抑郁症躯体化与心理社会因素的相关研究
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摘要
目的:采用病例-对照研究躯体症状表现为主抑郁症的临床现象学,心理社会相关危险因素,其与情绪障碍表现为主抑郁症及躯体形式障碍的异同。探讨抑郁症躯体化的自主神经功能紊乱特点和心理社会相关中介机制。
方法:按CCMD-3心境障碍抑郁发作的诊断标准,收集51例躯体症状表现为主抑郁症患者(躯体症状组,DSG)、57例情绪障碍表现为主抑郁症患者(情绪障碍组,DEG)、42例躯体形式障碍患者(躯体形式障碍组,SFD)及48例正常对照组(HCG)。完成一般状况调查问卷、汉密顿抑郁量表(HRSD)、汉密顿焦虑量表(HAMA)、多伦多述情障碍量表(TAS)、防御方式问卷(DSQ)、生活事件量表(LES)、社会支持评定量表(SSRS)、特质应对方式问卷(TCSQ)、家庭环境量表中文版(FES-CV)、生活质量综合评定问卷(GQOLI-74);并测定实验应激前后心率变异性(HRV),进行短时(10分钟)分析。
结果:1、临床现象学:(1) DSG组年龄大、女性比例大、文化程度低、居住农村多、病程长、发病诱因多、家族史少、间断发病多(P<0.05或P<0.01); DSG组和SFD组较多就诊于非精神科室(P<0.01),就诊医院数目、科室数目、用药种类、检查数目及检查费用都较DEG组高(P<0.05或P<0.01);(2) DSG组的首诊症状以胃部不适、颈(背或四肢)疼痛、睡眠障碍、腹痛、腹胀、腹泻、胸闷较多(P<0.05或P<0.01);(3) DSG组消化系统的症状较多(P<0.05);(4) DSG组患者的HRSD总分、因子焦虑?躯体化、认识障碍、睡眠障碍及绝望感、HAMA总评分及因子分都较DEG组和SFD组高(P<0.05或P<0.01)。
2、心理社会相关因素:(1) DSG组、DEG组和SFD组患者的TAS总分(68.93±14.71,65.67±18.19,66.26±17.70)较HCG组(56.62±21.85)高(P<0.05或P<0.01);(2) DSG组TAS因子Ⅱ得分(20.24±6.39)显著比DEG组(17.71±5.85)和SFD组(17.26±2.92)高(P<0.05);(3) DSG组、DEG组和SFD组较多使用不成熟防御方式(P<0.05或P<0.01);DSG组的压抑(7.3±2.7)得分显著较DEG组(5.9±2.6)、SFD组(4.3±2.2)和HCG组(5.3±2.7)高(P<0.05或P<0.01);(4) DSG组的生活事件总值和负性生活事件值明显较DEG组和SFD组高(P<0.01),对社会支持的利用度较DEG组和SFD组低(P<0.05);(5) DSG组、DEG组和SFD组患者的家庭环境功能均存在缺陷;DSG组在亲密度、情感表达、娱乐性和控制性方面得分较DEG组和SFD组低(P<0.05或P<0.01);(6) DSG组生活质量的躯体功能、心理功能、社会功能及生活质量总体评价方面均低于DEG组、SFD组和HCG组(P<0.05或P<0.01)。
3、心率变异性结果:(1) DSG组和SFD组的SDNN(61.32±29.08,75.42±33.78)较HCG组(106.10±45.05)降低(P<0.01);DSG组、DEG组和SFD组的LF?HF(5.14±1.39,3.90±1.40,4.28±2.34)明显较HCG组(2.74±2.61)升高(P<0.01);(2)实验应激后,DSG组、DEG组和SFD组患者HRV的变化幅度均较HCG组大(P<0.05或P<0.01);DSG组SDNN、SDSD、LF、VLF、LF?HF变化幅度(-23.25±10.59,-20.53±11.39, 341.94±207.25, 431.97±256.32,2.75±1.61)较DEG组(-8.69±6.68,-14.56±5.36,222.09±165.78,226.61±191.79,1.52±1.02)和SFD组(-16.42±8.33,-11.85±6.42,234.90±140.88,272.23±132.05,2.02±1.18)大(P<0.05或P<0.01);(3)放松训练后,DSG组、DEG组和SFD组患者的HRV均未恢复到基线值;DSG组LF、LF?HF恢复幅度(-101.84±84.52,-0.89±0.47)较DEG组(-122.21±59.25,-1.14±0.51)和SFD组(-134.63±89.08,-1.25±1.02)小(P<0.05);(4)老年组的SDNN、SDSD、RMS-SD和HF较青年组低(P<0.01),LF和LF?HF较青年组高(P<0.05或P<0.01);
结论:躯体症状表现为主抑郁症患者的临床特征与情绪障碍表现为主抑郁症和躯体形式障碍患者不同,躯体症状表现为主抑郁症可能是抑郁症的一种亚型;躯体症状表现为主抑郁症与情绪障碍表现为主抑郁症的心理社会中介机制存在差异;自主神经系统失平衡可能是躯体症状表现为主抑郁症患者躯体化表现的机制之一。
Objective: The aim of the present case-control study was to investigate clinical phenomenology,psychosocial related risk factors and the differences betwween depressive patients presented as emotional complains and somatoform disorder; and to find the psychosocial mechanisms and the characteristics of autonomic nervous system funtion for depression with somatization .
