躯体症状障碍的特点及综合诊疗原则

从美国精神疾病诊断与统计手册第三版（DSM-Ⅲ）的躯体形式障碍,到甚至更早的诊断名称为DSM-5的躯体症状障碍,这类疾病的名称一直在变化;学界对躯体化症状的分类和定义也一直存在争议.进行分类和诊断的主要目的是为了治疗.本文从躯体症状障碍相关概念的变迁及本质特点入手,分析、总结躯体症状障碍的心理行为特点及接诊和治疗原则,以期对广大临床工作者治疗工作的开展有所帮助.     

躯体化的心身交互机制及其中的文化因素

基于神经生物学的心身交互作用是当前躯体化病理机制的一个研究重点。在生理-心理的功能连续体中, 认知学习、感觉监控、注意、记忆过程等都会影响躯体症状的呈现。文化则会通过这些过程塑造个体对症状的归因和解释, 引发躯体症状的呈现和扩大, 最终通过不同文化特有的民族生理学模式形成具有文化特异性的疑病焦虑和医学无法解释症状。     

躯体化概念的争议及本土化审视

两种认识躯体化的方式值得关注:一是继发于精神痛苦的现象;一是以医学无法解释的症状为特征的基本现象.躯体化概念受到争议的根本原因,即其基于西方心身二元论的特征.本土背景下,躯体化应理解成一种普遍且正当的求医理由与症状诉说方式,应该更多倾向于临床评估与治疗.     

意象思维与躯体化症状：疾病表达的文化心理学途径

意象思维是中国人的传统思维模式, 它通过观物取象和取象比类的方式认知世界、推演联系。这种思维模式塑造了中国人特有的身心不分而非两分的身体观、疾病观和治疗观。在中国人的观念中, 身体不仅仅是一具生理躯体, 还具有气、阴阳、五行等本土概念所体现的弥合物质与精神、联结生理与心理的模糊性与开放性。人们在表达疾病感觉时通常不分生理与心理, 任何一方面出现不适感觉即可认为自己生病, 在面对心理医生时也倾向于同时报告躯体状况与心理感觉, 从而使得临床报告出现较高的躯体化报告率。这正是文化心理影响疾病表达的体现。这也使得疾病不仅是一种医学现象, 也是一种文化现象; 医学不仅需要生理知识, 也需要人文知识。     

中国人的躯体化现象探析

躯体化是一个较为复杂的概念。西方学者往往将其归结为是中国人不善表达情绪的结果。本文就躯体化现象进行了探究,着重分析了导致这一现象的经济、文化、社会因素。最后文章就躯体化进行了更深一步的思考和探索,分析了躯体化本身的适应性意义,以及盲目采用西方诊断方式对医患关系等方面造成的负面影响,从而指出发展本土化治疗的必要性。     

综合性医院中抑郁症患者述情障碍与躯体化症状的研究

1　前言　　综合性医院就诊者中心理障碍患者占 2 4 % ,其中抑郁症为 1 0 4 %。一部分抑郁症患者具有明显的躯体化症状 ,多以躯体病就诊 ;一部分抑郁症患者不具有明显的躯体化症状 ,以情绪障碍症状为主诉。国内已对心身疾病、神经症、物质依赖的抑郁症患者述情障碍进行研究 ,我们进一步研究抑郁症患者述情障碍与躯体化症状之间的关系。述情障碍 (ａｌｅｘｉｔｈｙｍｉａ)主要表现为对情绪状态描述困难 ,少幻想和实用性思维方法 ,人际关系僵化。述情障碍者难以区别情绪状态和躯体感觉 ,描述躯体不适较多 ,因为他们常过分关注自己的躯体感受 …     

疼痛表达与中国人表达的躯体化

西方研究者认为中国人习惯用躯体化方式表达心理不适,不能区分身体疼痛和心理痛苦。通过回顾中文文本,认为在传统中国的语境中,身心互应的哲学观念使个体能够以一种隐性但自明的方式来表达自身情感。但在社会变迁的环境中,原有的社会关联多数都已崩解,个体开始使用躯体化以及疼痛作为索引,从而提供自我的某种参照。     

