Fink P, Sørensen L, Engberg M, Holm M, Munk-Jørgensen P
Department of Psychiatric Demography, Psychiatric Hospital, Aarhus University Hospital, Risskov, Denmark.
Psychosomatics. 1999 Jul-Aug;40(4):330-8. doi: 10.1016/S0033-3182(99)71228-4.
To study the prevalence of somatoform disorders (SDs) in primary care, a questionnaire including the modified 25-item version of the Symptom Checklist-90 was administered to 191 patients consecutively consulting their family physician. A stratified sample of the patients was interviewed with the Schedules for Clinical Assessment in Neuropsychiatry. The study showed that 22.3% (confidence interval [CI]: 95%: 16.4-28.1) of the patients fulfilled the diagnostic criteria for an International Classification of Diseases--10th Revision (ICD-10) SD, excluding SD, unspecified, and 57.5% (CI: 95%: 50.5-64.5) for DSM-IV SD. But 30.3% met the criteria (CI: 95%: 23.8-36.9) when the DSM-IV Not Otherwise Specified (NOS) diagnostic group is excluded. The most frequent ICD-10 diagnosis was autonomous dysfunction, for which 14.1% of the patients fulfilled the criteria, whereas the prevalence of the other somatoform diagnosis was between 3.0% and 8.1%. The most frequent DSM-IV diagnoses were SD NOS and undifferentiated SD, which 29.93% and 27.3% of the interviewed patients, respectively, received, whereas the prevalence of the other diagnoses was between 1.0% and 8.1%. A high comorbidity between SDs and other mental disorders was found. The general practitioners identified between 50% and 71% of the patients with an ICD-10 SD and between 36% and 48%, according to DSM-IV criteria. Patients with SDs used more nonpsychiatric health care facilities than other patients (P = 0.01).
为研究基层医疗中躯体形式障碍（SDs）的患病率，我们对191名连续向家庭医生咨询的患者进行了问卷调查，问卷包含修改后的25项症状自评量表（Symptom Checklist-90）。我们采用神经精神病学临床评估量表对患者进行分层抽样访谈。研究表明，22.3%（95%置信区间[CI]：16.4 - 28.1）的患者符合《国际疾病分类》第10版（ICD - 10）中SDs的诊断标准，但不包括未特定的SDs；根据《精神疾病诊断与统计手册》第4版（DSM - IV）标准，这一比例为57.5%（95% CI：50.5 - 64.5）。但排除DSM - IV未另行规定（NOS）诊断组后，30.3%的患者符合标准（95% CI：23.8 - 36.9）。ICD - 10中最常见的诊断是自主神经功能紊乱，14.1%的患者符合该标准，而其他躯体形式障碍诊断的患病率在3.0%至8.1%之间。DSM - IV中最常见的诊断是SD NOS和未分化的SDs，接受访谈的患者中分别有29.93%和27.3%被诊断为此，而其他诊断的患病率在1.0%至8.1%之间。研究发现SDs与其他精神障碍之间存在高度共病现象。根据ICD - 10标准，全科医生识别出50%至71%的SDs患者；根据DSM - IV标准，这一比例为36%至48%。患有SDs的患者比其他患者更多地使用非精神科医疗设施（P = 0.01）。