Methods: In CCMD-3, 51 depressive patients presented as somatic complains (somatic group,DSG), 57 depressive patients presented as emotional complains (emotional group,DEG), 42 somotoform disorders patients(somotoform disorder group,SFD) and 48 normal controls(normal group,HCG)were investigated.All patients were interviewed in general condition questionnair,history questionnair, HRSD, HAMA, TAS, LES, SSRS, TCSQ, FES-CV, DSQ, GQOLI-74; and analysed the short-term heart rate variability (10 minutes) before and after stress stimulations and after relaxation training .
Results: 1、Clinical phenomenology showed : (1) DSG group were older,lower educated, and had more women,longer history,more incentives,less family history(P<0.05 or P<0.01); DSG group and SFD group received more treatment in non-psychiatric;The number of hospitals、departments、medications、medical examinations and the fees of examinations were higher than DEG group(P<0.05 or P<0.01); (2) DSG group presented more stomach discomfort and neck(back or limbs)pain、sleep disorders、abdominal discomfort and chest tightness(P<0.05 or P<0.01); (3) The physical symptoms of DSG group were more centered in digestive system(P<0.05); (4) DSG group gained higher score in HRSD total score、factor anxiety/somatization、awareness barriers、sleep disorders、hopelessness、HAMA total score and factor sores (P<0.05 or P<0.01).
2、Psychosocial factors showed: (1) Patients of DSG group、DEG group and SFD group (68.93±14.71,65.67±18.19,66.26±17.70)gained higher TAS total score than the HCG group(56.62±21.85)(P<0.05 or P<0.01); (2) DSG group (20.24±6.39)gained higher score in the factorⅡof TAS than the DEG group (17.71±5.85)and SFD group(17.26±2.92)(P<0.05); (3) Patients of DSG group、DEG group and SFD group used the immature defense styles more;DSG group (7.3±2.7)had higher score on inhibition than DEG group (5.9±2.6)、SFD group(4.3±2.2) and HCG group(5.3±2.7)(P<0.05或P<0.01); (4) DSG group had the more total life events and negative life events and lower score for the use of social support than DEG group and SFD group(P<0.05 or P<0.01); (5) DSG group、DEG group and SFD group all had family function deficits;the cohesion、emotional expression、control and entertainment of DSG group were lower than DEG group and SFD group(P<0.05 or P<0.01); (6) DSG group were lowest in the dimensions of physical function、psychological function、social function and the total quality of life dimebsion than DEG group、SFD group and HCG group(P<0.05 or P<0.01).
