Koyanagi Ai, Stickley Andrew, Haro Josep Maria
Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain.
The Stockholm Centre for Health and Social Change (SCOHOST), Södertörn University, Huddinge 141 89, Sweden.
Schizophr Res. 2016 Aug;175(1-3):209-215. doi: 10.1016/j.schres.2016.04.031. Epub 2016 May 5.
Information on the association between subclinical psychosis and pain is scarce, and the role of common mental disorders (CMDs) in this association is largely unknown. The aim of the current study was to therefore assess this association in the general population using nationally representative data from England.
Data for 7403 adults aged≥16years were used from the 2007 Adult Psychiatric Morbidity Survey. Five forms of psychotic symptoms were assessed by the Psychosis Screening Questionnaire, while pain was assessed in terms of the level of its interference with work activity in the past four weeks. The Clinical Interview Schedule Revised (CIS-R) was used to assess anxiety disorders, depressive episode, and mixed anxiety-depressive disorder (MADD). Participants with probable or definite psychosis were excluded. The association between psychotic symptoms and pain was assessed by ordinal and binary logistic regression analysis.
When adjusted for confounders other than CMDs, psychotic symptoms were significantly associated with pain [e.g., the OR (95%CI) for the severest form of pain (binary outcome) was 1.78 (1.11-2.85)]. However, this association was no longer significant when CMDs were controlled for in most analyses. Anxiety disorders and depressive episode explained 34.8%-47.1% of the association between psychotic symptoms and pain, while this percentage increased to 62.7%-78.0% when the sub-threshold condition of MADD was also taken into account.
When coexisting psychotic symptoms and pain are detected, assessing for anxiety and depression (even at sub-threshold levels) may be important for determining treatment options.
关于亚临床精神病与疼痛之间关联的信息匮乏，常见精神障碍（CMDs）在这种关联中的作用也大多未知。因此，本研究的目的是利用来自英格兰的具有全国代表性的数据，在普通人群中评估这种关联。
使用了2007年成人精神病发病率调查中7403名年龄≥16岁成年人的数据。通过精神病筛查问卷评估五种形式的精神病症状，同时根据过去四周疼痛对工作活动的干扰程度评估疼痛。使用修订后的临床访谈时间表（CIS-R）评估焦虑症、抑郁发作和混合性焦虑抑郁障碍（MADD）。排除可能或确诊为精神病的参与者。通过有序和二元逻辑回归分析评估精神病症状与疼痛之间的关联。
在对除CMDs之外的混杂因素进行调整后，精神病症状与疼痛显著相关[例如，最严重形式的疼痛（二元结局）的OR（95%CI）为1.78（1.11 - 2.85）]。然而，在大多数分析中，当对CMDs进行控制时，这种关联不再显著。焦虑症和抑郁发作解释了精神病症状与疼痛之间关联的34.8% - 47.1%，而当也考虑MADD的亚阈值状态时，这一百分比增加到62.7% - 78.0%。
当检测到同时存在精神病症状和疼痛时，评估焦虑和抑郁（即使处于亚阈值水平）对于确定治疗方案可能很重要。
