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山东大学学报（医学版） ›› 2014, Vol. 52 ›› Issue (9): 90-94.doi: 10.6040/j.issn.1671-7554.0.2014.289

• 医学心理学 • 上一篇    下一篇

综合医院“医学无法解释的躯体症状”患者症状特点及相关因素分析

毛雪琴1, 张蕊2, 王梦欣1   

  1. 1. 山东大学齐鲁医院 心理科, 山东 济南 250012;
    2. 山东大学齐鲁医院 药理基地, 山东 济南 250012
  • 收稿日期:2014-05-04 修回日期:2014-09-05 出版日期:2014-09-10 发布日期:2014-09-10
  • 基金资助:
    济南市科技局企业自主创新资助项目(201101115)

Characteristics and relevant factors of somatization symptoms in patients with “medically unexplained symptoms” in general hospital

MAO Xueqin1, ZHANG RUI2, WANG Mengxin1   

  1. 1. Department of Psychology, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China;
    2. Department of Pharmacology, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China
  • Received:2014-05-04 Revised:2014-09-05 Online:2014-09-10 Published:2014-09-10
  • Contact: 毛雪琴。E-mail:m_xqin@126.com E-mail:m_xqin@126.com

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摘要： 目的 探讨“医学无法解释的躯体症状（MUS）”患者症状特点及相关影响因素。方法 采用躯体化症状自评量表（SSS）、简易解释性访谈问卷（SEMI）和特质应对方式问卷（TCSQ）分别对MUS患者组50例和对照组30例进行评定。结果 与对照组比较，患者组90%的症状严重程度在重度范围；躯体化症状分和消极应对分（NC）平均数均高于对照组（P<0.01），而积极应对（PC）分平均数低于对照组（P<0.01）；68%的患者表现为超过6个月（最长5年）的慢性病程，就诊次数超过6次以上，涉及的症状在5种以上；96%的患者表达明显的疾病焦虑，坚信躯体症状提示有较严重的躯体疾病，同时流露明显的情绪反应如害怕死亡及功能丧失等。躯体症状严重程度与应对方式、疾病理念及就诊次数相关。结论 MUS患者有特殊的躯体化症状特点及疾病理念，疾病理念和就诊次数是症状严重程度的重要预测因子。

关键词: 医学无法解释的症状, 躯体化症状, 疾病理念

Abstract: Objective To explore the characteristics of somatization symptoms and the relevant factors in patients with medically unexplained symptoms (MUS) in general hospitals. Methods A total of 50 patients with MUS and 30 healthy controls were assessed with the Somatic Self-rating Scale (SSS), Trait Coping Style Questionnaire(TCSQ) and Short Explanatory Model Interview (SEMI). Results Compared with the controls, 90% of the patients had severe degree of somatization symptoms, and all patients had significantly higher scores of somatization symptoms and negative coping (NC), but significantly lower scores of positive coping (PC) (P<0.01); as many as 68% of the patients had been chronically ill for more than 6 months (ranging from 6 months to 5 years), with more than 5 symptoms and 6 or more doctor-visits over the past half a year. Up to 96% of the patients expressed significant illness worries, believing that their symptoms indicated serious diseases, and showing obvious fear for death or paralysis. There was significant relation among somatization symptoms, coping styles, illness perception model, and doctor-visits in patients with MUS. Conclusion The MUS patients present distinctive somatization symptoms and illness perception model. Illness perception model and doctor-visits are the important predicting factors for somatization symptoms.

Key words: Medically unexplained symptoms, Somatization symptoms, Illness perception model

中图分类号: 