3、Results of heart rate variability: (1) In resting baseline period, DSG group and SFD group ( 61.32±29.08 , 75.42±33.78 ) had lower SDSD than HCG group(106.10±45.05)(P<0.01); DSG group、DEG group and SFD group(5.14±1.39, 3.90±1.40,4.28±2.34) had higher LF?HF than HCG group(2.74±2.61)(P<0.01); (2) After the stress stimulations, DSG group、DEG group and SFD group had higher demention of changes than HCG group ( P < 0.05 or P < 0.01 ) ; DSG group (-23.25±10.59,-20.53±11.39, 341.94±207.25, 431.97±256.32,2.75±1.61)had higher demention of change on SDNN、SDSD、LF、VLF、LF?HF than DEG group(-8.69±6.68,-14.56±5.36,222.09±165.78,226.61±191.79,1.52±1.02)and SFD group(-16.42±8.33,-11.85±6.42,234.90±140.88,272.23±132.05,2.02±1.18)(P<0.05 or P<0.01); (3) After relaxation training, HRV of DSG group、DEG group and SFD group did not return to the basiline; DSG group(-101.84±84.52,-0.89±0.47) had lower degree of return demention on LF and LF?HF than DEG group(-122.21±59.25,-1.14±0.51) and SFD group(-134.63±89.08,-1.25±1.02)(P<0.05); (4) Compared with youth group, the elderly group are lower on SDNN、SDSD、RMS-SD、HF and higher on LF and LF?HF (P<0.05 or P<0.01).
Conclusions: There are differences in clinical phenomenology and psychosocial intermediation between depressive patients presented as somatic complains、depressive patients presented as emotional complains and somotoform disorder patients; Depression presented as somatic complains may be a subtype of depresion; Inbalance of autonomic nervous system may be one of the mechanisms for depression with somatization.
方法:按CCMD-3心境障碍抑郁发作的诊断标准,收集51例躯体症状表现为主抑郁症患者(躯体症状组,DSG)、57例情绪障碍表现为主抑郁症患者(情绪障碍组,DEG)、42例躯体形式障碍患者(躯体形式障碍组,SFD)及48例正常对照组(HCG)。完成一般状况调查问卷、汉密顿抑郁量表(HRSD)、汉密顿焦虑量表(HAMA)、多伦多述情障碍量表(TAS)、防御方式问卷(DSQ)、生活事件量表(LES)、社会支持评定量表(SSRS)、特质应对方式问卷(TCSQ)、家庭环境量表中文版(FES-CV)、生活质量综合评定问卷(GQOLI-74);并测定实验应激前后心率变异性(HRV),进行短时(10分钟)分析。
结果:1、临床现象学:(1) DSG组年龄大、女性比例大、文化程度低、居住农村多、病程长、发病诱因多、家族史少、间断发病多(P<0.05或P<0.01); DSG组和SFD组较多就诊于非精神科室(P<0.01),就诊医院数目、科室数目、用药种类、检查数目及检查费用都较DEG组高(P<0.05或P<0.01);(2) DSG组的首诊症状以胃部不适、颈(背或四肢)疼痛、睡眠障碍、腹痛、腹胀、腹泻、胸闷较多(P<0.05或P<0.01);(3) DSG组消化系统的症状较多(P<0.05);(4) DSG组患者的HRSD总分、因子焦虑?躯体化、认识障碍、睡眠障碍及绝望感、HAMA总评分及因子分都较DEG组和SFD组高(P<0.05或P<0.01)。
2、心理社会相关因素:(1) DSG组、DEG组和SFD组患者的TAS总分(68.93±14.71,65.67±18.19,66.26±17.70)较HCG组(56.62±21.85)高(P<0.05或P<0.01);(2) DSG组TAS因子Ⅱ得分(20.24±6.39)显著比DEG组(17.71±5.85)和SFD组(17.26±2.92)高(P<0.05);(3) DSG组、DEG组和SFD组较多使用不成熟防御方式(P<0.05或P<0.01);DSG组的压抑(7.3±2.7)得分显著较DEG组(5.9±2.6)、SFD组(4.3±2.2)和HCG组(5.3±2.7)高(P<0.05或P<0.01);(4) DSG组的生活事件总值和负性生活事件值明显较DEG组和SFD组高(P<0.01),对社会支持的利用度较DEG组和SFD组低(P<0.05);(5) DSG组、DEG组和SFD组患者的家庭环境功能均存在缺陷;DSG组在亲密度、情感表达、娱乐性和控制性方面得分较DEG组和SFD组低(P<0.05或P<0.01);(6) DSG组生活质量的躯体功能、心理功能、社会功能及生活质量总体评价方面均低于DEG组、SFD组和HCG组(P<0.05或P<0.01)。
