Wijeratne Chanaka, Brodaty Henry, Hickie Ian
St George Hospital, NSW, Australia.
Int J Geriatr Psychiatry. 2003 Sep;18(9):812-9. doi: 10.1002/gps.925.
The somatoform disorders have long been ignored by old age psychiatry. The main aim of this paper is to identify and examine possible reasons for this neglect.
A selective review of the general literature on somatoform disorders.
Significant conceptual, diagnostic and classificatory problems have impeded the consideration of somatoform disorders in older people. There is a perception that somatoform disorders are infrequent and have not been validated as independent clinical disorders. However, we present evidence that the more broadly defined somatoform disorders are common in all age groups in primary care and meet criteria for the determination of clinical validity. General difficulties in the assessment of psychiatric disorders in primary care, the setting in which somatoform disorders are most common, are compounded by a lack of support from old age psychiatry services. Effective psychological therapies may not be readily available to sufferers.
There is a need for change in the conceptualisation and nosology of the somatoform disorders. The formulation of age appropriate diagnostic criteria and presentations is a prerequisite for determining the clinical validity of these disorders in older people. This can be followed by study of their frequency, associated risk factors and treatment. A system of education that enhances the management of these disorders within primary care and old age psychiatry services is needed.
长期以来，老年精神病学一直忽视躯体形式障碍。本文的主要目的是找出并审视这种忽视可能存在的原因。
对有关躯体形式障碍的一般文献进行选择性综述。
重大的概念、诊断和分类问题阻碍了对老年人躯体形式障碍的考量。人们认为躯体形式障碍并不常见，且尚未被确认为独立的临床疾病。然而，我们提供的证据表明，在初级保健中，更广义定义的躯体形式障碍在所有年龄组中都很常见，并且符合确定临床有效性的标准。在初级保健（躯体形式障碍最常见的环境）中评估精神疾病时普遍存在的困难，因缺乏老年精神病学服务的支持而更加复杂。患者可能无法轻易获得有效的心理治疗。
有必要改变对躯体形式障碍的概念化和疾病分类学。制定适合年龄的诊断标准和表现形式是确定这些疾病在老年人中临床有效性的先决条件。接下来可以研究它们的发病率、相关风险因素和治疗方法。需要一个加强初级保健和老年精神病学服务中对这些疾病管理的教育体系。
