Piccinelli M, Rucci P, Ustün B, Simon G
UOP1, Azienda Ospedaliera Ospedale di Circolo e Fondazione Macchi, Varese and Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona, Italy.
Psychol Med. 1999 May;29(3):677-88. doi: 10.1017/s0033291799008478.
Typologies of anxiety, depression and somatization symptoms were investigated in individuals with no formal mental disorders, making no a priori assumptions about symptom distribution and inter-relationship.
The subjects were 1617 adult primary care attenders from the WHO Collaborative Project on Psychological Problems in General Health Care, with at least three symptoms of anxiety, depression and/or somatization, but with no formal ICD-10 disorders. Analyses were based on the grade of membership model, a multivariate statistical procedure exploring indistinct boundaries between disease categories and preserving the heterogeneity of clinical picture within each category.
Six prototype categories (or pure types) best described the structure of symptoms included in analyses. Pure type I included the full set of somatization symptoms. Pure type II was characterized by most anxiety and depression symptoms. Pure type III resembled generalized anxiety disorder. Pure type IV consisted of individuals reporting sporadic symptoms of anxiety, depression or somatization. Pure type V defined individuals with sleep problems. Finally, pure type VI was characterized by anxiety symptoms, including panic-like symptoms.
These findings provide support to the existence of a mixed anxiety-depression category crossing the diagnostic boundaries of current anxiety and depression disorders. Moreover, criteria of anxiety and somatization disorders may be re-examined to assess whether lower diagnostic thresholds can be identified that both preserve the symptom profile and clinical features of current diagnostic categories and allow for a better characterization of individuals with substantial psychopathology though not meeting the high symptom thresholds required for a diagnosis of formal mental disorders.
在无正式精神障碍的个体中研究焦虑、抑郁和躯体化症状的类型，对症状分布和相互关系不做先验假设。
研究对象为来自世界卫生组织普通医疗保健心理问题协作项目的1617名成年初级保健就诊者，他们至少有三种焦虑、抑郁和/或躯体化症状，但无正式的国际疾病分类第10版（ICD - 10）障碍。分析基于隶属度模型，这是一种多元统计程序，用于探索疾病类别之间不清晰的界限，并保留每个类别内临床症状的异质性。
六个原型类别（或纯类型）最能描述分析中所包含症状的结构。纯类型I包括全套躯体化症状。纯类型II的特征是大多数焦虑和抑郁症状。纯类型III类似于广泛性焦虑障碍。纯类型IV由报告焦虑、抑郁或躯体化散发性症状的个体组成。纯类型V定义为有睡眠问题的个体。最后，纯类型VI的特征是焦虑症状，包括类似惊恐的症状。
这些发现支持存在一个跨越当前焦虑和抑郁障碍诊断界限的混合焦虑 - 抑郁类别。此外，可能需要重新审视焦虑和躯体化障碍的标准，以评估是否可以确定更低的诊断阈值，既能保留当前诊断类别的症状特征和临床特征，又能更好地描述虽未达到正式精神障碍诊断所需的高症状阈值但有大量精神病理学表现的个体。
