Survey and Research for Mechanisms of Somatization of General Out-patients

最近老年人口和医疗信息的增加增加了对自身身体状况的焦虑和关注，导致将心理社会压力源转化为身体问题的恶性循环。躯体化的转化产生了大量的“医学上无法治愈的躯体病”患者，并带来了频繁的检查和过度的药物治疗等医疗经济问题。因此，我们探讨躯体化背后的社会因素、熟悉因素和心理因素。在内科、心身医学或精神病学门诊就诊的249名门诊患者回答了社会心理因素问卷，并在躯体化症状列表中选择了目前的症状。由主治医生判断各症状的心理和躯体效应的优势，将患者分为“无症状”、“心理优势”、“躯体优势”和“混合效应”4组。结果表明：(1)“心理优势”患者（简称躯体化患者）占总患者的37%，男女性别比为1:6 .6。发病率最高的是精神科门诊（74%），但12%的内科病人被躯体化。(2)躯体化症状可在1个月的评估中确定。(3)躯体化患者表现出以下倾向：在多病、讨厌精神问题的大家庭中长大；在学校生活中，他们曾经热衷于运动，但对友谊和健康漠不关心，身体发育迟缓；现在他们很少有娱乐和朋友，对运动和健康环境漠不关心，几乎每天都使用一些镇静剂和催眠药。他们表现出完美主义、忧虑和孤独等特征，并有一些妄想症的想法。

Recent increments of senile population and medical information have enhanced anxiety and attention for own somatic conditions, resulting in vicious circles converting psychosocial stressors into somatic problems. The convertion or somatization produces lots of the patients with "medically untreatable somatic conditions", and brings about medico-economical problems with frequent examinations and excessive pharmacotherapy. Thus we investigated social, familiar and psychological factors behind the somatization.Two hundreds and forty-nine out-patients, visiting a clinic of either internal medicine psychosomatic medicine or psychiatry, answered the questionnaire of socio-psychological factors and selected the present symptoms among the somatization symptom list. The doctor in charge judged predominance of psychological and somatic effects on each symptom and the patients were classified into 4 groups of "No Sympton", "Psychological Predominance", "Somatic Predominance" and "Mixed Effects".The main results were as follows : (1)the patients with "Psychological Predominance" briefly called somatized patients were 37% of the total patients and the sex ratio of male vs. female was 1 : 3.6. The incidence was the highest (74%) in the psychiatric clinic but 12% of the internal patients were somatized. (2)Somatization symptoms could be determined within one month evaluation. (3)The somatized patients showed the following tendencies : they had grown up in the extended families who were sickly and hated mental problems, they led the school life where they had been enthusiastic about sports but indifferent to friendship and health and delayd in physical development, and now they had few pleasures and friends, were indifferent to exercises and healthy circumstances, and used some tranquilizers and hypnotics almost daily. They showed characteristics such as perfectionism, apprehensions and loneliness, and had some hypochondrical ideations.