Nakamura Yuzo, Takeuchi Takeaki, Hashimoto Kazuaki, Hashizume Masahiro
Department of Psychosomatic Medicine, Toho University School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541 Japan.
Biopsychosoc Med. 2017 Jun 28;11:16. doi: 10.1186/s13030-017-0104-x. eCollection 2017.
Somatization is produced due to the summation of psychological factors, irrespective of the presence or absence of physical factors. A group of diseases with severe pain and other disorders exhibit so-called Medically Unexplained Symptoms (MUS), and the characteristics of patients with MUS are largely unexplained. In this paper, the characteristics of a series of new patients with somatization treated in a Japanese university hospital are discussed.
The subjects were 871 patients who newly visited the Department of Psychosomatic Medicine, Toho University Omori Medical Center between January and December of 2015. Under the assumption that the definition of somatization is same as that of MUS, the correlation between somatization and the age, sex, academic background, chief complaints, reasons for visiting the medical center, diagnosis, symptoms, presence or absence of a referral form, continued treatment after the first visit, and marital status of these patients at the time of their respective examinations were evaluated.
Of the patients studied, 68% suffered from somatization. Among them, 11% met the definition of Functional Somatic Symptoms (FSS) and 74% had somatization associated with mood disorder or anxiety disorder. Digestive symptoms were reported by 33%, headaches by 24%, and unusual sensations by 21%. Whereas no correlation was found between somatization symptoms and the patients' academic background, marital history, or medical history after the first visit, a positive correlation ( < 0.05) was found between somatization and patients who had been referred by their doctor.
Many of the studied patients who suffered from somatization, regardless of age and sex, were referred to us by doctors from other hospitals. It was concluded that many patients difficult to diagnose or deal with are referred the Department of Psychosomatic Medicine of Japanese university hospitals, thus these hospitals must assume great responsibility for preventing mistaken diagnoses by conducting effective psychological treatment and thorough medical examinations.
躯体化是由心理因素累积所致，与身体因素是否存在无关。一组伴有严重疼痛及其他紊乱症状的疾病呈现出所谓的医学无法解释的症状（MUS），而MUS患者的特征在很大程度上无法解释。本文讨论了日本一家大学医院收治的一系列新的躯体化患者的特征。
研究对象为2015年1月至12月期间首次就诊于东邦大学大森医疗中心身心医学科的871例患者。假设躯体化的定义与MUS相同，评估躯体化与这些患者各自检查时的年龄、性别、学历背景、主要诉求、就诊原因、诊断、症状、是否有转诊单、首次就诊后的持续治疗情况以及婚姻状况之间的相关性。
在研究的患者中，68%患有躯体化。其中，11%符合功能性躯体症状（FSS）的定义，74%的躯体化与情绪障碍或焦虑障碍相关。33%的患者报告有消化症状，24%有头痛症状，21%有异常感觉。虽然躯体化症状与患者的学历背景、婚姻史或首次就诊后的病史之间未发现相关性，但躯体化与经医生转诊的患者之间存在正相关（P<0.05）。
许多研究中患有躯体化的患者，无论年龄和性别，都是由其他医院的医生转诊至我院的。得出的结论是，许多难以诊断或处理的患者被转诊至日本大学医院的身心医学科，因此这些医院必须承担起重大责任，通过开展有效的心理治疗和全面的医学检查来防止误诊。