3、心率变异性结果:(1) DSG组和SFD组的SDNN(61.32±29.08,75.42±33.78)较HCG组(106.10±45.05)降低(P<0.01);DSG组、DEG组和SFD组的LF?HF(5.14±1.39,3.90±1.40,4.28±2.34)明显较HCG组(2.74±2.61)升高(P<0.01);(2)实验应激后,DSG组、DEG组和SFD组患者HRV的变化幅度均较HCG组大(P<0.05或P<0.01);DSG组SDNN、SDSD、LF、VLF、LF?HF变化幅度(-23.25±10.59,-20.53±11.39, 341.94±207.25, 431.97±256.32,2.75±1.61)较DEG组(-8.69±6.68,-14.56±5.36,222.09±165.78,226.61±191.79,1.52±1.02)和SFD组(-16.42±8.33,-11.85±6.42,234.90±140.88,272.23±132.05,2.02±1.18)大(P<0.05或P<0.01);(3)放松训练后,DSG组、DEG组和SFD组患者的HRV均未恢复到基线值;DSG组LF、LF?HF恢复幅度(-101.84±84.52,-0.89±0.47)较DEG组(-122.21±59.25,-1.14±0.51)和SFD组(-134.63±89.08,-1.25±1.02)小(P<0.05);(4)老年组的SDNN、SDSD、RMS-SD和HF较青年组低(P<0.01),LF和LF?HF较青年组高(P<0.05或P<0.01);
结论:躯体症状表现为主抑郁症患者的临床特征与情绪障碍表现为主抑郁症和躯体形式障碍患者不同,躯体症状表现为主抑郁症可能是抑郁症的一种亚型;躯体症状表现为主抑郁症与情绪障碍表现为主抑郁症的心理社会中介机制存在差异;自主神经系统失平衡可能是躯体症状表现为主抑郁症患者躯体化表现的机制之一。
Objective: The aim of the present case-control study was to investigate clinical phenomenology,psychosocial related risk factors and the differences betwween depressive patients presented as emotional complains and somatoform disorder; and to find the psychosocial mechanisms and the characteristics of autonomic nervous system funtion for depression with somatization .
Methods: In CCMD-3, 51 depressive patients presented as somatic complains (somatic group,DSG), 57 depressive patients presented as emotional complains (emotional group,DEG), 42 somotoform disorders patients(somotoform disorder group,SFD) and 48 normal controls(normal group,HCG)were investigated.All patients were interviewed in general condition questionnair,history questionnair, HRSD, HAMA, TAS, LES, SSRS, TCSQ, FES-CV, DSQ, GQOLI-74; and analysed the short-term heart rate variability (10 minutes) before and after stress stimulations and after relaxation training .
Results: 1、Clinical phenomenology showed : (1) DSG group were older,lower educated, and had more women,longer history,more incentives,less family history(P<0.05 or P<0.01); DSG group and SFD group received more treatment in non-psychiatric;The number of hospitals、departments、medications、medical examinations and the fees of examinations were higher than DEG group(P<0.05 or P<0.01); (2) DSG group presented more stomach discomfort and neck(back or limbs)pain、sleep disorders、abdominal discomfort and chest tightness(P<0.05 or P<0.01); (3) The physical symptoms of DSG group were more centered in digestive system(P<0.05); (4) DSG group gained higher score in HRSD total score、factor anxiety/somatization、awareness barriers、sleep disorders、hopelessness、HAMA total score and factor sores (P<0.05 or P<0.01).
