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1、Somatic Symptoms & Depression in General Practice 情緒障碍躯体化,David Wong 王大卫 MB.,BS, PDip.Com.Psy Med HONG KONG,9th Beijing/ Hong Kong Medical Exchange 第九届京港医学交流会议 Psychological medicine in Community社区心理医学 3 - 4 November 2007 Presidential, Plaza Hotel, Beijing, China,S.1,What is this & what do you see ?
2、 猜猜这是什么?,S.2,Review of patients record in General Practice 病人纪录在全科医学中的覆检,Somatic symptoms & depression,Associated with medical causes and now found increasingly so with psychiatric disorders as well.一向被认以为是躯体的疾病, 现在我们知道精神障碍也可以引起同样症状. Some medically unexplainable symptoms may be listed under well def
3、ined psychiatric disorders, the rest is grouped loosely as medically unexplained symptoms (MUS).部份躯体症状不能以身体疾病解释, 原来是精神障碍症侯一类. 目前还有一些躯体症状未能(起码暂时)有合理的解释, 有些学者就冠上一个名词”医学未能解释的症状” (MUS). Management of MUS, also not explainable by the present system of psychiatry, remains a challenge.对临床和做研究的医学界MUS都是一个挑战.
4、,Somatic symptoms躯体症狀,S.3,Somatic symptoms(躯体症狀) in DSM IV & HAM-D,Somatic symptoms & depression,S.4,Somatic symptoms(躯体症狀) in DSM IV & HAM-D,Somatic symptoms & depression,S.5,Significance of somatic symptoms 躯体症狀的重要性,Somatic symptoms & depression,Prevalent in depression忧郁病中很普遍Number of published ar
5、ticles found in PubMed:文献里越来越多关于情绪障碍躯体化的文章: Up to 2000: 1498 (2000年以前:1498) Up to 2007 Jan:2718 (2007年一月以前:2718)Diagnosis Implications 对診斷影响 higher no. of somatic symptoms predict depression.越多症状,患忧郁的机会起大。 Medically unexplained symptoms associate morefrequently with depression.越多医学未能解释的症状,患忧郁症的机会越大。
6、,S.6,Significance of somatic symptoms 躯体症狀的重要性,Somatic symptoms & depression,Treatment implications-higher no of SS delays:对治療的影响: response, 越多症状,越可能延誤,对藥物物的反應 remission,復原的時間 increases recurrence 增加復發的可能機會,S.7,Somatic symptoms & depression,70-75% (Gps家庭科医生) 60-65% (psychiatrist精神專 科医生) (Partners in
7、 Research,SA,04 南非Mitchell们做的研究) 45% to 95% (Gps) 69% (psychiatrist) present only with somatic symptoms 純粹躯体症状 (Simon GE et al, N.Eng.J Med 1999;341:1329-1335)65% depressed patients report somatic symptoms 忧郁病人有躯体症状 (Bair MJ et al, Arch Intern Med. 2003;163:2433-2445. Bair MJ et al, Psychosom Med. 2
8、004; 66: 17-22.),Percentage of depressed patients presenting with predominantly physical symptoms 抑鬱病人有躯体问题的比率,S.8,Somatic symptoms & depression,Analysis of total 437 patients 437病者的分析,S.9,Review of records of patients for January 07 复查2007年一月份病人的记录,Somatic symptoms & depression,Analysis of 429 pati
9、ents presenting with somatic symptoms 429位带躯体症状病者的分析,S.10,Review of records of patients for January 07 复查2007年一月份病人的记录,Unexplained Somatic Symptoms & Mood Disorders 医学上末能解释的症状与情绪障碍, 32% to 62% of such patients are depressive 32% to 62%病者有忧郁症 24% to 50% have anxiety disorders 24% to 50%病者有焦虑症(Kroenke
10、 K et al Arch Fam Med 1994;3-774-9)More frequent association with anxiety disorders and depressionMUS 跟焦虑和忧郁有密切出现的关系(Katon W et al. Ann Intern Med 2001;134-971-925),Somatic symptoms & depression,S.11,Somatic symptoms & depression,Analysis of 91 patients with medically unexplained symptoms (MUS) 91位带
11、有医学上末能解释症状的患者分析,54,30,7,Mood dominant somatic symptoms (m+ss+) 大部分情绪障碍症状 小部分躯体症状Somatic symptoms dominant, some mood symptoms (m+ss+) 大部分躯体症状 小部分情绪障碍症状Somatic symptoms only (ss+) 纯躯体症状,A,B,C,(7.7%),(33%),(59%),S.12,Review of records of patients for January 07 复查2007年一月份病人的记录,Somatic symptoms & depre
12、ssion,Analysis of 99 patients (91 patients with MUS & 8 patients with mood symptoms) 99 位病者（91 位未能解释 + 8 位情绪障碍）的分析,S.13,Review of records of patients for January 07 复查2007年一月份病人的记录,Somatic symptoms & depression,Diagnosis of “depressed group” of patients (53 patients) 53 位忧郁病者的分析,S.14,Review of recor
13、ds of patients for January 07 复查2007年一月份病人的记录,Somatic symptoms & depression,Prevalence of somatic symptoms in 53 “depressed group of patients” (depression, depression comorbid with anxiety, low mood with MUS),S.15,Review of records of patients for January 07 复查2007年一月份病人的记录,Somatic symptoms & depres
14、sion,Conclusion I 小结 (I)12.1% of 437 patients suffer from depression.437到诊病人中 12%患有忧郁症 21% of 429 patients with somatic symptoms present withmedically unexplained symptoms.429带有躯体各式各样的症状的病人中有 21%人属于医学解释不了的例子58.2% of patients presenting with medically unexplained symptoms suffer from depression.当中有分5
15、8.2%患有忧郁症All depressed patients have somatic symptoms.所有忧郁的患者都有躯体的问题,S.16,Review of records of patients for January 07 复查2007年一月份病人的记录,Somatic symptoms & depression,Treatment for the “depressed group” of patients (53 patients) 53位抑郁病者的治疗,All patients were receiving antidepressant drugs when surveyed
16、 (with or without atypical antipsychotics)所有患者在统计时正服用SSRls 4 patients discontinued subsequently.4位停止疗程49 patients remained on antidepressant treatment49人正继续服用SSRls Number of somatic symptoms per patient : between 1 to 9.每一位患者平均拥用一至九种躯体症体,S.17,Review of records of patients for January 07 复查2007年一月份病人的记录,Somatic symptoms & depression,Outcome of treatment in “depressed group”patients (53 patients) 治疗结果,