中国的“身体沟通”和躯体症状障碍:一个文化和性别视角下的案例研究

传统医疗支援服务在治疗躯体形式障碍和躯体症状障碍(somatic symptom disorder,SSD)上收效甚微。这些患者经历着越注意身体的痛感越感到难受的恶性循环,他们对这些现象的负面解释导致自身形成关注于身体(身体形象,强化患者的自我意识/自我观察)的“担忧型认知风格”,导致身体感觉不适与过度唤醒。身体心理治...     

躯体知觉的认知神经机制

摘 要：人类躯体是由各部位按照一定的空间关系组成的,与人类面孔相似,也是对称的。它也能提供个体身份和行为方式等信息,如年龄、性别、意图、情感状态等。它与面孔相辅相成,共同促成对个体身份的辨别。躯体知觉是指大脑对进入视觉加工系统中的人类躯体刺激的侦察,感知或识别。躯体知觉应当如面孔知觉研究一样受到更多的关注。文章概述、评价了躯体知觉相关的认知神经研究,着重介绍了躯体知觉的认知和神经机制,并提出了一些值得进一步研究的问题。     

躯体形式障碍的社会心理学分析

本研究对躯体形式障碍患者的社会心理特点进行调查分析.按照中国精神障碍分类与诊断标准第3版（CCMD-3）,试验组躯体形式障碍患者51例,在社区分层抽样51人作为对照组,用防御方式问卷、多伦多述情障碍量表进行测量.试验组不成熟型防御方式明显高于对照组,成熟型防御方式低于对照组,差异有统计学意义;述情障碍总分高于对照组,差异有统计学意义.情绪表达障碍、不成熟心理防御方式和社会文化因素共同作用形成了躯体形式障碍发病机制中的社会心理原因.在预防与治疗中需加强心理干预,以有效预防疾病的发生和提高治疗效果.     

Linking Family Functioning and Self-Discrepancies among Children with Functional Somatic Symptoms

Functional somatic symptoms (FSS), defined as physical symptoms of unknown pathology, are common among children and adolescents and are often associated with high levels of functional impairment. Self-discrepancy theory (SDT) suggests that discrepancies between one’s ideal, ought, or undesired self-states and one’s actual self-representation may lead to emotional distress. Among families with dysfunctional patterns, such emotional distress may result in FSS. The current study examined the relationship between familial patterns and children’s levels of self-discrepancies, among children with and without FSS. Twenty-three children diagnosed with FSS and 23 children with orthopedic problems (non-FSS) and their mothers participated in the study. Mothers and children completed the Child Somatization Inventory and the Integrated Self-Discrepancies Index. Mothers also completed the general scale of the Family Assessment Device. Higher levels of symptom intensity were found in the FSS group than in the non-FSS group. Dysfunctional familial patterns were significantly higher in the FSS group, and higher levels of discrepancies were reported in the FSS group, compared with the non-FSS group. No significant relationship was found in the FSS group between level of self-state discrepancies and level of family functioning. Higher levels of dysfunctional patterns are observed among families of children with FSS. Furthermore, children with FSS and their mothers hold relatively high levels of self-state discrepancies. However, these elevated discrepancies are not significantly related to familial dysfunctional patterns. Viewing self-state discrepancies together with family maladaptive patterns might help address both inter- and intrapersonal conflicts within the family and reduce children’s symptoms.     

