情緒障礙軀體化

1、Somatic Symptoms & Depression in General Practice情緒障礙軀體化,,What is this & what do you see ?猜猜這是什么?,,,,,,S.2,,,Review of patients’ record in General Practice病人紀(jì)錄在全科醫(yī)學(xué)中的覆檢,Somatic symptoms & depression,,Asso

2、ciated with medical causes and now found increasingly so with psychiatric disorders as well.一向被認(rèn)以為是軀體的疾病, 現(xiàn)在我們知道精神障礙也可以引起同樣癥狀.Some medically unexplainable symptoms may be listed under well defined psychiatric disorde

3、rs, the rest is grouped loosely as medically `unexplained` symptoms (MUS). 部份軀體癥狀不能以身體疾病解釋, 原來(lái)是精神障礙癥侯一類. 目前還有一些軀體癥狀未能(起碼暫時(shí))有合理的解釋, 有些學(xué)者就冠上一個(gè)名詞”醫(yī)學(xué)未能解釋的癥狀” (MUS).Management of MUS, also not explainable by the present

4、system of psychiatry, remains a challenge. 對(duì)臨床和做研究的醫(yī)學(xué)界MUS都是一個(gè)挑戰(zhàn).,Somatic symptoms軀體癥狀,S.3,,,Somatic symptoms(軀體癥狀) in DSM IV & HAM-D,,Somatic symptoms & depression,S.4,,,Somatic symptoms(軀體癥狀) in DSM IV &

5、; HAM-D,,Somatic symptoms & depression,S.5,,,Significance of somatic symptoms軀體癥狀的重要性,Somatic symptoms & depression,,Prevalent in depression憂郁病中很普遍 Number of published articles found in PubMed: 文獻(xiàn)里越來(lái)越多關(guān)于情

6、緒障礙軀體化的文章: Up to 2000: 1498 (2000年以前:1498)Up to 2007 Jan:2718 (2007年一月以前:2718) Diagnosis Implications 對(duì)診斷影響higher no. of somatic symptoms predict depression. 越多癥狀,患憂郁的機(jī)會(huì)起大。Medically unexplained symptoms associa

7、te more frequently with depression. 越多醫(yī)學(xué)未能解釋的癥狀,患憂郁癥的機(jī)會(huì)越大。,S.6,,,Significance of somatic symptoms軀體癥狀的重要性,Somatic symptoms & depression,,Treatment implications-higher no of SS delays: 對(duì)治療的影響:response, 越多癥

8、狀,越可能延誤,對(duì)藥物物的反應(yīng)remission,復(fù)原的時(shí)間 increases recurrence 增加復(fù)發(fā)的可能機(jī)會(huì),S.7,,,Somatic symptoms & depression,,70-75% (Gps`家庭科醫(yī)生) 60-65% (psychiatrist精神專 科醫(yī)生)(Partners in Research,SA,04 南非Mitchell們做的研究) 45% to 95% (Gps

9、`) 69% (psychiatrist) present only withsomatic symptoms 純粹軀體癥狀(Simon GE et al, N.Eng.J Med 1999;341:1329-1335) >65% depressed patients report somatic symptoms憂郁病人有軀體癥狀(Bair MJ et al, Arch Intern Med. 2003;163:24

10、33-2445.Bair MJ et al, Psychosom Med. 2004; 66: 17-22.),Percentage of depressed patients presenting withpredominantly physical symptoms抑鬱病人有軀體問(wèn)題的比率,S.8,,,Somatic symptoms & depression,,Analysis of total 437 patie

11、nts437病者的分析,S.9,Review of records of patients for January 07復(fù)查2007年一月份病人的記錄,,,Somatic symptoms & depression,,Analysis of 429 patients presenting with somatic symptoms429位帶軀體癥狀病者的分析,S.10,Review of records of patien

12、ts for January 07復(fù)查2007年一月份病人的記錄,,,,,Unexplained Somatic Symptoms & Mood Disorders醫(yī)學(xué)上末能解釋的癥狀與情緒障礙,~ 32% to 62% of such patients are depressive ~ 32% to 62%病者有憂郁癥 ~ 24% to 50% have anxiety disorders ~ 2

13、4% to 50%病者有焦慮癥 (Kroenke K et al Arch Fam Med 1994;3-774-9) More frequent association with anxiety disorders and depression MUS 跟焦慮和憂郁有密切出現(xiàn)的關(guān)系 (Katon W et al. Ann Intern Med 2001;134-971-925),Somatic symptoms

14、& depression,S.11,,,Somatic symptoms & depression,,Analysis of 91 patients with medically unexplained symptoms (MUS)91位帶有醫(yī)學(xué)上末能解釋癥狀的患者分析,54,30,7,,Mood dominant somatic symptoms (m++ss+)大部分情緒障礙癥狀小部分軀體癥狀Somati

15、c symptoms dominant, some mood symptoms (m+ss++)大部分軀體癥狀小部分情緒障礙癥狀Somatic symptoms only (ss+++)純軀體癥狀,,,,,,,A,B,C,(7.7%),(33%),(59%),S.12,Review of records of patients for January 07復(fù)查2007年一月份病人的記錄,,,Somatic symptoms

16、& depression,,Analysis of 99 patients (91 patients with MUS & 8 patients with mood symptoms)99 位病者（91 位未能解釋 + 8 位情緒障礙）的分析,S.13,Review of records of patients for January 07復(fù)查2007年一月份病人的記錄,,,Somatic symptoms &

17、; depression,,Diagnosis of “depressed group” of patients (53 patients)53 位憂郁病者的分析,S.14,Review of records of patients for January 07復(fù)查2007年一月份病人的記錄,,,Somatic symptoms & depression,,Prevalence of somatic symptoms in

