Psychiatric disorders in older primary care patients
Psychiatric disorders in older primary care patients
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DOI：
10.1046/j.1525-1497.1999.00326.x
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发表时间：
1999-04-01
影响因子：
5.7
通讯作者：
Yoediono, Z
中科院分区：
文献类型：
--
作者：
Lyness, JM;Caine, ED;Yoediono, Z
目的：大多数患有精神疾病的老年人从未接受过精神卫生专家的治疗，尽管他们会定期去看初级保健医生。目前还没有发表的研究描述了使用有效的诊断工具在这类患者中广泛的精神疾病。因此，我们描述了在初级保健中看到的老年患者的I轴精神病诊断。设计：采用标准化诊断方法进行精神病理学调查。周边环境：这里有三名获得委员会认证的普通内科医生的私人诊所，以及一间独立的家庭医学诊所。参与者：所有给予知情同意的60岁及以上患者均符合条件。测量和主要结果：对于完成研究的224名受试者，精神病学诊断基于DSM-III-R的结构化临床访谈。点患病率估计采用基于分层抽样方法的加权平均值。对于合并站点，31.7%的患者至少有一种活跃的精神病学诊断。目前流行的疾病包括重度抑郁症（6.5%）、轻度抑郁症（5.2%）、痴呆（5.0%）、酒精滥用或依赖（2.3%）和精神障碍（2.0%）。心境恶劣障碍、原发性焦虑和躯体形式障碍较少见，且常与重度抑郁症共病。结论：精神障碍，尤其是抑郁症，在这些初级保健机构的老年人中很常见。考虑到原发性焦虑和躯体形式障碍的患病率相对较低，临床医生在评估有焦虑或疑似躯体形式症状的老年患者时应特别警惕抑郁症。
OBJECTIVE: Most older people with psychiatric disorders are never treated by mental health specialists, although they visit their primary care physicians regularly. There are no published studies describing the broad array of psychiatric disorders in such patients using validated diagnostic instruments. We therefore characterized Axis I psychiatric diagnoses among older patients seen in primary care.DESIGN: Survey of psychopathology using standardized diagnostic methods.SETTING: The private practices of three board-certified general internists, and a free-standing family medicine clinic.PARTICIPANTS: All patients aged 60 years or older who gave informed consent were eligible.MEASUREMENTS AND MAIN RESULTS: For the 224 subjects completing the study, psychiatric diagnoses were based on the Structured Clinical Interview for DSM-III-R. Point prevalence estimates used weighted averages based on the stratified sampling method. For the combined sites, 31.7% of the patients had at least one active psychiatric diagnosis. Prevalent current disorders included major depression (6.5%), minor depression (5.2%), dementia (5.0%), alcohol abuse or dependence (2.3%), and psychotic disorders (2.0%). Dysthymic disorder and primary anxiety and somatoform disorders were less common and frequently comorbid with major depression.CONCLUSIONS: Mental disorders, particularly depression, are common among older persons seen in these primary care settings. Clinicians should be particularly vigilant about depression when evaluating older patients with anxiety or putative somatoform symptoms, given the relatively low prevalences of primary anxiety and somatoform disorders.