Efficacy of a Brief Relaxation Training Intervention for Pediatric Recurrent Abdominal Pain

This study is a preliminary investigation of the efficacy of a brief intervention for recurrent abdominal pain (RAP) via a multiple baseline across subjects design. The intervention consisted of a single 1-hour session including psychoeducation and coaching of breathing retraining; the length, duration, and content of the intervention were designed with a goal of maximum portability to primary-care settings. Five children with recurrent abdominal pain participated in this study, 1 of whom served as a pilot participant. Children received the intervention at 1-week intervals. Parent and child reports of each child's abdominal pain, general somatic complaints, functional disability, and anxiety were collected throughout the study. All children participated in a 3-month follow-up session. Results indicated that this brief intervention was successful in lessening abdominal pain, as demonstrated by decreased Abdominal Pain Index (API) scores in two children and decreased abdominal pain following breathing retraining practice in all children. The intervention was also successful in decreasing some children's general somatic symptoms. Functional disability and anxiety symptoms remained consistent for all children throughout the study, which may be due to low levels of these symptoms pretreatment. Limitations and directions for future research are discussed.     

Somatization,sensitization, and functional dyspepsia

Functional dysepsia (FD) is defined as persistent or recurrent pain or discomfort centered in the upper abdomen without evidence of organic disease likely to explain the symptoms. Visceral hypersensitivity, motor dysfunction, and impaired gastric accommodation are found in some patients with FD, and psychological factors like chronic stress, attention and perception bias are also likely to play a part in the symptom formation. There is considerable overlap of non-specific symptoms like fatigue, headache, abdominal discomfort, muscle pain, and sleep disturbance in patients with different functional disorders, in this article exemplified by FD, fibromyalgia, and chronic fatigue syndrome. This overlap of symptoms indicates a common underlying sensitization process, leading to somatization.     

The Relationships of Stress to Angioneurotic Edema:

Hereditary angioneurotic edema is a disease characterized by attacks of swelling of the extremities, face, and airways, frequently accompanied by abdominal pain and gastrointestinal symptoms such as vomiting and nausea. The possibility of improving the management of hereditary angioneurotic edema through psychological interventions was raised by the fact that stress has been implicated as a potential precipitant for acute attacks as well as a common psychological sequala to them. The current case evaluates efficacy of Psychological interventions in reducing the frequency and intensity of symptoms associated with this disorder in a 16-year-old white female. The combination of family therapy and behavior management was more successful than an initial effort utilizing stress management techniques in combination with positive reinforcement alone.     

功能性消化不良

功能性消化不良（FD）是临床上常见的症候群,其发病机制可能与胃及十二指肠的高敏感、胃肠运动障碍、幽门螺杆菌（H．pylori）感染、精神心理因素等有关。症状为反复发作的上腹部不适、疼痛、早饱、腹胀等。目前FD的诊断以罗马Ⅲ为标准,即无可以解释症状的器质性疾病的证据（包括内镜）,诊断前症状至少出现6个月,近3个月症状符合以下1点或1点以上：餐后饱胀不适、早饱、上腹痛、上腹烧灼感。治疗以去除诱因及对症治疗为主,包括避免劳累及精神紧张,应用抑酸药、促胃肠动力药、根除H．pylori、西甲硅油乳剂、抗抑郁及中药等。     

Childhood anxiety sensitivity index factors predict unique variance in DSM-IV anxiety disorder symptoms

Anxiety sensitivity (AS) is an established cognitive risk factor for anxiety disorders. In children and adolescents, AS is usually measured with the Childhood Anxiety Sensitivity Index (CASI). Factor analytic studies suggest that the CASI is comprised of 3 lower-order factors pertaining to Physical, Psychological and Social Concerns. There has been little research on the validity of these lower-order factors. We examined the concurrent and incremental validity of the CASI and its lower-order factors in a non-clinical sample of 349 children and adolescents. CASI scores predicted symptoms of DSM-IV anxiety disorder subtypes as measured by the Spence Children's Anxiety Scale (SCAS) after accounting for variance due to State-Trait Anxiety Inventory scores. CASI Physical Concerns scores incrementally predicted scores on each of the SCAS scales, whereas scores on the Social and Psychological Concerns subscales incrementally predicted scores on conceptually related symptom scales (e.g. CASI Social Concerns scores predicted Social Phobia symptoms). Overall, this study demonstrates that there is added value in measuring AS factors in children and adolescents.     

