University of Groningen, University Medical Center Groningen, Interdisciplinary Center for Psychopathology of Emotion Regulation (ICPE), Groningen, The Netherlands.
SeniorBeter, Practice for Old Age Psychiatry, Gendt, The Netherlands.
Eur Psychiatry. 2020 May 20;63(1):e56. doi: 10.1192/j.eurpsy.2020.51.
Empirical studies on the clinical characteristics of older persons with medically unexplained symptoms are limited to uncontrolled pilot studies. Therefore, we aim to examine the psychiatric characteristics of older patients with medically unexplained symptoms (MUS) compared to older patients with medically explained symptoms (MES), also across healthcare settings.
A case-control study including 118 older patients with MUS and 154 older patients with MES. To include patients with various developmental and severity stages, patients with MUS were recruited in the community (n = 12), primary care (n = 77), and specialized healthcare (n = 29). Psychopathology was assessed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria (Mini-International Neuropsychiatric Interview) and by dimensional measures (e.g., psychological distress, hypochondriasis, and depressive symptoms).
A total of 69/118 (58.5%) patients with MUS met the criteria for a somatoform disorder according to DSM-IV-TR criteria, with the highest proportion among patients recruited in specialized healthcare settings (p = 0.008). Patients with MUS had a higher level of psychological distress and hypochondriasis compared to patients with MES. Although psychiatric disorders (beyond somatoform disorders) were more frequently found among patients with MUS compared to patients with MES (42.4 vs. 24.8%, p = 0.008), this difference disappeared when adjusted for age, sex, and level of education (odds ratio = 1.7 [95% confidence interval: 1.0-3.0], p = 0.070).
Although psychological distress is significantly higher among older patients with MUS compared to those with MES, psychiatric comorbidity rates hardly differ between both patient groups. Therefore, treatment of MUS in later life should primarily focus on reducing psychological distress, irrespective of the healthcare setting patients are treated in.
针对有医学无法解释症状的老年人的临床特征的实证研究仅限于无对照的试点研究。因此，我们旨在检查与有医学可解释症状（MES）的老年人相比，有医学无法解释症状（MUS）的老年患者的精神科特征，同时也涵盖不同的医疗保健环境。
本项病例对照研究纳入了 118 名有 MUS 的老年患者和 154 名有 MES 的老年患者。为了纳入具有不同发展和严重程度阶段的患者，MUS 患者在社区（n=12）、初级保健（n=77）和专门的医疗保健机构（n=29）中进行招募。采用《精神障碍诊断与统计手册》第四版修订版（DSM-IV-TR）标准（迷你国际神经精神病访谈）和维度测量（如心理困扰、疑病症和抑郁症状）来评估精神病理学。
根据 DSM-IV-TR 标准，共有 69/118（58.5%）名 MUS 患者符合躯体形式障碍的标准，在专门医疗保健机构招募的患者中比例最高（p=0.008）。与 MES 患者相比，MUS 患者的心理困扰和疑病症程度更高。尽管与 MES 患者相比，MUS 患者的精神障碍（躯体形式障碍以外）更为常见（42.4%比 24.8%，p=0.008），但在调整年龄、性别和教育程度后，这种差异消失（比值比=1.7[95%置信区间：1.0-3.0]，p=0.070）。
尽管与 MES 患者相比，有 MUS 的老年患者的心理困扰明显更高，但两组患者的精神共病率几乎没有差异。因此，无论患者在哪个医疗保健环境中接受治疗，针对晚年 MUS 患者的治疗都应主要集中于减轻心理困扰。
