psychological and social factors, in order to increase the attention of non-psychiatrists in general hospitals to the disease. At the same time, it provides some reference for the comprehensive treatment of somatoform disorder. Methods according to the diagnostic criteria of mental and behavioral disorders of ICD-10, 120 patients with somatoform disorders who were admitted to Tianjin Port Hospital from 2015 to 2016 were selected as the observation group. At the same time, 120 volunteers were selected as the healthy control group. The two groups completed SCL-90, Eysenck Personality questionnaire (EPQN), Defense style questionnaire (DSQS) and Social support rating scale (SSRSX) respectively. The mental health level and social psychological characteristics of the two groups were compared, and the correlation between the psychological health level and psychosocial factors in the observation group was tested. In statistics, SPSS software 19.0 was used for statistics and analysis, 蠂 2 test was used for counting data comparison, t test and variance analysis were used for measurement data comparison, there was significant difference in correlation analysis of corresponding data (P0.05). Whether the score of SCL-90 is higher than 160 is regarded as dependent variable, and the significant factor in univariate analysis is taken as independent variable, and the Logistic regression analysis is carried out. Results in the aspect of mental health, the total score of SCL-90, somatization, anxiety, depression and paranoid ideation in the observation group were higher than those in the control group, the difference was significant (P 0.05), the score of introversion and extroversion in the observation group was lower than that in the control group, and the score of neuroticism in the observation group was higher than that in the control group. The scores of immature defense mechanism in the observation group were higher than those in the control group, the mature defense mechanism was lower than that in the control group, and the difference was significant (P 0.05). In the aspect of social support, the observation group had objective social support. The total scores of subjective social support and social support utilization were significantly lower than that of the control group (P 0.05). The patients with somatization disorder, undifferentiated somatoform disorder, somatoform function disorder have different social and psychological characteristics. The mental health status, neuroticism and immature defense mechanism of somatoform disorder patients are negatively correlated. There was a positive correlation with social support and a regression relationship with neuroticism factor, mask factor, subjective support, age, sex, and years of education. Conclusion the patients with somatoform disorder are more likely to have somatization, anxiety, depression and other mental health problems. We should pay attention to the correct diagnosis and regular treatment of patients with SFD in general hospitals. Patients' defense style and patients' social support system are closely related to the development of the disease. These conditions can be included in the intervention category of psychotherapy. Comprehensive treatment should be carried out for patients with SFD.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.7

【参考文献】