Nifosì F, Violato E, Pavan C, Sifari L, Novello G, Guarda Nardini L, Manfredini D, Semenzin M, Pavan L, Marini M
University of Padova, Italy.
Int J Psychiatry Med. 2007;37(3):283-300. doi: 10.2190/PM.37.3.f.
Aim of this study was to provide data on the relationships between psychopathological variables and temporomandibular disorders (TMD). Sixty-three TMD patients were investigated using clinical and anamnestical psychiatric informations and psychopathological measures.
Three groups of TMD patients were recruited according to the Research Diagnostic Criteria for TMD guidelines: a group of patients presenting myofascial pain alone (RDC/TMD axis I group I), a group with temporomandibular joint (TMJ) pain alone (RDC/TMD axis I group IIIa, IIIb), and a group presenting both myofascial and TMJ pain. Two secondary groups were identified on the basis of the presence/absence of myofascial pain. The study design provided a psychiatric interview and psychometric assessment including the Symptom Check List-90-Revised (SCL-90-R), the Hamilton Depression Rating Scale (HDRS), and the Hamilton Anxiety Rating Scale (HARS).
--Psychiatric evaluation: Myofascial pain patients had higher scores for personal psychiatric history and a history of more frequent psychotropic drug use. --HDRS and HARS: The sample presented scores indicating mild depressive symptoms and moderate anxiety symptoms. --SCL-90-R: The global sample showed acute levels of psychological distress as measured by the GSI score (Global Severity Index). Myofascial pain patients scored higher than TMJ pain patients in the GSI (p = .028), PAR (paranoia; p = .015), PSY (psychoticism; p = .032), and HOS (hostility; p = .034) subscales.
TMD patients showed elevated levels of depression, somatization, and anxiety. These characteristics did not differ significantly between patients with myofascial or TMJ pain. Other specific psychopathological dimensions, detected with SCL-90-R, appeared to be closely associated to the myofascial component.
本研究旨在提供有关心理病理学变量与颞下颌关节紊乱病（TMD）之间关系的数据。使用临床和既往精神科信息以及心理病理学测量方法对63名TMD患者进行了调查。
根据TMD研究诊断标准指南招募了三组TMD患者：一组仅表现为肌筋膜疼痛的患者（RDC/TMD轴I组I），一组仅表现为颞下颌关节（TMJ）疼痛的患者（RDC/TMD轴I组IIIa、IIIb），以及一组同时表现出肌筋膜和TMJ疼痛的患者。根据是否存在肌筋膜疼痛确定了两个次级组。该研究设计包括一次精神科访谈和心理测量评估，其中包括症状自评量表90修订版（SCL-90-R）、汉密尔顿抑郁量表（HDRS）和汉密尔顿焦虑量表（HARS）。
——精神科评估：肌筋膜疼痛患者的个人精神病史得分较高，且使用精神药物的频率更高。——HDRS和HARS：样本得分表明存在轻度抑郁症状和中度焦虑症状。——SCL-90-R：总体样本显示，根据GSI评分（总体严重指数）测量，心理困扰处于急性水平。在GSI（p = 0.028）、PAR（偏执；p = 0.015）、PSY（精神病性；p = 0.032）和HOS（敌对；p = 0.034）分量表中，肌筋膜疼痛患者的得分高于TMJ疼痛患者。
TMD患者表现出抑郁、躯体化和焦虑水平升高。这些特征在肌筋膜疼痛或TMJ疼痛患者之间没有显著差异。用SCL-90-R检测到的其他特定心理病理学维度似乎与肌筋膜成分密切相关。
