Barsky A J, Barnett M C, Cleary P D
Department of Psychiatry, Brigham and Women's Hospital, Boston, Mass.
Arch Gen Psychiatry. 1994 Nov;51(11):918-25. doi: 10.1001/archpsyc.1994.03950110078010.
To determine the nosological and phenomenological overlap and boundaries between panic disorder and hypochondriasis, we compared the symptoms, disability, comorbidity, and medical care of primary care patients with each diagnosis.
Patients with DSM-III-R panic disorder were recruited by screening consecutive primary care clinic attenders and then administering a structured diagnostic interview for panic disorder. Patients also completed self-report questionnaires, and their primary care physicians completed questionnaires about them. They were then compared with patients with DSM-III-R hypochondriasis from the same setting who had been studied previously.
One thousand six hundred thirty-four patients were screened; 135 (71.0% of the 190 eligible patients) completed the research battery; 100 met lifetime panic disorder criteria. Twenty-five of these had comorbid hypochondriasis. Those without comorbid hypochondriasis (n = 75) were then compared with patients with hypochondriasis without comorbid panic disorder (n = 51). Patients with panic disorder were less hypochondriacal (P < .001), somatized less (P < .05), were less disabled (P < .001), were more satisfied with their medical care (P < .001), and were rated by their physicians as less help rejecting (P < .05) and less demanding (P < .01). Major depression was more prevalent in the group with panic disorder (66.7% vs 45.1%; P < .05), as were phobias (76.0% vs 37.3%; P < .001), but somatization disorder symptoms (P < .0001) and generalized anxiety disorder were less prevalent (74.5% vs 16.0%; P < .001) in panic disorder than was hypochondriasis.
While hypochondriasis and panic disorder co-occur to some extent in a primary care population, the overlap is by no means complete. These patients are phenomenologically and functionally differentiable and distinct and are viewed differently by their primary care physicians.
为确定惊恐障碍与疑病症之间的疾病分类学及现象学上的重叠与界限，我们比较了患有这两种诊断的初级保健患者的症状、残疾情况、共病情况及医疗护理情况。
通过筛查连续就诊于初级保健诊所的患者，然后对其进行惊恐障碍的结构化诊断访谈，招募出符合《精神疾病诊断与统计手册》第三版修订版（DSM-III-R）惊恐障碍的患者。患者还完成了自我报告问卷，其初级保健医生也完成了关于他们的问卷。然后将他们与来自同一机构、之前已被研究过的符合DSM-III-R疑病症的患者进行比较。
共筛查了1634名患者；135名（占190名符合条件患者的71.0%）完成了整套研究；100名符合终生惊恐障碍标准。其中25名患有共病疑病症。然后将那些无共病疑病症的患者（n = 75）与无共病惊恐障碍的疑病症患者（n = 51）进行比较。惊恐障碍患者的疑病观念较少（P < .001），躯体化症状较少（P < .05），残疾程度较低（P < .001），对医疗护理的满意度较高（P < .001），并且其医生评定他们较少拒绝帮助（P < .05）且要求较低（P < .01）。重度抑郁症在惊恐障碍组中更为普遍（66.7% 对45.1%；P < .05），恐惧症也是如此（76.0% 对37.3%；P < .001），但与疑病症相比，惊恐障碍中的躯体化障碍症状（P < .0001）和广泛性焦虑障碍则不太普遍（74.5% 对16.0%；P < .001）。
虽然疑病症和惊恐障碍在初级保健人群中在一定程度上共同出现，但重叠并不完全。这些患者在现象学和功能上是可区分且不同的，并且他们的初级保健医生对他们的看法也不同。
