Bujoreanu Simona, Randall Edin, Thomson Katharine, Ibeziako Patricia
Boston Children's Hospital and Harvard Medical School, Boston, MA
Boston Children's Hospital and Harvard Medical School, Boston, MA.
Hosp Pediatr. 2014 Sep;4(5):283-90. doi: 10.1542/hpeds.2014-0023.
To describe demographic, diagnostic, and psychosocial characteristics of medically admitted patients diagnosed with somatoform disorders.
Retrospective chart reviews were performed for pediatric patients (ages 3-18 years) seen by the Psychiatry Consultation Service in 2010 and 2011 on inpatient medical/surgical units and diagnosed with somatoform disorders. Data included demographic information; patient medical history, physical symptom characteristics, and service utilization; psychiatric diagnoses, history, and comorbidities, patient temperament, and coping style; family characteristics; and academic and social characteristics.
Mean age for the 161 identified patients was 14.4 years. The majority of patients were female (75%) and white (73%). Chief physical symptoms were pain (58%) and neurologic symptoms (40%); 73% of patients had medical diagnoses, and 66% had a history of prior psychiatric treatment. The most common somatoform diagnoses, using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, were pain (50%) and conversion disorders (28%). Psychiatric comorbidities were predominantly mood and anxiety disorders (42% and 29%, respectively). Mean hospitalization length was 4.9 days, with 14% of patients readmitted with psychiatric reinvolvement during the study period. Patients had sensitive temperaments (80%) and internalizing coping styles (76%) and were described as "good children" (72%). School absences (55%), academic pressures (51%), and learning difficulties (36%) were reported.
Clarifying the prevalence and nature of such characteristics can help pediatric providers improve patient care and minimize unnecessary medical interventions with early detection of risk for somatoform processes, provision of psychoeducation for patients and families, and early referral to mental health clinicians.
描述被诊断为躯体形式障碍的内科住院患者的人口统计学、诊断及心理社会特征。
对2010年和2011年在住院内科/外科病房接受精神科会诊服务且被诊断为躯体形式障碍的儿科患者（3至18岁）进行回顾性病历审查。数据包括人口统计学信息；患者病史、躯体症状特征及服务利用情况；精神科诊断、病史及共病情况、患者气质及应对方式；家庭特征；以及学业和社会特征。
161名确诊患者的平均年龄为14.4岁。大多数患者为女性（75%）且为白人（73%）。主要躯体症状为疼痛（58%）和神经症状（40%）；73%的患者有医学诊断，66%有既往精神科治疗史。根据《精神障碍诊断与统计手册》第四版修订版，最常见的躯体形式诊断为疼痛（50%）和转换障碍（28%）。精神科共病主要为情绪和焦虑障碍（分别为42%和29%）。平均住院时长为4.9天，14%的患者在研究期间因精神科问题再次入院。患者气质敏感（80%），采用内化应对方式（76%），被描述为“好孩子”（72%）。报告显示存在缺课（55%）、学业压力（51%）和学习困难（36%）。
明确此类特征的患病率及性质有助于儿科医疗人员改善患者护理，通过早期发现躯体形式障碍的风险、为患者及家属提供心理教育以及尽早转诊至心理健康临床医生，尽量减少不必要的医疗干预。
