Medical symptoms without identified pathology: Relationship to psychiatric disorders, childhood and adult trauma, and personality traits
Medical symptoms without identified pathology: Relationship to psychiatric disorders, childhood and adult trauma, and personality traits
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DOI：
10.7326/0003-4819-134-9_part_2-200105011-00017
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发表时间：
2001-05-01
影响因子：
39.2
通讯作者：
Walker, E
中科院分区：
文献类型：
--
作者：
Katon, W;Sullivan, M;Walker, E
社区研究表明，应激性生活事件、心理困扰以及抑郁和焦虑障碍与以下情况相关：1）一系列无明确病理学依据的医学症状，2）医疗保健利用率增加，3）成本增加。在初级医疗和专科医疗样本中，患有病理机制不明确的综合征（如肠易激综合征和纤维肌痛）的患者，其焦虑和抑郁障碍的发生率明显高于患有类似且病理明确的疾病以及相似症状的患者。其他研究表明，在对疾病严重程度进行调整后，患有抑郁症或焦虑症且合并内科疾病的患者，其无明确病理学依据的医学症状明显多于仅患有类似内科疾病的患者。儿童期虐待和成年期的心理创伤都与精神疾病易感性增加以及更多的医学症状有关。与无明确病理学依据的医学症状相关的严重功能损害、痛苦和成本表明，促进更好地理解这些症状的生物 - 心理 - 社会病因的研究可能会在医疗环境中产生实用、具有成本效益的治疗方法。
Community studies have shown that stressful life events, psychological distress, and depressive and anxiety disorders are associated with 1) a range of medical symptoms without identified pathology, 2) increased health care utilization, and 3) increased costs. In both primary care and medical specialty samples, patients who have syndromes with ill-defined pathologic mechanisms (such as the irritable bowel syndrome and fibromyalgia) have been shown to have significantly higher rates of anxiety and depressive disorders than do patients with comparable, well-defined medical diseases and similar symptoms. Other studies show that after adjustment for severity of medical illness, patients with depression or anxiety and comorbid medical disease have significantly more medical symptoms without identified pathology than do patients with a similar medical disease alone. Both childhood maltreatment and psychological trauma in adulthood have been associated with increased vulnerability to psychiatric illness and more medical symptoms. The substantial functional impairment, distress, and costs associated with medical symptoms without identified pathology suggest that research studies promoting a better understanding of the biopsychosocial cause of these symptoms may yield pragmatic, cost-effective approaches to treatment in medical settings.