House A
Department of Clinical Neurology, Radcliffe Infirmary, Oxford, UK.
Gen Hosp Psychiatry. 1989 May;11(3):156-65. doi: 10.1016/0163-8343(89)90035-2.
This article outlines the main components of a comprehensive plan for the assessment and management of patients referred for a psychiatric opinion with hypochondriasis and related disorders. Particular emphasis is placed on the discussion of attitudes to previous medical contact, to the value of physical investigations, and to the psychiatric referral itself; these attitudes are often neglected and yet are of clinical importance because they are usually associated with resistance to psychiatric treatment. A short-term flexible therapeutic approach to the presenting syndrome itself is outlined, which is based on cognitive-behavioral strategies used in other emotional disorders and on the literature on hypochondriasis. Clinical experience with this approach suggests that nonattendance may be high even in those who present for initial assessment, but that for attenders the prognosis may be good, with 80% showing a marked or moderate improvement on discharge. Younger patients, those with a past psychiatric history, and those receiving state benefits did worse, and those with major depression had the best prognosis. Social function, personal distress, and preoccupation with symptoms all tend to improve more than the underlying physical symptoms themselves.
本文概述了针对因疑病症及相关障碍而寻求精神科意见的患者进行评估与管理的综合计划的主要组成部分。特别强调了对既往医疗接触的态度、体格检查的价值以及精神科转诊本身的讨论；这些态度常常被忽视，但却具有临床重要性，因为它们通常与抗拒精神科治疗相关。文中概述了针对所呈现综合征本身的短期灵活治疗方法，该方法基于用于其他情绪障碍的认知行为策略以及关于疑病症的文献。采用这种方法的临床经验表明，即使在前来进行初次评估的患者中，失访率可能也很高，但对于前来就诊的患者，预后可能良好，80%的患者在出院时显示出明显或中度改善。年轻患者、有既往精神病史的患者以及领取国家福利的患者预后较差，而患有重度抑郁症的患者预后最佳。社会功能、个人痛苦以及对症状的过度关注往往比潜在的躯体症状本身改善得更多。
