Lee S, Yu H, Wing Y, Chan C, Lee A M, Lee D T, Chen C, Lin K, Weiss M G
Department of Psychiatry, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin.
Am J Psychiatry. 2000 Mar;157(3):380-4. doi: 10.1176/appi.ajp.157.3.380.
The authors' goal was to examine the prevalence and experience of psychiatric morbidity among primary care patients with chronic fatigue in Hong Kong.
One hundred adult patients with medically unexplained fatigue for 6 or more months were assessed with the Explanatory Model Interview Catalogue, psychopathological rating scales, and an enhanced version of the Structured Clinical Interview for DSM-III-R.
The lifetime prevalence of DSM-III-R depressive and anxiety disorders was 54%. Current depressive and anxiety disorders were identified in 28 patients, who exhibited more psychopathology and functional impairment than other patients. Thirty-three patients had somatoform pain disorder, and 30 had undifferentiated somatoform disorder, but most of them could also be diagnosed as having shenjing shuairuo (weakness of nerves) and, to a lesser extent, ICD-10 neurasthenia. Chronic fatigue syndrome diagnosed according to the 1988 Centers for Disease Control criteria was rare (3%) and atypical. Generally, patients mentioned fatigue if asked, but pains (36%), insomnia (20%), and worries (13%) were the most troublesome symptoms. Most patients attributed illness onset to psychosocial sources.
Psychiatric morbidity was common among primary care patients with chronic fatigue. Subthreshold psychiatric morbidity was very common and was more validly represented by the disease construct of shenjing shuairuo or neurasthenia than somatoform disorder.
作者旨在调查香港患有慢性疲劳的基层医疗患者中精神疾病的患病率及患病体验。
采用解释模型访谈目录、心理病理学评定量表以及《精神疾病诊断与统计手册第三版修订版》结构化临床访谈的增强版，对100名患有医学上无法解释的疲劳达6个月或更长时间的成年患者进行评估。
《精神疾病诊断与统计手册第三版修订版》中抑郁和焦虑障碍的终生患病率为54%。在28名患者中识别出当前的抑郁和焦虑障碍，这些患者比其他患者表现出更多的心理病理学症状和功能损害。33名患者患有躯体形式疼痛障碍，30名患有未分化躯体形式障碍，但其中大多数也可被诊断为神经衰弱，在较小程度上还可诊断为国际疾病分类第十版中的神经衰弱。根据1988年美国疾病控制中心标准诊断的慢性疲劳综合征很罕见（3%）且不典型。一般来说，如果被问及，患者会提及疲劳，但疼痛（36%）、失眠（20%）和担忧（13%）是最困扰他们的症状。大多数患者将疾病发作归因于心理社会因素。
在患有慢性疲劳的基层医疗患者中，精神疾病很常见。阈下精神疾病非常普遍，用神经衰弱或神经官能症的疾病概念比躯体形式障碍能更有效地体现这一点。