Editorial

Fatigue is among the most common and disabling symptoms in multiple sclerosis (MS). However, the relationship of perfectionism to fatigue in MS patients remains poorly understood. One hundred and twenty MS patients (79 women, 41 men) were compared with 120 healthy individuals (79 women, 41 men) to explore whether differences exist between the two groups with respect to perfectionistic characteristics and to investigate whether dimensions of positive and negative perfectionism are related to the symptomatology of fatigue. All participants were asked to complete the positive and negative perfectionism scale (PANPS), the modified fatigue impact scale (MFIS), the fatigue severity scale (FSS) and the Beck depression inventory (BDI). The results revealed that the MS group reported lower levels of positive perfectionism and higher levels of negative perfectionism as well as depressive symptoms than the control group. Perfectionism was also significantly related to fatigue symptoms in both groups. These findings suggest that the fatigue symptoms are strongly associated with perfectionistic characteristics. The negative (maladaptive) dimension of perfectionism may play a predisposing role in the development and/or perpetuation of fatigue in MS patients. The findings are discussed within the scope of current literature and implications for clinical applications are suggested.     

Family Interaction and Individual Psychological Health

Two studies explored the relationships between individual psychological health (PH) status and perceptions of family interaction and family climate variables as perceived by young adults. Psychological health was defined within inter- and intrapersonal domains, represented by social interest and psychological hardiness. Scores on social interest and hardiness instruments were standardized and added to put the construct of psychological health into practice. Family interaction variables were measured with Family Adaptability and Cohesion Evaluation Scales-III (FACES-III), the Children's Report of Parent Behavior Inventory-30 (CRPBI-30), Parent-Adolescent Communication Scale (PAC), Family Satisfaction Scale (FSS), and the Family Environment Scale (FES). Multivariate analyses indicated that PH status was associated with several family variables, with cohesion emerging as a key dimension. Implications for counseling are discussed.     

Research to Practice: Implementation of Family School Success for Parents of Children With ADHD

“Family-School Success” (FSS) is an efficacious intervention improving the home and school functioning of children with ADHD in grades 2–6. An extension of this intervention designed for a younger population also showed positive effects for kindergarten and first grade students in a pilot study. Following the completion of these trials, FSS was implemented in a fee-for-service tertiary care ADHD center. The implementation process included adapting the manual and treatment procedures to be feasible outside the structure and support of a federally funded randomized control trial (RCT). The current study examines the process of adapting the treatment protocol and examines the acceptability and effectiveness of the adapted FSS, as well as predictors of family treatment response including parent engagement in treatment (as measured by attendance and homework adherence). A case study illustrates the adaptations to the intervention and its implementation in the clinic-based setting. In line with findings from clinical trials, families reported high satisfaction with the adapted FSS intervention and showed significant improvement in parental self-efficacy, child academic homework performance, and reduction in child impairment. Additionally, as in the initial FSS RCT, parental attendance in the adapted FSS program predicted child attention to academic homework, controlling for parental adherence to between-session homework. Furthermore, controlling for attendance at FSS sessions, parent adherence to between-session homework assignments predicted improvements in parent self-efficacy as well as child’s homework productivity. These results replicate those of the original RCT and confirm that both session attendance and between-session homework completed are important for improvement during the program. Overall, this study provides support for the acceptability and effectiveness of this treatment model and suggests that future work toward dissemination to community-based settings would be worthwhile.     

慢性腰背痛患者和抑郁症患者的情绪、睡眠及疼痛症状

本研究对慢性腰背痛患者、抑郁症患者和对照人群的疼痛、抑郁水平、焦虑水平和睡眠质量进行测评,发现慢性腰背痛患者的抑郁、焦虑程度增高,失眠较常见;抑郁症患者的焦虑和失眠现象严重,疼痛是其常见症状。结果提示临床上对慢性疼痛患者和抑郁症患者的疼痛、情绪和睡眠问题予以评定和治疗具有重要意义。