Pélissolo A, André C, Chignon J-M, Dutoit D, Martin P, Richard-Berthe C, Tignol J
Service de Psychiatrie Adulte et CNRS UMR 7593, Hôpital Pitié-Salpêtrière, AP-HP, 47, boulevard de l'Hôpital, 75013 Paris.
Encephale. 2002 Nov-Dec;28(6 Pt 1):510-9.
Few data are currently available on the prevalence and associated characteristics of anxiety disorders in psychiatric out-patients in France, in particular in the private health-care. However, this represents one of the principal systems of care for patients suffering from anxiety disorders, with a possible direct access and several types of treatments available (pharmacotherapy but also different kinds of psychotherapy). The aim of our study was to describe the prevalence of anxiety disorders in a large sample of patients consulting in the private sector, and in addition to study the comorbidity, the severity of the disorders, their consequences on quality of life and health care consumption. The studied patients were included and assessed by 501 psychiatrists from all the country, at the time of a first visit. Inclusions were to be made in a consecutive way, but with the exclusion of psychotic disorders and dementia. A sample of 1 955 patients was obtained, and all subjects had a standardized diagnostic assessment with the Mini International Neuropsychiatric Interview (MINI) and with various dimensional scales of symptomatology severity, quality of life, and health care consumption. On the whole, at least one current anxiety disorder was found in 64.3% of the patients, while 55% had a depressive disorder. Individually, the prevalence rates are 29.4% for generalized anxiety disorder, 25.9% for agoraphobia, 19.2% for panic disorder, 15.3% for social phobia, 11.4% for obsessive-compulsive disorder, and 5.4% for post-traumatic stress disorder (PTSD). A history of suicide attempts was found in 12-20% of patients, and an elevated suicide risk was found for example in 25% of PTSD patients. The scores of the symptomatic scales, adaptation and quality of life measure show a very significant anxious symptomatology, with serious functional consequences. Approximately 75% of patients had another medical consultation during the three previous months, and 9% have been hospitalized. An interruption of work was found in 25% of the patients during the last three months, in average for 35 days. Concerning drug consumption before the visit by anxiety disorders patients, the preponderance of anxiolytic use is notable (85 to 98% according to categories of anxiety disorders) when compared to that of antidepressants (20 to 40%). Moreover, 38.4% of the whole sample took an anxiolytic once a day for at least three months and about 40% of them had dependence symptoms. In conclusion, this study showed the quantitative importance of anxiety disorders among psychiatric out-patients in the private practice sector in France, all the categories of anxiety being represented, and the high level of severity and burden of these disorders. Compared to some data published before, the prevalence rates of these anxiety disorders seem to be increasing.
目前，关于法国精神科门诊患者焦虑症的患病率及相关特征的数据较少，尤其是在私立医疗保健领域。然而，这是焦虑症患者主要的护理体系之一，患者可直接就诊，并可获得多种治疗方式（药物治疗以及不同类型的心理治疗）。我们研究的目的是描述在大量私立部门就诊患者中焦虑症的患病率，此外还要研究其共病情况、疾病严重程度、对生活质量的影响以及医疗保健消费情况。来自全国各地的501名精神科医生在患者首次就诊时对研究对象进行纳入和评估。纳入过程应连续进行，但排除精神障碍和痴呆患者。最终获得了1955名患者的样本，所有受试者均通过迷你国际神经精神访谈（MINI）以及各种症状严重程度、生活质量和医疗保健消费的维度量表进行标准化诊断评估。总体而言，64.3%的患者至少患有一种当前焦虑症，而55%的患者患有抑郁症。具体来说，广泛性焦虑症的患病率为29.4%，广场恐惧症为25.9%，惊恐障碍为19.2%，社交恐惧症为15.3%，强迫症为11.4%，创伤后应激障碍（PTSD）为5.4%。12%至20%的患者有自杀未遂史，例如25%的PTSD患者自杀风险升高。症状量表、适应能力和生活质量测量的得分显示出非常明显的焦虑症状，且伴有严重的功能后果。大约75%的患者在过去三个月内有过其他医疗咨询，9%的患者曾住院治疗。在过去三个月中，25%的患者工作中断，平均中断35天。关于焦虑症患者就诊前的药物使用情况，与抗抑郁药（20%至40%）相比，抗焦虑药的使用占主导地位（根据焦虑症类别，比例为85%至98%）。此外，整个样本中有38.4%的患者每天服用一次抗焦虑药至少三个月，其中约40%有依赖症状。总之，本研究表明焦虑症在法国私立医疗领域精神科门诊患者中具有重要的数量意义，涵盖了所有焦虑症类别，且这些疾病的严重程度和负担水平较高。与之前发表的一些数据相比，这些焦虑症的患病率似乎在上升。
