本文選題：多軀體不適主訴 + 心理-行為特點�。� 參考：《北京協(xié)和醫(yī)學(xué)院》2013年博士論文

【摘要】：目的：有多個軀體不適主訴的患者普遍存在于各國各級醫(yī)療機構(gòu),又存在一定的文化差異,給醫(yī)療工作帶來挑戰(zhàn)。目前只有較少的資料對我國此類患者的臨床特點進行直接研究,也缺乏他們對衛(wèi)生資源的使用的系統(tǒng)描述。我們通過對綜合醫(yī)院不同科室的就診者展開橫斷面調(diào)查,旨在回答：a)綜合醫(yī)院門診的多軀體癥狀患者的臨床特點,b)他們對醫(yī)療資源的使用及對疾病的歸因。 方法：本研究是一項橫斷面調(diào)查性研究。為搜集具有多個軀體癥狀的患者的心理-行為相關(guān)的資料,研究者向就診北京協(xié)和醫(yī)院門診消化科、中醫(yī)科、心理醫(yī)學(xué)科的符合入組條件的患者行知情同意并請患者填寫自評問卷(包括人口學(xué)資料、軀體癥狀量表PHQ-15及其他臨床心理學(xué)量表),之后對患者進行衛(wèi)生資源的使用訪談及國際精神科簡式訪談(M.I.N.I.)。 結(jié)果：a)共搜集的到多軀體癥狀患者(SOM+,PHQ-15≥10)的有效案例143例,平均年齡為44±15歲,女性占68.9%,調(diào)查過程中發(fā)現(xiàn)SOM+患者在被調(diào)查科室具有普遍性。b)臨床特點方面：SOM+患者臨床量表得分M(SD):PHQ-911.82[6.374]. GAD-78.51(6.02).WIT-74.04(2.26).SF-12MCS42.8[11.75].SF-12PCS42.13(8.48),各科室患者間過去12個月軀體疾病患病率不同(GI88.0%,TCM68.6%,PSY47.6%,p0.001),MINI陽性率沒有明顯統(tǒng)計學(xué)差異(GI54.5%,TCM48%,PSY48%,p=0.539)。c)就醫(yī)行為方面：31.8%的患者在過去1年有10次以上的就診經(jīng)歷,另43.8%看過3-10次醫(yī)生,57.7%的患者癥狀持續(xù)大于1年,有81.6%的患者認為這些癥狀嚴重影響了日常生活。來自不同科室的被訪者都接受“心理因素”疾病歸因(GI52％,TCM40％,PSY68％). 結(jié)論：a)有多個軀體不適的受訪者在被調(diào)查的各個科室具有普遍性,且多數(shù)為女性。b)臨床特點上,有超過2/3的患者在過去一年內(nèi)患有軀體疾病,1/2或更多的患者共病至少一種精神障礙(M.I.N.I.+)；大多數(shù)患者的不適趨于慢性化,并嚴重影響到他們的日常生活。c)對醫(yī)療資源的使用上,就診于不同科室的被訪者曾接受過的治療及對治療期望各有不同；在疾病歸因上“心理因素”被來自不同科室的被訪者普遍認同。
[Abstract]:Objective: patients with multiple complaints of physical discomfort generally exist in medical institutions at all levels of countries, and there are certain cultural differences, which brings challenges to medical work. At present, there are only a few data on the clinical characteristics of such patients in China, and lack of systematic description of their use of health resources. By conducting a cross-sectional survey on the patients in different departments of the General Hospital, we aim to answer the clinical characteristics of multi-somatic symptom patients in the General Hospital (A)) their use of medical resources and the attribution of diseases. Methods: this study is a cross-sectional investigation. In order to collect psycho-behavioral data of patients with multiple somatic symptoms, the researchers went to the Department of Digestive Medicine, the Department of traditional Chinese Medicine, the outpatient Department of Peking Union Hospital, and the Department of traditional Chinese Medicine. Patients eligible for admission in the Department of Psychiatry were given informed consent and were asked to fill out self-assessment questionnaires (including demographic data). The somatic symptom scale (PHQ-15) and other clinical psychological scales were followed by interviews on the use of health resources and international psychiatric interviews. Results one hundred and forty-three effective cases (mean age 44 鹵15 years, female: 68.9%) of multiple somatic symptom patients (PHQ-15 鈮，

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