Limburg Karina, Sattel Heribert, Radziej Katharina, Lahmann Claas
Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität, Klinikum Großhadern, Munich, Germany.
Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
J Psychosom Res. 2016 Dec;91:26-32. doi: 10.1016/j.jpsychores.2016.10.005. Epub 2016 Oct 18.
DSM-5 somatic symptom disorder (SSD) could potentially be a highly relevant diagnosis for patients with vertigo and dizziness. The criteria of SSD, particularly the B-criterion with its three components (cognitive, affective, behavioral), have however not yet been investigated in this patient group.
We evaluated a large sample (n=399) of outpatients presenting in a neurological setting. Physical examinations and a psychometric assessment (SCID-I) were conducted; patients completed self-report questionnaires. The diagnosis of SSD was assigned retrospectively. The prevalence of SSD, its diagnostic criteria, and its overlap with former DSM-IV somatoform disorders were evaluated; comparisons were drawn between (1) patients fulfilling different components of the B-criterion and (2) patients with diagnoses after DSM-IV vs. DSM-5.
SSD was almost twice as common as DSM-IV somatoform disorders. Patients with all three components of the B-criterion reported the highest impairment levels. Patients with both DSM-IV somatoform disorders and DSM-5 SSD were more impaired compared to groups with one of the diagnoses; patients with DSM-IV somatoform disorders only were more impaired than those with SSD only.
Our findings demonstrate that SSD is highly prevalent in patients with vertigo and dizziness. The classification of severity based on the number of psychological symptoms appears valid and may assist in finding suitable treatment options according to clinical practice guidelines. Future studies should investigate the overlap of SSD and other psychiatric disorders, this may assist in better defining the diagnostic criteria of SSD.
《精神疾病诊断与统计手册》第5版（DSM-5）中的躯体症状障碍（SSD）可能是眩晕和头晕患者的一个高度相关诊断。然而，SSD的标准，特别是具有三个组成部分（认知、情感、行为）的B标准，尚未在该患者群体中进行研究。
我们评估了一大样本（n = 399）在神经科就诊的门诊患者。进行了体格检查和心理测量评估（SCID-I）；患者完成了自我报告问卷。SSD的诊断是回顾性确定的。评估了SSD的患病率、其诊断标准以及与既往DSM-IV躯体形式障碍的重叠情况；对（1）满足B标准不同组成部分的患者之间以及（2）DSM-IV与DSM-5诊断后的患者之间进行了比较。
SSD几乎是DSM-IV躯体形式障碍的两倍常见。具有B标准所有三个组成部分的患者报告的损伤水平最高。与仅有一种诊断的组相比，同时患有DSM-IV躯体形式障碍和DSM-5 SSD的患者损伤更严重；仅患有DSM-IV躯体形式障碍的患者比仅患有SSD的患者损伤更严重。
我们的研究结果表明，SSD在眩晕和头晕患者中高度普遍。基于心理症状数量的严重程度分类似乎有效，并且可能有助于根据临床实践指南找到合适的治疗选择。未来的研究应调查SSD与其他精神障碍的重叠情况，这可能有助于更好地界定SSD的诊断标准。
