【作者】 徐阿红；

【导师】 吴爱勤；

【作者基本信息】 苏州大学 ， 精神病与精神卫生学， 2010， 硕士

【摘要】 目的:采用病例-对照研究躯体症状表现为主抑郁症的临床现象学,心理社会相关危险因素,其与情绪障碍表现为主抑郁症及躯体形式障碍的异同。探讨抑郁症躯体化的自主神经功能紊乱特点和心理社会相关中介机制。方法:按CCMD-3心境障碍抑郁发作的诊断标准,收集51例躯体症状表现为主抑郁症患者(躯体症状组,DSG)、57例情绪障碍表现为主抑郁症患者(情绪障碍组,DEG)、42例躯体形式障碍患者(躯体形式障碍组,SFD)及48例正常对照组(HCG)。完成一般状况调查问卷、汉密顿抑郁量表(HRSD)、汉密顿焦虑量表(HAMA)、多伦多述情障碍量表(TAS)、防御方式问卷(DSQ)、生活事件量表(LES)、社会支持评定量表(SSRS)、特质应对方式问卷(TCSQ)、家庭环境量表中文版(FES-CV)、生活质量综合评定问卷(GQOLI-74);并测定实验应激前后心率变异性(HRV),进行短时(10分钟)分析。结果:1、临床现象学:(1) DSG组年龄大、女性比例大、文化程度低、居住农村多、病程长、发病诱因多、家族史少、间断发病多(P<0.05或P<0.01); DSG组和SFD组较多就诊于非精神科室(P<0.01),就诊医院数目、科室数目、用药种类、检查数目及检查费用都较DEG组高(P<0.05或P<0.01);(2) DSG组的首诊症状以胃部不适、颈(背或四肢)疼痛、睡眠障碍、腹痛、腹胀、腹泻、胸闷较多(P<0.05或P<0.01);(3) DSG组消化系统的症状较多(P<0.05);(4) DSG组患者的HRSD总分、因子焦虑?躯体化、认识障碍、睡眠障碍及绝望感、HAMA总评分及因子分都较DEG组和SFD组高(P<0.05或P<0.01)。2、心理社会相关因素:(1) DSG组、DEG组和SFD组患者的TAS总分(68.93±14.71,65.67±18.19,66.26±17.70)较HCG组(56.62±21.85)高(P<0.05或P<0.01);(2) DSG组TAS因子Ⅱ得分(20.24±6.39)显著比DEG组(17.71±5.85)和SFD组(17.26±2.92)高(P<0.05);(3) DSG组、DEG组和SFD组较多使用不成熟防御方式(P<0.05或P<0.01);DSG组的压抑(7.3±2.7)得分显著较DEG组(5.9±2.6)、SFD组(4.3±2.2)和HCG组(5.3±2.7)高(P<0.05或P<0.01);(4) DSG组的生活事件总值和负性生活事件值明显较DEG组和SFD组高(P<0.01),对社会支持的利用度较DEG组和SFD组低(P<0.05);(5) DSG组、DEG组和SFD组患者的家庭环境功能均存在缺陷;DSG组在亲密度、情感表达、娱乐性和控制性方面得分较DEG组和SFD组低(P<0.05或P<0.01);(6) DSG组生活质量的躯体功能、心理功能、社会功能及生活质量总体评价方面均低于DEG组、SFD组和HCG组(P<0.05或P<0.01)。3、心率变异性结果:(1) DSG组和SFD组的SDNN(61.32±29.08,75.42±33.78)较HCG组(106.10±45.05)降低(P<0.01);DSG组、DEG组和SFD组的LF?HF(5.14±1.39,3.90±1.40,4.28±2.34)明显较HCG组(2.74±2.61)升高(P<0.01);(2)实验应激后,DSG组、DEG组和SFD组患者HRV的变化幅度均较HCG组大(P<0.05或P<0.01);DSG组SDNN、SDSD、LF、VLF、LF?HF变化幅度(-23.25±10.59,-20.53±11.39, 341.94±207.25, 431.97±256.32,2.75±1.61)较DEG组(-8.69±6.68,-14.56±5.36,222.09±165.78,226.61±191.79,1.52±1.02)和SFD组(-16.42±8.33,-11.85±6.42,234.90±140.88,272.23±132.05,2.02±1.18)大(P<0.05或P<0.01);(3)放松训练后,DSG组、DEG组和SFD组患者的HRV均未恢复到基线值;DSG组LF、LF?HF恢复幅度(-101.84±84.52,-0.89±0.47)较DEG组(-122.21±59.25,-1.14±0.51)和SFD组(-134.63±89.08,-1.25±1.02)小(P<0.05);(4)老年组的SDNN、SDSD、RMS-SD和HF较青年组低(P<0.01),LF和LF?HF较青年组高(P<0.05或P<0.01);结论:躯体症状表现为主抑郁症患者的临床特征与情绪障碍表现为主抑郁症和躯体形式障碍患者不同,躯体症状表现为主抑郁症可能是抑郁症的一种亚型;躯体症状表现为主抑郁症与情绪障碍表现为主抑郁症的心理社会中介机制存在差异;自主神经系统失平衡可能是躯体症状表现为主抑郁症患者躯体化表现的机制之一。更多还原

