Maizels Morris, Smitherman Todd A, Penzien Donald B
Department of Family Medicine, Kaiser Permanente, Woodland Hills, CA 91365, USA.
Headache. 2006 Oct;46 Suppl 3:S98-109. doi: 10.1111/j.1526-4610.2006.00561.x.
Psychiatric comorbidity, especially depression and anxiety, has been well documented in patients with primary headache disorders. The presence of psychiatric comorbidity in headache patients is associated with decreased quality-of-life, poorer prognosis, chronification of disease, poorer response to treatment, and increased medical costs. Despite the prevalence and impact, screening for psychiatric disorders in headache patients is not systematically performed, either clinically or in research studies, and there are no guidelines to suggest which patients should be screened or in what manner. We review a variety of screening methods and instruments, focusing primarily on self-report measures and those available in the public domain. Informal verbal screening may be sufficient in a primary care setting, but should include screening for both anxiety and depression. Explicit screening for anxiety is important, as anxiety may have a more significant impact on headache than does depression and may occur in the absence of clinical depression. Formal screening with instruments that can identify a variety of psychiatric disorders is appropriate for patients with daily headache syndromes, patients who are refractory to usual care, and patients referred for specialty evaluation. Limitations of screening instruments include the influence of transdiagnostic symptoms and the need for confirmatory diagnostic interview. The following instruments appear most suitable for use in headache patients: for depression, the Patient Health Questionnaire Depression Module, the Beck Depression Inventory-II, or the Beck Depression Inventory-Primary Care; for anxiety, the Beck Anxiety Inventory and the Generalized Anxiety Disorder 7-item Scale; and for multidimensional psychiatric screening, the Patient Health Questionnaire or Primary Care Evaluation of Mental Disorders.
精神共病，尤其是抑郁症和焦虑症，在原发性头痛疾病患者中已有充分记录。头痛患者中精神共病的存在与生活质量下降、预后较差、疾病慢性化、治疗反应较差以及医疗费用增加有关。尽管患病率和影响较大，但在临床或研究中，并未系统地对头痛患者进行精神障碍筛查，也没有指南表明哪些患者应接受筛查或采用何种方式进行筛查。我们回顾了多种筛查方法和工具，主要侧重于自我报告测量方法以及公共领域可用的方法。在初级保健环境中，非正式的口头筛查可能就足够了，但应包括焦虑和抑郁的筛查。对焦虑进行明确筛查很重要，因为焦虑对头痛的影响可能比抑郁更大，且可能在无临床抑郁的情况下出现。对于每日头痛综合征患者、对常规治疗无效的患者以及转诊进行专科评估的患者，使用能够识别多种精神障碍的工具进行正式筛查是合适的。筛查工具的局限性包括跨诊断症状的影响以及需要进行确诊性诊断访谈。以下工具似乎最适合用于头痛患者：用于抑郁症筛查的患者健康问卷抑郁模块、贝克抑郁量表第二版或贝克抑郁量表初级保健版；用于焦虑症筛查的贝克焦虑量表和广泛性焦虑障碍7项量表；用于多维精神筛查的患者健康问卷或精神障碍初级保健评估量表。
