Carson A J, Ringbauer B, Stone J, McKenzie L, Warlow C, Sharpe M
University Department of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh EH10 5HF, UK.
J Neurol Neurosurg Psychiatry. 2000 Feb;68(2):207-10. doi: 10.1136/jnnp.68.2.207.
To determine (a) the proportion of patients referred to general neurology outpatient clinics whose symptoms are medically unexplained; (b) why they were referred; (c) health status and emotional disorder in this group compared with patients whose symptoms are explained by "organic" neurological disease.
The prospective cohort study with case note follow up at 6 months was carried out in the regional neurology service in Lothian, Scotland with 300 newly referred outpatients. Neurologists rated the degree to which patients' symptoms were explained by organic disease (organicity), GPs' reasons for referral, health status (SF-36), anxiety, and depressive disorders (PRIME-MD), RESULTS: Of 300 new patients 11% (95% confidence interval (95% CI) 7%-14%) had symptoms that were rated as "not at all explained" by organic disease, 19% (15% to 23%) "somewhat explained", 27% (22% to 32%) "largely explained", and 43% (37% to 49%) "completely explained" by organic disease. Reason for referral was not associated with "organicity". Comparison of these groups showed that although physical function was similar, the median number of physical symptoms and pain were greater in patients with lower organicity ratings (p<0.0005, p<0. 0005). Depressive and anxiety disorders were more common in patients with symptoms of lower organicity (70% of patients in the not at all group had an anxiety or depressive disorder compared with 32% in the completely explained group (p<0.0005).
One third of new referrals to general neurology clinics have symptoms that are poorly explained by identifiable organic disease. These patients were disabled and distressed. They deserve more attention.
确定（a）转诊至普通神经科门诊的患者中，症状无法用医学解释的患者比例；（b）他们被转诊的原因；（c）与症状由“器质性”神经疾病解释的患者相比，该组患者的健康状况和情绪障碍情况。
在苏格兰洛锡安地区的神经科服务机构对300名新转诊的门诊患者进行了为期6个月的病例记录随访的前瞻性队列研究。神经科医生对患者症状由器质性疾病解释的程度（器质性）、全科医生的转诊原因、健康状况（SF - 36）、焦虑和抑郁障碍（PRIME - MD）进行评分。结果：在300名新患者中，11%（95%置信区间（95%CI）7% - 14%）的症状被评为“完全无法用器质性疾病解释”，19%（15%至23%）“部分可以解释”，27%（22%至32%）“大部分可以解释”，43%（37%至49%）“完全可以用器质性疾病解释”。转诊原因与“器质性”无关。这些组的比较表明，尽管身体功能相似，但器质性评分较低的患者身体症状和疼痛的中位数更多（p<0.0005，p<0.0005）。抑郁和焦虑障碍在器质性较低的患者中更常见（完全无法解释组中70%的患者有焦虑或抑郁障碍，而完全可以解释组中为32%（p<0.0005）。
三分之一转诊至普通神经科门诊的新患者症状难以用可识别的器质性疾病解释。这些患者存在残疾且痛苦。他们值得更多关注。
