综合医院全科医疗门诊中精神心理障碍的患病率及诊疗情况研究  

Prevalence and Management of Mental Disorders in General Practice Clinic of General Hospital

作　　者：周仲华[1] 黄文娟[1] 金世红[1] 郭敬柱[1] 陈仕银[1] 

机构地区：[1]海南省海口市人民医院全科医学科,570208

出　　处：《中国全科医学》2012年第25期2942-2945,共4页Chinese General Practice

摘　　要：目的了解综合医院全科医疗门诊中精神心理障碍的患病率及诊疗情况,为制定全科医生精神心理培训内容提供参考。方法回顾性分析2011年6月—2012年5月到海口市人民医院全科医疗门诊就诊的所有患者的健康档案资料,选取其中患有精神心理障碍的全部患者作为本研究对象。根据基层医疗国际分类第2版(ICPC-2)对患者的就诊原因、诊断和治疗情况进行手工编码。结果诊断为精神心理障碍的患者共416人次,占所有就诊人次的14.4%。精神心理障碍初诊患者的前10位就诊原因依次为:乏力、睡眠障碍、腹痛、胸闷、头晕、胸痛、头痛、感觉焦虑、感觉抑郁、咳嗽,分别占精神心理障碍初诊患者所有诊断原因的9.4%、9.0%、5.6%、4.7%、4.3%、3.8%、3.4%、3.0%、3.0%、2.6%。精神心理障碍患者的前10位诊断依次为:抑郁症、焦虑症/焦虑状态、睡眠障碍、烟草滥用、躯体化障碍、强迫症、双相抑郁、急性应激反应、成人生活阶段问题、儿童行为的症状;其中抑郁症是最常见的诊断,平均每100个就诊人次中有4.7人次诊断为抑郁症,占全部精神心理障碍诊断的27.7%;前10位诊断累计占全部精神心理障碍诊断的90.4%。结论精神心理障碍在综合医院全科医疗门诊具有较高的患病率;全科医生经过培训完全可以胜任在社区筛查、诊断、治疗绝大多数精神心理障碍的工作。Objective To investigate the prevalence and management of mental disorders in a general practice （GP） clinic affiliated to a general hospital, so as to provide a reference for GP educators to design training curriculums in mental health. Methods The data of health records of all the patients who paid visits to the GP clinic affiliated to Haikou Municipal Hos- pital from June 2011 to May 2012 were analyzed retrospectively, and thus the patients with mental disorders were selected as the subjects. The patients＇ reasons for encounter （RFEs）, diagnoses, and treatments were coded according to International Classifi- cation of Primary Care -2 （ ICPC -2） . Results There were totally 416 encounters with diagnosis of mental disorders, account- ing for 14. 4% of all the encounters. The top 10 RFEs of the patients for the initial visit were in order of weakness, sleep disor- der, abdominal pain, chest distress, dizziness, chest pain, headache, anxiety, depression, and cough, which respectively accounting for 9.4%, 9. 0%, 5.6%, 4. 7%, 4. 3%, 3.8%, 3.4%, 3.0%, 3.0%, and 2. 6% of RFEs for the initial visit. The top 10 diagnoses of mental disorders were in order of depressive disorder, anxiety or anxiety state, sleep disorder, to- bacco abuse, somatization disorder and compulsive disorder, bipolar depression, acute stress reaction, problem as stage of adult life, and anomaly in children＇s behavior. And among all these the depressive disorder was the commonest, at a rate of 4.7 per 100 encounters, accounting for 27.7% of all the mental disorders. The top 10 diagnoses accounted for 90. 4% of all the mental disorders diagnosis recorded. Conclusion The prevalence of mental disorders is higher in general practice clinic of general hos- pital. With adequate training, general practitioners could work competently in screening, diagnosing and treating most of the mental disorders.

关 键 词：精神心理障碍 患病率 诊断和治疗 全科医疗 门诊 

分 类 号：R749[医药卫生—神经病学与精神病学]