Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil.
Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
Braz J Psychiatry. 2019 Jan-Feb;41(1):15-21. doi: 10.1590/1516-4446-2018-0003. Epub 2018 Oct 11.
Disorders characterized by "distressing unexplained somatic symptoms" are challenging. In the ICD-11 Primary Health Care (PHC) Guidelines for Diagnosis and Management of Mental Disorders (ICD-11 PHC), a new category, bodily stress syndrome (BSS), was included to diagnose patients presenting unexplained somatic symptoms. The present study investigated the association of BSS with anxiety, depression, and four subgroups of physical symptoms in a Brazilian primary health care (PHC) sample.
As part of the international ICD-11 PHC study, 338 patients were evaluated by their primary care physicians, followed by testing with Clinical Interview Schedule (CIS-R) and World Health Organization Disability Assessment Schedule, Version 2.0 (WHODAS 2.0). BSS was diagnosed in the presence of at least three somatic symptoms associated with incapacity. The association between anxiety, depression, and four subgroups of physical symptoms with being a BSS case was analyzed.
The number of somatic symptoms was high in the overall sample of 338 patients (mean = 8.4), but even higher in the 131 BSS patients (10.2; p < 0.001). Most BSS patients (57.3%) had at least three symptoms from two, three, or four subgroups, and these were associated with anxiety and depression in 80.9% of these patients. The symptom subgroup most strongly associated with "being a BSS" case was the non-specific group (OR = 6.51; 95%CI 1.65-24.34), followed by musculoskeletal (OR = 2,31; 95%CI 1.19-4.72).
Somatic symptoms were frequent in a sample of PHC patients in Brazil. In the present sample, one third were BSS cases and met the criteria for at least two symptom subgroups, supporting the hypothesis that different functional symptoms are related to each other.
以“令人痛苦的无法解释的躯体症状”为特征的疾病具有挑战性。在《国际疾病分类第 11 版初级保健（PHC）精神障碍诊断和管理指南》（ICD-11 PHC）中，纳入了一个新类别，即身体应激综合征（BSS），用于诊断出现无法解释的躯体症状的患者。本研究调查了 BSS 与焦虑、抑郁以及巴西初级保健（PHC）样本中躯体症状的四个亚组之间的关系。
作为 ICD-11 PHC 国际研究的一部分，338 名患者由其初级保健医生进行评估，随后进行临床访谈表（CIS-R）和世界卫生组织残疾评估表第 2.0 版（WHODAS 2.0）测试。在至少有三个与能力丧失相关的躯体症状存在的情况下，诊断 BSS。分析焦虑、抑郁和躯体症状的四个亚组与 BSS 病例之间的关系。
338 名患者的总体样本中躯体症状数量较高（平均值=8.4），但在 131 名 BSS 患者中更高（10.2；p<0.001）。大多数 BSS 患者（57.3%）至少有三个来自两个、三个或四个亚组的症状，这些症状与 80.9%的患者的焦虑和抑郁有关。与“成为 BSS 病例”关系最密切的症状亚组是非特异性组（OR=6.51；95%CI 1.65-24.34），其次是肌肉骨骼组（OR=2.31；95%CI 1.19-4.72）。
巴西 PHC 患者样本中的躯体症状很常见。在本样本中，三分之一是 BSS 病例，符合至少两个症状亚组的标准，这支持了不同功能症状相互关联的假设。