2、Psychosocial factors showed: (1) Patients of DSG group、DEG group and SFD group (68.93±14.71,65.67±18.19,66.26±17.70)gained higher TAS total score than the HCG group(56.62±21.85)(P<0.05 or P<0.01); (2) DSG group (20.24±6.39)gained higher score in the factorⅡof TAS than the DEG group (17.71±5.85)and SFD group(17.26±2.92)(P<0.05); (3) Patients of DSG group、DEG group and SFD group used the immature defense styles more;DSG group (7.3±2.7)had higher score on inhibition than DEG group (5.9±2.6)、SFD group(4.3±2.2) and HCG group(5.3±2.7)(P<0.05或P<0.01); (4) DSG group had the more total life events and negative life events and lower score for the use of social support than DEG group and SFD group(P<0.05 or P<0.01); (5) DSG group、DEG group and SFD group all had family function deficits;the cohesion、emotional expression、control and entertainment of DSG group were lower than DEG group and SFD group(P<0.05 or P<0.01); (6) DSG group were lowest in the dimensions of physical function、psychological function、social function and the total quality of life dimebsion than DEG group、SFD group and HCG group(P<0.05 or P<0.01).
3、Results of heart rate variability: (1) In resting baseline period, DSG group and SFD group ( 61.32±29.08 , 75.42±33.78 ) had lower SDSD than HCG group(106.10±45.05)(P<0.01); DSG group、DEG group and SFD group(5.14±1.39, 3.90±1.40,4.28±2.34) had higher LF?HF than HCG group(2.74±2.61)(P<0.01); (2) After the stress stimulations, DSG group、DEG group and SFD group had higher demention of changes than HCG group ( P < 0.05 or P < 0.01 ) ; DSG group (-23.25±10.59,-20.53±11.39, 341.94±207.25, 431.97±256.32,2.75±1.61)had higher demention of change on SDNN、SDSD、LF、VLF、LF?HF than DEG group(-8.69±6.68,-14.56±5.36,222.09±165.78,226.61±191.79,1.52±1.02)and SFD group(-16.42±8.33,-11.85±6.42,234.90±140.88,272.23±132.05,2.02±1.18)(P<0.05 or P<0.01); (3) After relaxation training, HRV of DSG group、DEG group and SFD group did not return to the basiline; DSG group(-101.84±84.52,-0.89±0.47) had lower degree of return demention on LF and LF?HF than DEG group(-122.21±59.25,-1.14±0.51) and SFD group(-134.63±89.08,-1.25±1.02)(P<0.05); (4) Compared with youth group, the elderly group are lower on SDNN、SDSD、RMS-SD、HF and higher on LF and LF?HF (P<0.05 or P<0.01).
Conclusions: There are differences in clinical phenomenology and psychosocial intermediation between depressive patients presented as somatic complains、depressive patients presented as emotional complains and somotoform disorder patients; Depression presented as somatic complains may be a subtype of depresion; Inbalance of autonomic nervous system may be one of the mechanisms for depression with somatization.
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22. Katrin Barkow, Reinhard Heun, T. Bedirhanüstün, et al, Identification of somatic and anxiety symptoms which contribute to the detection of depression in primary health care, European Psychiatry, 2004,19(5): 250-257
23. Bernhard T. Baune, Riccardo N. Caniato, Miguel A. Garcia-Alcaraz, et al, Combined effects of major depression, pain and somatic disorders on general functioning in the general adult population, Pain, 2008,138(2):310-317
24. Mutsuhiro Nakao, Eiji Yano.Reporting of somatic symptoms as a screening marker for detecting major depression in a population of Japanese white-collar workers, Journal of Clinical Epidemiology, 2003,56(10): 1021-1026
25.季建林,张虹,抑郁症躯体症状及其相关因素分析[J],中国心理卫生杂志,2002,16(9),605-608
26. Mutsuhiro Nakao, Eiji Yano. Prediction of major depression in Japanese adults: Somatic manifestation of depression in annual health examinations, Journal of Affective Disorders, 2006,90(1):29-35
27. Sullivan MJ,Reesor K,Mikail S, et al. The treatment of depression in chronic low back pain:review and recommendations, Pain, 1992, 50:5-13
28. J. Wright, I.J. Deary, P.R. Geissler.Depression, hassles and somatic symptoms in mandibular dysfunction syndrome patients, Journal of Dentistry, 1991,19(6):352-356
29. Ulrike Willinger, Sabine V?lkl-Kernstock, Harald Nikolaus Aschauer.Marked depression and anxiety in patients with functional dysphonia, Psychiatry Research, 2005,134(1):85-91
30. Stefan G. Hofmann, Stefan M. Schulz, