CAJ | 학술논문

目的：了解综合医院门诊焦虑障碍患者的就诊特点。方法于2007年5-6月对北京市三所综合医院神经内科、消化内科、心内科和妇科的门诊患者进行调查。采用一般筛查问卷、医院焦虑抑郁量表（ hospital anxiety and depression scale，HADS）、患者健康问卷（patient health questionnaire somatic symptom severity scale，PHQ -15）进行筛查，对 HADS 评分≥8分的就诊者由经过培训的精神科医师采用国际神经精神科简式访谈问卷（the mini international neuropsychiatric interview，MINI）进行精神状况检查，并做出精神科诊断。结果共有2074人完成调查，其中诊断为焦虑障碍者（焦虑障碍组）110例，其中57例（51.8%）共患抑郁障碍；无精神障碍者（正常组）1538例（HADS评分<8分者915例，经 MINI 诊断无精神障碍者623例）。焦虑障碍组的平均年龄为（45.3±14.1）岁，正常组为（49.7±16.8）岁，两组年龄间差异有统计学意义（t =2.667，P <0.05）；两组性别、职业间差异无统计学意义（P >0.05）。焦虑障碍组的 PHQ -15总分为（12.5±5.7）分，正常组为（7.1±4.3）分，两组间比较差异有统计学意义（t =12.371，P <0.01）。焦虑障碍组患者 PHQ -15中出现频率前三位的条目为：感到疲劳37.3%（41例）；睡眠问题37.3%（41例）；虚弱感30.0%（33例）。正常组和焦虑障碍组的误工天数、目前疾病造成的功能损害（对家庭生活和家庭责任的影响、对工作和学习的影响、对社交生活的影响）间差异有统计学意义（P <0.05）。焦虑障碍组患者有自杀倾向者占32.7%（36例），只有22例患者（20.0%）被建议转诊到精神科（16例，14.5%）或予以精神类药物（6例，5.5%）。结论综合医院门诊的焦虑障碍患者共病抑郁障碍的比例高、躯体主诉多、生活质量差、自杀倾向高，但被识别的比例较低。
목적：료해종합의원문진초필장애환자적취진특점。방법우2007년5-6월대북경시삼소종합의원신경내과、소화내과、심내과화부과적문진환자진행조사。채용일반사사문권、의원초필억욱량표（ hospital anxiety and depression scale，HADS）、환자건강문권（patient health questionnaire somatic symptom severity scale，PHQ -15）진행사사，대 HADS 평분≥8분적취진자유경과배훈적정신과의사채용국제신경정신과간식방담문권（the mini international neuropsychiatric interview，MINI）진행정신상황검사，병주출정신과진단。결과공유2074인완성조사，기중진단위초필장애자（초필장애조）110례，기중57례（51.8%）공환억욱장애；무정신장애자（정상조）1538례（HADS평분<8분자915례，경 MINI 진단무정신장애자623례）。초필장애조적평균년령위（45.3±14.1）세，정상조위（49.7±16.8）세，량조년령간차이유통계학의의（t =2.667，P <0.05）；량조성별、직업간차이무통계학의의（P >0.05）。초필장애조적 PHQ -15총분위（12.5±5.7）분，정상조위（7.1±4.3）분，량조간비교차이유통계학의의（t =12.371，P <0.01）。초필장애조환자 PHQ -15중출현빈솔전삼위적조목위：감도피로37.3%（41례）；수면문제37.3%（41례）；허약감30.0%（33례）。정상조화초필장애조적오공천수、목전질병조성적공능손해（대가정생활화가정책임적영향、대공작화학습적영향、대사교생활적영향）간차이유통계학의의（P <0.05）。초필장애조환자유자살경향자점32.7%（36례），지유22례환자（20.0%）피건의전진도정신과（16례，14.5%）혹여이정신류약물（6례，5.5%）。결론종합의원문진적초필장애환자공병억욱장애적비례고、구체주소다、생활질량차、자살경향고，단피식별적비례교저。
Objective To explore the characteristics of anxiety disorder in outpatient of general hospitals. Methods The outpatients in Neurology,Gastroenterology,Cardiology,and Gynecology department were screened using general information questionnaire,Hospital Anxiety and Depression Scale( HADS),Patient Health Questionnaire somatic symptom severity scale (PHQ - 15). All the patients who's HADS score were 8 or above were examined by psychiatrists using the Mini International Neuropsychiatry Interview(MINI)and were determined the psychiatric diagnosis. Results All in all 2 074 outpatients completed the investigation:110 with anxiety disorder(anxiety disorder group)among which 57(51. 8% )with comorbid anxiety depres-sion,1 538 cases without anxiety disorder(normal group)(915 cases' HADS were under 8,623 cases were determined by MINI). The depression group was younger than the normal control〔(45. 3 ± 14. 1)vs. (49. 7 ± 16. 8),t = 2. 667,P <0. 05〕,and there was of no significant difference between the two groups on gender and occupation distribution( P > 0. 05).The total score in PHQ - 15 of anxiety patient were higher than those of normal controls〔(12. 5 ± 5. 7)vs. (7. 1 ± 4. 3),t =12. 371,P < 0. 01〕. The most common chief complaints were tiredness,sleep problem and weakness and the occurrence fre-quency was 37. 3% (41)、37. 3% (41)、30. 0% (33)separately. The days of absent from work in anxiety patients were more than those of normal control(P < 0. 05),and the impairment on work,life and social functions was also higher in anxiety patients(P < 0. 05). Total 32. 7% (36)anxiety patients had suicide idea or attempts,and among which 22 cases(20. 0% ) were recommended consulting psychiatric department(16 cases,14. 5% ) or taking antipsychotic drugs(6 cases,5. 5% ). Conclusion Outpatients with anxiety disorder in general hospitals had a high frequency of depression co - morbidity,with many somatic complaints,poor life quality and high suicide risk,but the rate of physician's identification was low.