18、 53 “depressed group of patients”(depression, depression comorbid with anxiety, low mood with MUS),S.15,Review of records of patients for January 07復(fù)查2007年一月份病人的記錄,,,Somatic symptoms & depression,,Conclusion I 小結(jié) (

19、I) 12.1% of 437 patients suffer from depression. 437到診病人中 12%患有憂郁癥 21% of 429 patients with somatic symptoms present with medically unexplained symptoms. 429帶有軀體各式各樣的癥狀的病人中有 21% 人屬于醫(yī)學(xué)解釋不了的例子 58.2% o

20、f patients presenting with medically unexplained symptoms suffer from depression. 當(dāng)中有分58.2%患有憂郁癥 All depressed patients have somatic symptoms. 所有憂郁的患者都有軀體的問(wèn)題,S.16,Review of records of patients for January 0

21、7復(fù)查2007年一月份病人的記錄,,,Somatic symptoms & depression,,Treatment for the “depressed group” of patients (53 patients)53位抑郁病者的治療,All patients were receiving antidepressant drugs when surveyed (with or without

22、atypical antipsychotics) 所有患者在統(tǒng)計(jì)時(shí)正服用SSRls 4 patients discontinued subsequently. 4位停止療程 49 patients remained on antidepressant treatment 49人正繼續(xù)服用SSRls Number of somatic symptoms per patient : between

23、1 to 9. 每一位患者平均擁用一至九種軀體癥體,S.17,Review of records of patients for January 07復(fù)查2007年一月份病人的記錄,,,Somatic symptoms & depression,,Outcome of treatment in “depressed group”patients (53 patients)治療結(jié)果,S.18,Review of rec

24、ords of patients for January 07復(fù)查2007年一月份病人的記錄,,,Somatic symptoms & depression,,Outcome of treatment in “depressed group” patients (53 patients)痊愈結(jié)果,Number of patients,S.19,Review of records of patients for January

25、07復(fù)查2007年一月份病人的記錄,,,,,Antidepressants are useful in the treatment of somatic symptoms associated with depression. 抗憂郁藥可有效治療憂郁引起的軀體癥狀A(yù)ntidepressants are useful in the treatment of somatic symptoms in the patients w

26、ith medically unexplained symptoms(MUS). 對(duì)MUS,目前未能解釋的軀體癥狀,抗憂郁藥可能有效 A systemic review of 96 randomized trials found antidepressants to be moderately effective. Odd Ratio comparing with placebo 3.4 (O’Malley, PG et

27、 al. Antidepressant therapy for unexplained symptoms and symptom syndromes. J Fam Pract. 1999;48:980-990). 奧馬(O‘Malley)重復(fù)檢視了96個(gè)隨機(jī)對(duì)照試驗(yàn)發(fā)現(xiàn)抗憂郁藥用于治療MUS有中度效用。,,Somatic symptoms & depression,Conclusion II結(jié)果二,S.20,R

28、eview of records of patients for January 07復(fù)查2007年一月份病人的記錄,,,Review of records of patients for January 07,Somatic symptoms & depression,,Analysis of somatic symptoms in 53 patients with depression53位憂郁人位的軀體癥狀分析,S.2

29、1,Review of records of patients for January 07復(fù)查2007年一月份病人的記錄,,,Somatic symptoms & depression,,Analysis of 41 depressed patients with pain痛楚類別分折(4l人),S.22,Review of records of patients for January 07復(fù)查2007年一月份病人的記

30、錄,,,Somatic symptoms & depression,,Analysis of 35 patients with GI upset 腸胃常見(jiàn)的問(wèn)題(35人),S.23,Review of records of patients for January 07復(fù)查2007年一月份病人的記錄,,,,,Questions to be answered有待回答的問(wèn)題,Why & How are antidepre

31、ssants effective in the treatment of somatic symptoms? 為何抗憂郁藥物對(duì)軀體病微有療效Are all patients with medically unexplained symptoms psychiatric? 一部分患者的軀體癥狀， 我們目前不能解釋，他們是否都有精神上的問(wèn)題呢？,Somatic symptoms & depression,S.

32、24,,,,,Questions to be answered有待回答的問(wèn)題,How does the mind generate symptoms of the body?精神（尤其是情緒障礙）如何導(dǎo)致身體不適呢？Is the pathophysiology producing the psychiatric & medical somatic symptoms the same biological mechan

33、ism?同是軀體不適，情緒障礙和肉體病癥引起的不適是不是一樣？它們是否共用同一機(jī)制呢?,Somatic symptoms & depression,S.25,,,,Are doctors feeling different parts of the same depressed elephant?不同科目的醫(yī)生可能正在摸著同一只大象不同的部位?,,,Somatic symptoms & depression,

34、The body and the mind精神與身體,S.26,,,Psychiatrists, researchers & GPs seeing different parts of a depressed elephant,,Non-psychiatric doctors in general practice & other specialitiese.g. Dr. David Wong家庭及其它非精神科醫(yī)

35、生，例如王大衛(wèi),A depressed elephant,,The Body身體:,S.27,一只憂郁的大象,,,Psychiatrists精神科醫(yī)生,,,Psychiatrists:e.g. Prof. S W TANG精神科醫(yī)生:e.g. 鄧兆華教授,A depressed elephant,S.28,一只憂郁的大象,,,Researchers研究者,,Researchers & Psychopharmacologis

36、ts:e.g. Prof. Brian Leonarde.g.自爛尼教授,,A depressed elephant,S.29,一只憂郁的大象,,,,,A depressed elephant,Mind & Body is One精神與身體是共為一體,S.30,一只憂郁的大象,,,Acknowledgment鳴謝,I would like to thank Professor SW Tang & Professor