七轴诊断在围绝经期抑郁障碍评估中的应用  

Seven axial diagnosis for menopausal patients with depression

作　　者：肖春玲[1] 陈彦方[1] 王昕[2] 尹福波[3] 王秋燕[2] 孙航克[2] 张莉[2] 杨钟莉[3] 侯洪春[4] 

机构地区：[1]北京回龙观医院 [2]济南铁路中心医院 [3]山东省立医院妇产科 [4]济南市妇幼保健院

出　　处：《上海精神医学》2008年第4期219-222,共4页Shanghai Archives of Psychiatry

基　　金：济南铁路局课题(02Y43-2)

摘　　要：目的探讨"健康与疾病定量测试法(RTHD-LVS)"七轴诊断系统对评估综合医院围绝经期抑郁障碍的适用性。方法按ICD-10抑郁发作诊断标准,选取66例围绝经期患者,应用RTHD-LVS等进行评估,并应用氟西汀和心理干预等治疗6周。结果轴1精神障碍:66例患者的第一诊断均符合ICD-10抑郁发作诊断标准;轴2人格特征:66例内、外向人格特征突出者各7例(10.6%),中间型人格52例(78.8%);轴3躯体状况:本组患者均符合WHO围绝经期研究组对围绝经期的定义,有月经紊乱史。其中部分患者在评定时存在一项或多项中重度躯体症状,如神经系统及内分泌系统症状45例(68.2%);轴4社会心理因素:患者病前1年以内有肯定的精神刺激作为诱因者42例(63.6%),主要为求医问题、职业问题等。轴5社会功能:本组患者目前社会功能水平评为较好与一般者10例(15.2%),而病前两年最佳社会功能水平较好与一般65例(98.5%),二者差异有统计学意义(χ2=8.03,P<0.01)。患者目前功能稍差或更差者(F50≥5)55例(83.3%),与最重社会功能损害稍差或更差者(F51≥5)56例(84.8%)几近相等。轴6现状总评:本组患者评定当时现状为无效或恶化者61例(92.4%)。患者的现状总评与M41自知力及轴5目前社会功能评定的相关系数分别为r=0.464(P<0.001)与r=0.254(P<0.01);轴7诊断轴间的关系:本组患者的抑郁障碍系围绝经期月经紊乱所致,表达为:轴3围绝经期月经紊乱—(3)→轴1围绝经期抑郁障碍。结论RTHD-LVS的七轴诊断系统适用于绝经期抑郁障碍的诊断,并且从生物心理社会各层面作了全面的评估。Objective： To assess the applicability of the seven axial diagnosis system of Rating Test for Health and Disease and its logical verdict system （RTHD- LVS） among menopausal patients with depression. Methods The seven axes of RTHD for 66 patients who met International Classification of Deseases - 10（ ICD - 10） criteria of menopausal depression were assessed. All the patients were treated with fluoxetine and psychological intervention for 6 weeks. Results Axis I （ mental disorder） all 66 patients had the primary diagnosis of menopausal depression; Axis II （personality traits） 7 patients were introverted, 7 extroverted and 52 demonstrated both introverted and extroverted traits （ i. e. , middle personality traits ）. Axis III（ general medical conditions） all 66 patients were currently in their menopausal phase and had abnormal menstruation.＂ Some had physical symptoms, such as neurological endocrine symptoms （68. 2% ）. Axis IV （bio - psychosocial stressors） 42（63.6% ） had experienced negative life events within one year of premorbidity. Axis V （ social functioning） 56 had grossly inadequate functioning at the time of their worst impairment, and 55 had poor or grossly inadequate functioning during the interview. Axis VI （global assessment of present state） 61 （92.4%） had experienced no effects or had become worse. Axis VII （relationship between axes） all 66 patients were in their menopausal phase. This can be expressed as [ X3--（ 3 ） →X1 ]. This means that the mental disorders were certainly caused by their physical conditions. Conclusion It is feasible to employ the seven axes of the RTHD to provide a comprehensive assessment of patients with menopausal depression.

关 键 词：健康问题与疾病定量测试法 七轴诊断 围绝经期抑郁障碍 评估 

分 类 号：R749.4[医药卫生—神经病学与精神病学]