Olfson M, Weissman M M, Leon A C, Farber L, Sheehan D V
College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA.
J Fam Pract. 1996 Nov;43(5):481-8.
Psychotic symptoms include a variety of disturbances in perception, reality testing, speech, and behavior. We examine the prevalence, distribution, treatment, and functional impairment associated with psychotic symptoms in primary care patients.
Data are drawn from a recent study of adult primary care patients (N = 1001) in a large, urban, prepaid group practice. At the medical visit, patients completed a questionnaire that probed demographic characteristics, health status, and mental health care utilization. Following the visit, patients received a telephone-administered, structured psychiatric interview that included 11 psychotic symptoms. Medication prescription data were also available. Comparisons are presented of patients with and without psychotic symptoms.
Thirty-seven (3.7%) patients reported one or more psychotic symptoms, most commonly a belief that others were spying on or following them (n = 16). As compared with patients without psychotic symptoms, a larger proportion of the patients with psychotic symptoms reported mental health-related work loss (54.1% vs 17.9%, P < .0001), suicidal ideation (21.6% vs 2.6%, P < .0001), major depressive disorder (32.4% vs 6.3%, P < .0001), bipolar disorder (29.7% vs 1.2%, P < .0001), and several other mental disorders. An antipsychotic medication had been prescribed during the previous 17 to 20 months for only two (5.4%) of the patients with psychotic symptoms.
Psychotic symptoms were relatively common (3.7%) in this practice and were strongly associated with functional impairment and affective, anxiety, or substance use disorders. Primary care physicians are encouraged to examine patients with these mental disorders for the presence of psychotic symptoms.
精神病性症状包括感知、现实检验、言语和行为方面的多种障碍。我们研究了初级保健患者中与精神病性症状相关的患病率、分布、治疗及功能损害情况。
数据来自对一个大型城市预付费团体医疗实践中成年初级保健患者（N = 1001）的近期研究。在就诊时，患者完成一份问卷，询问人口统计学特征、健康状况和精神卫生保健利用情况。就诊后，患者接受电话进行的结构化精神科访谈，其中包括11种精神病性症状。还可获取药物处方数据。对有和没有精神病性症状的患者进行了比较。
37名（3.7%）患者报告有1种或更多种精神病性症状，最常见的是认为他人在监视或跟踪自己（n = 16）。与没有精神病性症状的患者相比，有精神病性症状的患者中报告因心理健康问题导致工作损失的比例更高（54.1% 对17.9%，P < .0001）、有自杀观念的比例更高（21.6% 对2.6%，P < .0001）、患有重度抑郁症的比例更高（32.4% 对6.3%，P < .0001）、患有双相情感障碍的比例更高（29.7% 对1.2%，P < .0001）以及患有其他几种精神障碍的比例更高。在之前17至20个月期间，只有两名（5.4%）有精神病性症状的患者曾开具过抗精神病药物处方。
在该医疗实践中，精神病性症状相对常见（3.7%），且与功能损害以及情感、焦虑或物质使用障碍密切相关。鼓励初级保健医生检查患有这些精神障碍的患者是否存在精神病性症状。
