Roy-Byrne P P
Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center, Seattle 98104, USA.
J Clin Psychiatry. 1996;57 Suppl 7:86-91.
Generalized anxiety and mixed anxiety-depression have received less attention than the major mood and anxiety disorders ith respect to their possible effects in increasing disability and health care utilization. A review of recent studies, however, indicates that these conditions are prevalent in primary care medical settings and are associated with significant social and occupational disability. Generalized anxiety disorder is also one of the most common diagnoses seen in patients presenting with medically unexplained somatic complaints such as chest pain, irritable bowel symptoms, and hyperventilation and in patients prone to overutilize health care services in general. It is poorly recognized by primary care physicians, possibly due to its chronicity, which may limit the ability of symptoms to "stand out" and be easily detected. However, it is disproportionately present in "high utilizer" samples found to be particularly "frustrating" to their physicians and is accompanied by a high rate of personality disorders, suggesting that maladaptive personality traits and styles of interaction in such patients may also contribute to underrecognition of symptoms by primary care physicians. These preliminary associations between generalized anxiety disorder/mixed anxiety-depression and both disability and increased health care utilization need to be confirmed with carefully designed and controlled studies.
与主要的情绪和焦虑障碍相比，广泛性焦虑症和混合性焦虑抑郁在增加残疾和医疗保健利用方面的可能影响受到的关注较少。然而，对近期研究的回顾表明，这些病症在初级保健医疗环境中很普遍，并且与严重的社会和职业残疾相关。广泛性焦虑症也是出现医学上无法解释的躯体症状（如胸痛、肠易激症状和换气过度）的患者以及总体上倾向于过度使用医疗保健服务的患者中最常见的诊断之一。初级保健医生对其认识不足，可能是由于其慢性病程，这可能会限制症状“突出”并易于检测的能力。然而，它在被发现对医生特别“令人沮丧”的“高利用者”样本中不成比例地存在，并且伴随着高比例的人格障碍，这表明这些患者中适应不良的人格特征和互动方式也可能导致初级保健医生对症状的认识不足。广泛性焦虑症/混合性焦虑抑郁与残疾和医疗保健利用增加之间的这些初步关联需要通过精心设计和对照的研究来证实。
