Interian Alejandro, Gara Michael A, Díaz-Martínez Angélica M, Warman Melissa J, Escobar Javier I, Allen Lesley A, Manetti-Cusa Julian
UMDNJ-Robert Wood Johnson Medical School, Piscataway, New Jersey 08854-5635, USA.
Psychosom Med. 2004 Jan-Feb;66(1):141-6. doi: 10.1097/01.psy.0000107883.14385.ec.
This study sought to examine the relationship between pseudoneurological symptoms (PNS) and somatic and psychiatric symptom severity, physical functioning, and psychiatric comorbidity.
Interview and questionnaire data were obtained from 120 patients with somatization who participated in a study assessing the efficacy of cognitive-behavioral therapy. Measures elicited information on psychiatric diagnoses, anxiety and depressive symptom levels, somatic symptoms, and physical functioning. Statistical analyses examined the relationship between PNS and the diagnosis of somatization disorder, physical and psychiatric symptom severity, and psychiatric comorbidity.
Roughly half of the sample had a history of four or more PNS. Results showed that having four or more PNS was not predictive of somatization disorder. However, having four or more PNS was found to be significantly correlated with the severity of anxiety, depression, somatic complaints, and physical dysfunction. These associations were identified while controlling for the symptom count of nonpseudoneurological symptoms, the presence of somatization disorder, and the presence of chronic painful physical conditions. In addition, having four or more PNS was significantly associated with a higher likelihood of receiving a diagnosis of major depression, dysthymia, panic disorder, and generalized anxiety disorder.
A history of four or more PNS is common among somatizing patients in primary care and associated with a more severe clinical presentation, even after controlling for other factors known to be associated with severity. Four or more PNS may identify a distinct subgroup of somatization and serve as a clinical indicator for identifying psychiatric disorders in primary care. Future studies should explore the assessment of PNS using briefer measures. Furthermore, PNS should be evaluated with samples more representative of US primary care populations, as well as samples that include adequate representation from other ethnic backgrounds (eg, African-American, Asian, etc.).
本研究旨在探讨假性神经症状（PNS）与躯体及精神症状严重程度、身体功能以及精神共病之间的关系。
从120名参与评估认知行为疗法疗效研究的躯体化患者处获取访谈及问卷数据。测量方法获取了有关精神诊断、焦虑和抑郁症状水平、躯体症状及身体功能的信息。统计分析检验了PNS与躯体化障碍诊断、身体和精神症状严重程度以及精神共病之间的关系。
大约一半的样本有四种或更多PNS病史。结果显示，有四种或更多PNS并不能预测躯体化障碍。然而，发现有四种或更多PNS与焦虑、抑郁、躯体主诉及身体功能障碍的严重程度显著相关。这些关联是在控制了非假性神经症状的症状数量、躯体化障碍的存在以及慢性疼痛身体状况的存在后确定的。此外，有四种或更多PNS与被诊断为重度抑郁、心境恶劣、惊恐障碍及广泛性焦虑障碍的更高可能性显著相关。
在初级保健的躯体化患者中，有四种或更多PNS病史很常见，并且与更严重的临床表现相关，即使在控制了已知与严重程度相关的其他因素之后也是如此。四种或更多PNS可能识别出一个独特的躯体化亚组，并作为在初级保健中识别精神障碍的临床指标。未来的研究应探索使用更简短的测量方法评估PNS。此外，应使用更能代表美国初级保健人群的样本以及包括其他种族背景（如非裔美国人、亚洲人等）充分代表性的样本对PNS进行评估。
