Nickel Ralf, Hardt Jochen, Kappis Bernd, Schwab Rainer, Egle Ulrich T
HSK, Klinik für Psychosomatische Medizin und Psychotherapie, Dr. Horst Schmidt Klinik Wiesbaden, 65388 Schlangenbad.
Z Psychosom Med Psychother. 2010;56(1):3-22. doi: 10.13109/zptm.2010.56.1.3.
What impact do the degree of somatization and the presence of a comorbid psychological disorder have on health-related quality of life in patients with pain-dominated somatoform disorders?
282 consecutive patients (57.6 %) from a total population of N=490 patients fulfilling the criteria of somatoform pain disorders were included in the study following a thorough interdisciplinary diagnostic process at a German university hospital. Structured interviews (SKIDI and SKID-II) to assess comorbid psychological disorders as well as a structured biographical interview to assess chronification factors were conducted. We employed the Screening for Somatoform Disorders form (SOMS) to discover the extent and distribution of somatic symptoms and the SF-36 to determine the health-related quality of life.
The patients exhibited a multiplicity of further somatic complaints apart from pain. 69 % had a comorbid psychological disorder. The health-related physical and psychological quality of life was clearly impaired in patients with "small", "substantial" and "pronounced" somatization. Regression analysis explained 48 % of the variance of the body-related and 35 % of the variance of the psychological quality of life: Besides the extent of somatization, older age, duration of pain-associated hospitalizations and the subjective amount of occupational impairment proved to be important. With regard to the psychological (but not the somatic) health-related quality of life, the presence of a current comorbid psychological disorder was also relevant.
Patients with pain-dominated somatoform disorders are substantially impaired in their quality of life. Because 31 % of the patients with such disorders have no additional comorbid psychic disorder and the existence of a comorbid psychic disorder impacts only the psychological domain of their health-related quality of life, the results appear to strongly support maintaining the diagnostic category of somatoform disorders in ICD-11 and DSM-V. They also support the grading of the severity of the somatization similar to the grading of depressive disorders.
在以疼痛为主的躯体形式障碍患者中，躯体化程度和共病心理障碍的存在对健康相关生活质量有何影响？
在德国一家大学医院经过全面的多学科诊断流程后，从符合躯体形式疼痛障碍标准的490名患者总体中纳入了282名连续患者（占57.6%）。进行了结构化访谈（SKIDI和SKID-II）以评估共病心理障碍，并进行了结构化的个人经历访谈以评估慢性化因素。我们使用躯体形式障碍筛查表（SOMS）来发现躯体症状的程度和分布，并使用SF-36来确定健康相关生活质量。
除疼痛外，患者还表现出多种其他躯体不适。69%的患者患有共病心理障碍。在存在“轻度”、“中度”和“重度”躯体化的患者中，与健康相关的生理和心理生活质量明显受损。回归分析解释了与身体相关的生活质量方差的48%和心理生活质量方差的35%：除了躯体化程度外，年龄较大、与疼痛相关的住院时间以及职业损伤的主观程度也被证明是重要的。关于与心理（而非躯体）健康相关的生活质量方面，当前共病心理障碍的存在也具有相关性。
以疼痛为主的躯体形式障碍患者的生活质量受到严重损害。由于此类障碍患者中有31%没有额外的共病精神障碍，且共病精神障碍仅影响其与健康相关生活质量的心理领域，因此这些结果似乎有力地支持在《国际疾病分类第11版》（ICD-11）和《精神疾病诊断与统计手册第5版》（DSM-V）中保留躯体形式障碍的诊断类别。它们还支持类似于抑郁症严重程度分级的躯体化严重程度分级。
