医学上不能解释的慢性疼痛主诉患者临床特征和精神病学诊断  

Clinical characteristics and psychiatric diagnosis of patients with medically unexplained complaints of chronic Pain

作　　者：史继红[1] 李成文[1] 葛欣[1] 楚圆圆[1] 

机构地区：[1]山东省济宁市第一人民医院,272100

出　　处：《精神医学杂志》2013年第4期261-264,共4页Journal of Psychiatry

基　　金：济宁市医药卫生科技项目(编号:2012jnjc12)

摘　　要：目的观察疼痛科医学上不能解释的慢性疼痛主诉(MUP)门诊患者的临床特征,完善其临床诊断。方法对疼痛科门诊87例MUP患者转诊至心理科门诊进行会诊-联络精神病学研究,记录患者相关疾病信息和疼痛科诊断,进行症状自评量表(SCL-90)和综合性医院焦虑抑郁量表(HAD)测查和面谈并作出精神病学诊断。结果MUP患者的躯体形式疼痛主诉以头、面、口腔部(56.3%)、胸部(49.4%)和腰背部(25.3%)为主,疼痛科诊断以不定陈述综合征(33.3%)、慢性头痛综合征(20.7%)、疼痛原因待查(心因性疼痛,29.9%)为主。男、女性MUP患者的疼痛科诊断存在显著性差异(P<0.05)。MUP患者的SCL-90各因子评分均显著高于中国常模(P<0.05)。HAD(d)评分≥8分为66.7%,HAD(a)评分≥8分为49.4%。MUP患者的精神病学诊断高达96.6%。结论 MUP患者焦虑抑郁情绪明显,躯体化症状多,会诊-联络精神病学研究有助于完善其临床诊断。Objective To investigate the clinical characteristics and to identify the clinical diagnosis of patients with medically unexplained complaints of chronic pain （MUP）. Methods 87 patients with MUP seeking for consultation- liaison psychiatry services were recorded with their case history and diagnosis in pain department. All subjects were assessed with Symptom Checklist 90 （SCL-90） and Hospital Anxiety and Depression Scale （HAD） , and then were interviewed with psychiatric examination by psychologists. Results Pain complaints of patients with MUP mainly involve head or face （56.3%） , chest （49.4%） , waist and back （25.3%）. The diagnosis in pain department were mostly consisted of unidentified clinical syndrome （33.3%） , chronic headache syndrome （20.7%） and pain needs to be examined （psychological pain, 29. 9% ）. There was significant gender difference in diagnosis made in pain department （ P 〈 0.05 ）. All factor scores of SCL-90 in MUP patients were significantly higher than chinese norm （ P 〈 0.05 ） .. The incidence of suspectable depression （ score above 8 in depression subscale of HAD） and suspectable anxiety （score above 8 in anxiety subscale of HAD）were 66.7% and 49.4% respectively in MUP patients. The rate of psychiatric diagnosis was 96.6% in patients with MUP. Conclusion Patients with MUP often suffer form depression, anxiety and have multiple somatoform symptoms. Consultation-liaison psychiatry is helpful to improve the clinical diagnoses for patients with MUP.

关 键 词：医学上不能解释的躯体症状 慢性疼痛 躯体形式障碍 会诊-联络精神病学 

分 类 号：R749.4[医药卫生—神经病学与精神病学]