本文選題：軀體形式障礙 + 抑郁�。� 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的軀體形式障礙(Somatoform Disorders,SFD),是一種很常見的精神心理疾病�；颊咭蜍|體各種不適反復(fù)就診,盡管各種醫(yī)學(xué)檢查的結(jié)果都是陰性或者正常的,盡管醫(yī)生反復(fù)告知和解釋,都不能使患者減輕疑慮。該疾病患者首診多在初級醫(yī)療機(jī)構(gòu)或綜合醫(yī)院,但是這些醫(yī)院的非精神科醫(yī)生對該病種識別率較低,且容易忽視患者的焦慮和抑郁情況,不能對疾病正確的診治,不能共情患者的心理苦惱,導(dǎo)致降低患者就診的滿意度,降低治療的依從性,增大了醫(yī)療糾紛的發(fā)生率,同時患者本人的痛苦和經(jīng)濟(jì)負(fù)擔(dān)也隨之增大。本文旨在通過全面的研究分析,探究綜合醫(yī)院就診的SFD患者心理健康狀況以及該病的發(fā)生發(fā)展與心理社會因素的關(guān)系,以期提高綜合醫(yī)院非精神科醫(yī)生對該病的重視,同時為軀體形式障礙的綜合治療提供一定的參考。方法依據(jù)國際疾病分類第十次修訂版(ICD-10)的精神與行為障礙分類的診斷標(biāo)準(zhǔn),選取2015-2016年就診于天津港口醫(yī)院的軀體形式障礙患者120例作為觀察組,同期選取志愿者120例作為健康對照組。兩組分別填寫癥狀自評量表(SCL-90)、艾森克人格問卷(EPQ)、防御方式問卷(DSQ)以及社會支持評定量表(SSRS)。分別比較兩組心理健康水平以及社會心理特質(zhì),并檢驗(yàn)觀察組的心理健康水平和社會心理因素的相關(guān)性。統(tǒng)計上采用常用的SPSS軟件19.0進(jìn)行統(tǒng)計與分析,計數(shù)資料比較采用χ2檢驗(yàn),計量資料比較采用t檢驗(yàn)及方差分析,對相應(yīng)數(shù)據(jù)做相關(guān)分析,P0.05為差異有統(tǒng)計學(xué)意義,將SCL-90分值是否高于160分作為因變量,將單因素分析中有顯著意義的因素作為自變量,進(jìn)行Logistic回歸分析。結(jié)果心理健康方面,觀察組SCL-90總分以及軀體化、焦慮、抑郁、偏執(zhí)得分均高于對照組,差異均有顯著性(P0.05);人格特征方面觀察組內(nèi)外向得分低于對照組,神經(jīng)質(zhì)得分高于對照組,差異有顯著性(P0.05);防御方式方面,觀察組不成熟的防御機(jī)制得分高于對照組,成熟的防御機(jī)制低于對照組,差異均有顯著性(P0.05);社會支持方面,觀察組在客觀社會支持、主觀社會支持和社會支持利用度總分均顯著低于對照組(P0.05)。軀體化障礙、未分化的軀體形式障礙、軀體形式的植物功能紊亂患者的社會心理特性不盡相同,軀體形式障礙患者的心理健康狀況和神經(jīng)質(zhì)值、不成熟的防御機(jī)制呈負(fù)相關(guān),與社會支持呈正相關(guān),與神經(jīng)質(zhì)因子、掩飾因子、主觀支持、年齡、性別、受教育年限有回歸關(guān)系。結(jié)論軀體形式障礙患者更容易出現(xiàn)軀體化、焦慮、抑郁等心理健康問題,應(yīng)該重視綜合醫(yī)院中SFD患者的正確診斷和正規(guī)治療。SFD患者性格多為情緒不穩(wěn)定型,患者的防御方式以及患者的社會支持系統(tǒng)與疾病的發(fā)展密切相關(guān),這些情況可以納入心理治療的干預(yù)范疇,應(yīng)該對SFD患者進(jìn)行綜合治療。
[Abstract]:Objective somatoform Disorders (SFDD) is a common mental and psychological disorder. Although the results of various medical examinations are negative or normal, despite repeated notification and explanation by the doctor, they cannot allay the patient's doubts. Most of the patients were first diagnosed in primary medical institutions or general hospitals, but the non-psychiatrists in these hospitals had a low recognition rate of the disease, and were prone to ignore the anxiety and depression of the patients, and could not correctly treat the disease. The psychological distress of unsympathetic patients leads to the decrease of patients' satisfaction and compliance, which increases the incidence of medical disputes, and the pain and economic burden of the patients themselves are also increased. The purpose of this paper is to explore the mental health status of SFD patients in general hospitals and the relationship between the occurrence and development of the disease and psychological and social factors, in order to increase the attention of non-psychiatrists in general hospitals to the disease. At the same time, it provides some reference for the comprehensive treatment of somatoform disorder. Methods according to the diagnostic criteria of mental and behavioral disorders of ICD-10, 120 patients with somatoform disorders who were admitted to Tianjin Port Hospital from 2015 to 2016 were selected as the observation group. At the same time, 120 volunteers were selected as the healthy control group. The two groups completed SCL-90, Eysenck Personality questionnaire (EPQN), Defense style questionnaire (DSQS) and Social support rating scale (SSRSX) respectively. The mental health level and social psychological characteristics of the two groups were compared, and the correlation between the psychological health level and psychosocial factors in the observation group was tested. In statistics, SPSS software 19.0 was used for statistics and analysis, 蠂 2 test was used for counting data comparison, t test and variance analysis were used for measurement data comparison, there was significant difference in correlation analysis of corresponding data (P0.05). Whether the score of SCL-90 is higher than 160 is regarded as dependent variable, and the significant factor in univariate analysis is taken as independent variable, and the Logistic regression analysis is carried out. Results in the aspect of mental health, the total score of SCL-90, somatization, anxiety, depression and paranoid ideation in the observation group were higher than those in the control group, the difference was significant (P 0.05), the score of introversion and extroversion in the observation group was lower than that in the control group, and the score of neuroticism in the observation group was higher than that in the control group. The scores of immature defense mechanism in the observation group were higher than those in the control group, the mature defense mechanism was lower than that in the control group, and the difference was significant (P 0.05). In the aspect of social support, the observation group had objective social support. The total scores of subjective social support and social support utilization were significantly lower than that of the control group (P 0.05). The patients with somatization disorder, undifferentiated somatoform disorder, somatoform function disorder have different social and psychological characteristics. The mental health status, neuroticism and immature defense mechanism of somatoform disorder patients are negatively correlated. There was a positive correlation with social support and a regression relationship with neuroticism factor, mask factor, subjective support, age, sex, and years of education. Conclusion the patients with somatoform disorder are more likely to have somatization, anxiety, depression and other mental health problems. We should pay attention to the correct diagnosis and regular treatment of patients with SFD in general hospitals. Patients' defense style and patients' social support system are closely related to the development of the disease. These conditions can be included in the intervention category of psychotherapy. Comprehensive treatment should be carried out for patients with SFD.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R749.7

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