symptoms depression in general practice 情緒障碍躯体化课件

Somatic Symptoms 341:1329-1335) 65% depressed patients report somatic symptoms 忧郁病人有躯体症状 (Bair MJ et al, Arch Intern Med. 2003;163:2433-2445. Bair MJ et al, Psychosom Med. 2004; 66: 17-22.) Percentage of depressed patients presenting with predominantly physical symptoms 抑鬱病人有躯体问题的比率 S.8 Somatic symptoms 3-774-9) More frequent association with anxiety disorders and depression MUS 跟焦虑和忧郁有密切出现的关系 (Katon W et al. Ann Intern Med 2001;134-971-925) Somatic symptoms 48:980-990). 奥马(OMalley)重复检视了96个随机对照试验发现抗忧郁药用于治疗 MUS有中度效用。 Somatic symptoms & depression Conclusion II结果二 S.20 Review of records of patients for January 07 复查2007年一月份病人的记录 Review of records of patients for January 07 Somatic symptoms & depression Analysis of somatic symptoms in 53 patients with depression 53位忧郁人位的躯体症状分析 A (Total=2, 共2 人) B (Total=16,共16 人) C (Total=35,共35 人 ) Prevalence 現患率 m+ & m+ss+ m+ss+ss+ Sleep睡眠 2143087% pain痛楚 2132677% GI upset 肠胃1102466% Tiredness疲累1101651% Dizziness晕眩 131434% Blood Pressure血压( 不稳定) 02819% Others其它 Malaise不适, hotness & chills寒颤, numbness麻木, palpitation 心悸, urgency, shortness of breath S.21 Review of records of patients for January 07 复查2007年一月份病人的记录 Somatic symptoms & depression Analysis of 41 depressed patients with pain 痛楚类别分折(4l人) A (Total=2, 共2 人 ) B (Total=13,共13 人 ) C (Total=26,共26 人 ) Prevalence 現患率 m+ & m+ss+ m+ss+ss+ General 广泛 191459% Head头部 19844% Chest胸口 131342% Neck & Shoulder 颈及肩膊 04624% Limbs四肢 02517% Back背部 0139.8% Others其它 pain of tongue,soles, joints, heaviness of lower limb 舌头, 脚板, 关节, 下身沉重 S.22 Review of records of patients for January 07 复查2007年一月份病人的记录 Somatic symptoms & depression Analysis of 35 patients with GI upset 肠胃常见的问题(35人) A (Total=1, 共1 人) B (Total=10,共10 人 ) C (Total=24,共24人) Prevalence 現患率 m+ & m+ss+ m+ss+ss+ Pain痛,食欲不振 0102291% IBS肠胃焦虑 00411.4% OGD胃镜(阴性结果) 03831% Colonoscopy大肠内窥(阴性 结果) 00514% Gastrectomy胃部切除(莫须 有) 0128.5% Tenesmus裏急後重 0012.8% Abdominal mass疑似肿瘤 0012.8% Others其它 Swallowing difficulty, constipation 吞咽困难、大便秘结 S.23 Review of records of patients for January 07 复查2007年一月份病人的记录 Questions to be answered 有待回答的问题 1. Why & How are antidepressants effective in the treatment of somatic symptoms? 为何抗忧郁药物对躯体病微有疗效 2. Are all patients with medically unexplained symptoms psychiatric? 一部分患者的躯体症状， 我们目前不能解释，他 们是否都有精神上的问题呢？ Somatic symptoms & depression S.24 Questions to be answered 有待回答的问题 3. How does the mind generate symptoms of the body? 精神（尤其是情绪障碍）如何导致身体不适呢？ 4. Is the pathophysiology producing the psychiatric & medical somatic symptoms the same biological mechanism? 同是躯体不适，情绪障碍和肉体病症引起的不适 是不是一样？它们是否共用同一机制呢? Somatic symptoms & depression S.25 Are doctors feeling different parts of the same depressed elephant? 不同科目的医生可能正在摸着同一只大象不同的部位? Somatic symptoms & depression The body and the mind精神与身体 S.26 Psychiatrists, researchers & GPs seeing different parts of a depressed elephant Non-psychiatric doctors in general practice & other specialities e.g. Dr. David Wong 家庭及其它非精 神科医生，例如王 大卫 A depressed elephant The Body身体: S.27 一只忧郁的大象 Psychiatrists精神科医生 Psychiatrists: e.g. Prof. S W TANG 精神科医生: e.g. 邓兆华教授 A depressed elephant S.28 一只忧郁的大象 Researchers研究者 Researchers & Psychopharmacologists: e.g. Prof. Brian Leonard e.g.自烂尼教授 A depressed elephant S.29 一只忧郁的大象 A depressed elephant Mind & Body is One 精神与身体是共为一体 S.30 一只忧郁的大象 Acknowledgment鸣谢 I would like to thank Pr