Department of Neurosciences, Section of Psychiatry, University of Genova, Genoa, Italy;
Neuropsychiatr Dis Treat. 2011;7:217-21. doi: 10.2147/NDT.S17949. Epub 2011 Apr 21.
To assess the prevalence and distribution of medically unexplained painful somatic symptoms (PSSs) versus nonpainful somatic symptoms (NPSSs) in patients diagnosed with major depressive episode (MDE).
A total of 571 outpatients diagnosed with MDE according to DSM-IV-TR criteria were consecutively enrolled into a cross-sectional, multicentric, observational study over a period of 7 months. Subjects were evaluated by means of the ad hoc validated 30-item Somatic Symptoms Checklist (SSCL-30) and Zung's questionnaires for depression and anxiety. The 32-item Hypomania Checklist (HCL-32) was also administered in order to explore any eventual association of PSSs or NPSSs with sub-threshold (DSM-IV-TR [Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision] not recognized) bipolar disorder (BD).
In our sample, just 183 patients (32%) did not report painful somatic symptoms (NPSSs). Of these, 90 patients (15.76%) had no somatic symptoms at all. The remaining 388 (68%) had at least one PSS being subdivided as follows: 248 (43%) had one or two PSSs, while 140 (25%) experienced two or more. Patients with at least one PSS also reported a greater number of nonpainful somatic symptoms than NPSS. Bipolar patients (associated with higher HCL-32 scores) were less represented across PSS cases than NPSS subjects. Conversely, females were more prone to having a higher number of total somatic symptoms (and bipolar features).
PSSs are common in patients with MDE, especially among those patients reporting fewer somatic symptoms in general as opposed to those patients who exhibit more somatic symptoms (both PSSs and NPSSs) with lower relative number of PSSs. A major therapeutic implication is that antidepressant monotherapy could be used with more confidence in unexplained PSS patients than in NPSS patients because of the latter group's lower frequency of (sub)-threshold bipolar features.
评估在符合 DSM-IV-TR 标准诊断为重度抑郁发作（MDE）的患者中，与非疼痛躯体症状（NPSS）相比，无法用医学解释的疼痛躯体症状（PSS）的患病率和分布情况。
连续纳入 571 名根据 DSM-IV-TR 标准诊断为 MDE 的门诊患者，进行为期 7 个月的横断面、多中心、观察性研究。通过专门验证的 30 项躯体症状清单（SSCL-30）和 Zung 的抑郁和焦虑问卷对患者进行评估。还使用 32 项轻躁狂清单（HCL-32）以探索 PSS 或 NPSS 与阈下（DSM-IV-TR [精神障碍诊断与统计手册，第四版，修订版]未识别）双相障碍（BD）的任何潜在关联。
在我们的样本中，只有 183 名患者（32%）没有报告疼痛躯体症状（NPSS）。其中，90 名患者（15.76%）根本没有躯体症状。其余 388 名患者（68%）至少有一种 PSS，分为以下几种情况：248 名患者（43%）有 1 或 2 种 PSS，而 140 名患者（25%）有 2 种或更多种 PSS。至少有一种 PSS 的患者报告的非疼痛躯体症状也多于 NPSS 患者。与更高的 HCL-32 评分相关的双相患者在 PSS 病例中的比例低于 NPSS 患者。相反，女性更容易出现更多的躯体症状（和双相特征）。
在 MDE 患者中，PSS 很常见，尤其是与那些总体报告躯体症状较少的患者相比，而与那些表现出更多躯体症状（PSS 和 NPSS）且 PSS 相对数量较少的患者相比。一个主要的治疗意义是，与 NPSS 患者相比，抗抑郁药单药治疗在无法解释的 PSS 患者中可能更有信心，因为后者出现（阈下）双相特征的频率较低。
