Fishbain David A, Goldberg Myron, Meagher Robert B, Steele Renee, Rosomoff Hubert
Neurological Surgery, University of Miami School of Medicine, Comprehensive Pain and Rehabilitation Center, South Shore Hospital, Miami Beach, FL 33139 U.S.A.
Pain. 1986 Aug;26(2):181-197. doi: 10.1016/0304-3959(86)90074-6.
Two hundred and eighty-three chronic pain patients, consecutive admissions to the Comprehensive Pain Center of the University of Miami School of Medicine, received an extensive psychiatric evaluation based upon the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (DSM-III) criteria and flowsheets. All patients received the following type of diagnoses: DSM-III axis I; DSM-III axis II, and personality type. The distribution of assigned diagnoses for the entire patient sample was reviewed and a statistical comparison between male and female patients was performed with regards to the prevalence of each diagnosis. Anxiety syndromes and depression of various diagnostic types were the most frequently assigned axis I diagnoses with over half the patient sample receiving each of these diagnoses. Males were significantly overrepresented in the axis I diagnoses of intermittent explosive disorders, adjustment disorders with work inhibitions, and alcohol abuse and other drug dependence, while females were significantly overrepresented in disorders of current depression of various diagnostic types and somatization disorders. 58.4% of the patients fulfilled criteria for axis II personality disorder diagnoses. The most frequently personality disorders found in the patient group were dependent (17.4%), passive aggressive (14.9%), and histrionic (11.7%). Males were significantly overrepresented in paranoid and narcissistic disorders while females were overrepresented in histrionic disorder. The most frequent personality types found in the patient group were compulsive (24.5%) and dependent (10.6%). All personality types were similarly distributed between the sexes. The results of the present study were compared to a previous study of DSM-III diagnoses in chronic pain patients and are discussed in terms of the prevalence of DSM-III diagnoses in the general population. Questions are raised as to the applicability of certain DSM-III diagnoses in the chronic pain population.
283名慢性疼痛患者，均为迈阿密大学医学院综合疼痛中心的连续入院患者，依据美国精神病学协会《精神疾病诊断与统计手册》（DSM-III）标准及流程表接受了全面的精神科评估。所有患者均接受了以下类型的诊断：DSM-III轴I；DSM-III轴II以及人格类型。对整个患者样本的诊断分布进行了审查，并就每种诊断的患病率对男性和女性患者进行了统计比较。焦虑综合征和各种诊断类型的抑郁症是最常被指定的轴I诊断，超过一半的患者样本接受了这些诊断中的每一种。在间歇性爆发性障碍、伴有工作抑制的适应障碍、酒精滥用和其他药物依赖的轴I诊断中，男性的比例明显过高，而在各种诊断类型的当前抑郁症和躯体化障碍中女性的比例明显过高。58.4%的患者符合轴II人格障碍诊断标准。在患者组中最常见的人格障碍是依赖型（17.4%）、被动攻击型（14.9%）和表演型（11.7%）。在偏执型和自恋型障碍中男性的比例明显过高，而在表演型障碍中女性的比例过高。在患者组中最常见的人格类型是强迫型（24.5%）和依赖型（10.6%）。所有人格类型在性别之间的分布相似。本研究的结果与之前一项关于慢性疼痛患者DSM-III诊断的研究进行了比较，并根据DSM-III诊断在一般人群中的患病率进行了讨论。针对某些DSM-III诊断在慢性疼痛人群中的适用性提出了疑问。