  • R395.6
[1] Christopher B. Beyond somatization: a review of the understanding and treatment of medically unexplained physical symptoms (MUPS)[J]. British Journal of General Practice, 2003, 53:233-241.
[2] Sumathipala A, Siribaddna S, Hewege S. Understanding the explanatory model of the patient on their medically unexplained symptoms and its implication on treatment development research: a Sri Lanka Study[J]. BMC Psychiatry, 2008, 8:54-64.
[3] 孙夏媛, 魏镜. 医患对“医学难以解释的躯体症状”的观念和互动差异及影响因素[J]. 中华医学杂志, 2013, 93(23):1850-1852. SUN Xiayuan, WEI Jing. Differences of perspective on “medically unexplained symptoms” between doctors and patients[J]. Natl Med J China, 2013, 93(23):1850-1852.
[4] Baker M, Stallard J, Gibson S. A pilot project targeting frequent attenders at the emergency department with medically unexplained symptoms[J]. Emerg Med J, 2013, 30(10):866.
[5] Gormley K. Medically unexplained symptoms: the need for effective communication and an integrated care strategy[J]. Br J Community Nurs, 2014, 19(2):86-90.
[6] Robea C, Smith M D, Dwamena M D, et al. Classifica-tion and diagnosis of patients with medically unexplained symptoms[J]. Society of General Internal Medicine, 2007, 22(1):685-691.
[7] 刘峰海, 王爽, 于晓松. 医学无法解释的症状研究进展[J]. 中国全科医学, 2013, 16 (4):1192-1194. LIU Fenghai, WANG Shuang, YU Xiaosong. Progress in research of medically unexplained symptoms[J]. Journal of Chinese General Practice, 2013, 16(4):1192-1194.
[8] 庄琦, 毛家亮, 李春波, 等. 躯体化症状自评量表的初步编制及信度和效度的研究[J]. 中华行为医学与脑科学杂志, 2010, 19(9):847-849. ZHANG Qi, MAO Jialiang, LI Chunbo, et al. Developing of somatic self-rating scale and its reliability and validity[J]. Chin J Behav Med & Brain Sci, 2010, 19(9):847-849.
[9] Lloyd K R, Jacob K S, Patel V, et al. The development of the Short Explanatory Model Interview (SEMI) and its use among primary-care attenders with common mental disorders[J]. Psychol Med, 1998, 28(5):1231-1237.
[10] 汪向东, 王希林, 马弘. 心理卫生评定量表手册增订版[J]. 中国心理卫生杂志, 1999. WANG Xiangdong, WANG Xilin, MA Hong. Rating Scales for Mental Health[J]. Chin Ment Health J, 1999.
[11] 吴文源. 心身医学基本技能(Asia-Link project, VN009)[M]. 上海: 同济大学出版社, 2009: 147-171.
[12] Steinbrecher N, Koerber S, Ffieser D, et al. The prevalence of medically unexplained symptoms in primary care[J]. Psychosomatics, 2011, 52:263-271.
[13] 赵晓晖, 洪霞, 史丽丽, 等. 某三级甲等综合医院住院患者精神科会诊3年资料分析[J]. 中国心理卫生杂志, 2011, 25(1):30-34. ZHAO Xiaohui, HONG Xia, SHI Lili, et al. Analysis of data from consultation-liaison psychiatry service for the inpatients in a tertiary general hospital[J]. Chin Ment Health J, 2011, 25(1):30-34.
[14] Burton C, McGorm K, Richardson G, et al. Healthcare costs incurred by patients repeatedly referred to secondary medical care with medicallyunexplained symptoms: a cost of illness study[J]. J Psychosom Res, 2012, 72(3):242-247.
[15] Diefenbach M A, Leventhal E A. Illness Cognition: Using common sense to understand treatment adherence and affect cognition interactions[J]. Cognitive Therapy and Research, 1992, 16:143-163.
[16] Moss-Morris R, Weinman J, Petrie K J, et al. The revised illness perception questionnaire (IPQ-R)[J]. Psy-chology and Health, 2002, 17:1-16.
[17] van Ravenzwaaij J, Olde Hartman T, van Ravesteijn H, et al. Explanatory models of medically unexplained symptoms: a qualitative analysis of the literature[J]. Ment Health Fam Med, 2010, 7(4):223-231.
[18] 李昌俊, 郑涌, 刘新丰, 等. 影响躯体化症状的人格因素及其实践意义[J]. 中国神经精神疾病杂志, 2010, 36(2):125-128. LI Changjun, ZHEN Yong, LIU Xinfeng, et al. Personality factors and its contributions to somatization symptoms[J]. Chin Nerv Ment Dis, 2010, 36(2):125-128.
[19] 陈力. 医学心理学[M]. 北京: 北京大学医学出版社, 2003.
[20] Shattock L, Williamson H, Caldwell K, et al. They've just got symptoms without science': Medical trainees' acquisition of negative attitudes towards patients with medically unexplained symptoms[J]. Patient Educ Couns, 2013, 91(2):249-254.
[21] Howman M, Walters K, Rosenthal J, et al. Teaching about medically unexplained symptoms at medical schools in the United Kingdom[J]. Med Teach, 2012, 34(4):327-329.
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