【Abstract】 Objective: The aim of the present case-control study was to investigate clinical phenomenology,psychosocial related risk factors and the differences betwween depressive patients presented as emotional complains and somatoform disorder; and to find the psychosocial mechanisms and the characteristics of autonomic nervous system funtion for depression with somatization .Methods: In CCMD-3, 51 depressive patients presented as somatic complains (somatic group,DSG), 57 depressive patients presented as emotional complains (emotional group,DEG), 42 somotoform disorders patients(somotoform disorder group,SFD) and 48 normal controls(normal group,HCG)were investigated.All patients were interviewed in general condition questionnair,history questionnair, HRSD, HAMA, TAS, LES, SSRS, TCSQ, FES-CV, DSQ, GQOLI-74; and analysed the short-term heart rate variability (10 minutes) before and after stress stimulations and after relaxation training .Results: 1、Clinical phenomenology showed : (1) DSG group were older,lower educated, and had more women,longer history,more incentives,less family history(P<0.05 or P<0.01); DSG group and SFD group received more treatment in non-psychiatric;The number of hospitals、departments、medications、medical examinations and the fees of examinations were higher than DEG group(P<0.05 or P<0.01); (2) DSG group presented more stomach discomfort and neck(back or limbs)pain、sleep disorders、abdominal discomfort and chest tightness(P<0.05 or P<0.01); (3) The physical symptoms of DSG group were more centered in digestive system(P<0.05); (4) DSG group gained higher score in HRSD total score、factor anxiety/somatization、awareness barriers、sleep disorders、hopelessness、HAMA total score and factor sores (P<0.05 or P<0.01). 2、Psychosocial factors showed: (1) Patients of DSG group、DEG group and SFD group (68.93±14.71,65.67±18.19,66.26±17.70)gained higher TAS total score than the HCG group(56.62±21.85)(P<0.05 or P<0.01); (2) DSG group (20.24±6.39)gained higher score in the factorⅡof TAS than the DEG group (17.71±5.85)and SFD group(17.26±2.92)(P<0.05); (3) Patients of DSG group、DEG group and SFD group used the immature defense styles more;DSG group (7.3±2.7)had higher score on inhibition than DEG group (5.9±2.6)、SFD group(4.3±2.2) and HCG group(5.3±2.7)(P<0.05或P<0.01); (4) DSG group had the more total life events and negative life events and lower score for the use of social support than DEG group and SFD group(P<0.05 or P<0.01); (5) DSG group、DEG group and SFD group all had family function deficits;the cohesion、emotional expression、control and entertainment of DSG group were lower than DEG group and SFD group(P<0.05 or P<0.01); (6) DSG group were lowest in the dimensions of physical function、psychological function、social function and the total quality of life dimebsion than DEG group、SFD group and HCG group(P<0.05 or P<0.01).3、Results of heart rate variability: (1) In resting baseline period, DSG group and SFD group ( 61.32±29.08 , 75.42±33.78 ) had lower SDSD than HCG group(106.10±45.05)(P<0.01); DSG group、DEG group and SFD group(5.14±1.39, 3.90±1.40,4.28±2.34) had higher LF?HF than HCG group(2.74±2.61)(P<0.01); (2) After the stress stimulations, DSG group、DEG group and SFD group had higher demention of changes than HCG group ( P < 0.05 or P < 0.01 ) ; DSG group (-23.25±10.59,-20.53±11.39, 341.94±207.25, 431.97±256.32,2.75±1.61)had higher demention of change on SDNN、SDSD、LF、VLF、LF?HF than DEG group(-8.69±6.68,-14.56±5.36,222.09±165.78,226.61±191.79,1.52±1.02)and SFD group(-16.42±8.33,-11.85±6.42,234.90±140.88,272.23±132.05,2.02±1.18)(P<0.05 or P<0.01); (3) After relaxation training, HRV of DSG group、DEG group and SFD group did not return to the basiline; DSG group(-101.84±84.52,-0.89±0.47) had lower degree of return demention on LF and LF?HF than DEG group(-122.21±59.25,-1.14±0.51) and SFD group(-134.63±89.08,-1.25±1.02)(P<0.05); (4) Compared with youth group, the elderly group are lower on SDNN、SDSD、RMS-SD、HF and higher on LF and LF?HF (P<0.05 or P<0.01).Conclusions: There are differences in clinical phenomenology and psychosocial intermediation between depressive patients presented as somatic complains、depressive patients presented as emotional complains and somotoform disorder patients; Depression presented as somatic complains may be a subtype of depresion; Inbalance of autonomic nervous system may be one of the mechanisms for depression with somatization.更多还原