Wright A F, Anderson A J
Department of Mathematical Sciences, University of Aberdeen.
Br J Gen Pract. 1995 Feb;45(391):83-7.
Relatively little is known about the natural history and outcome of psychological problems in patients who present to general practitioners. Only a small proportion of such patients are seen by specialists. Clinical experience suggests that patient personality is one of the factors influencing outcome in patients diagnosed as having psychiatric illness.
This study set out to examine prospectively the progress and 12-month outcome of patients with newly identified psychiatric illness, and the association of patients' personality with outcome.
One hundred and seventy one patients with clinically significant psychiatric illness attending one practice in a Scottish new town were followed up prospectively (96 presented with psychological symptoms and 75 with somatic symptoms), and were compared with a group of 127 patients with chronic physical illness. Patients were assessed in terms of psychiatric state, social problems and personality using both computer-based and pencil and paper tests in addition to clinical assessments at each consultation during the follow-up year and structured interview one year after recruitment.
Most of the improvement in psychiatric state scores on the 28-item general health questionnaire occurred in the first six months of the illness. Of the 171 patients with psychiatric illness 34% improved quickly and remained well, 54% had an intermittent course but had improved at 12-month follow up while 12% pursued a chronic course without improvement. The mean number of consultations in the follow-up year was 8.4 for patients presenting with psychological symptoms, 7.2 for those presenting with somatic symptoms and 6.6 for patients with chronic physical illness. The Eysenck N score proved a strong predictor of the outcome of new psychiatric illness.
Only one in three patients with newly identified psychiatric illness improved quickly and and remained well, reflecting the importance of continuing care of patients with psychological problems. This study has confirmed the feasibility of simple personality testing in everyday practice and shown a link between Eysenck N score and the outcome of new psychiatric illness. The predictive value of the Eysenck N score in general practice requires further research.
对于就诊于全科医生处的患者心理问题的自然病史和转归，人们了解相对较少。这类患者中只有一小部分会被专科医生诊治。临床经验表明，患者个性是影响被诊断患有精神疾病患者转归的因素之一。
本研究旨在前瞻性地考察新确诊精神疾病患者的病情进展及12个月的转归情况，以及患者个性与转归之间的关联。
对苏格兰一个新城镇一家诊所的171例有临床显著精神疾病的患者进行前瞻性随访（96例有心理症状，75例有躯体症状），并与127例慢性躯体疾病患者进行比较。在随访的一年中，每次会诊时除临床评估外，还使用基于计算机和纸笔的测试对患者的精神状态、社会问题和个性进行评估，并在招募一年后进行结构化访谈。
在28项一般健康问卷的精神状态评分中，大部分改善发生在疾病的前六个月。171例精神疾病患者中，34%迅速改善并保持良好状态，54%病情呈间歇性，但在12个月随访时有所改善，12%病情呈慢性进展且无改善。随访年度内，有心理症状的患者平均会诊次数为8.4次，有躯体症状的患者为7.2次，慢性躯体疾病患者为6.6次。艾森克N分证实是新患精神疾病转归的有力预测指标。
新确诊的精神疾病患者中只有三分之一迅速改善并保持良好状态，这反映了持续护理心理问题患者的重要性。本研究证实了在日常实践中进行简单个性测试的可行性，并显示了艾森克N分与新患精神疾病转归之间的联系。艾森克N分在全科医疗中的预测价值有待进一步研究。
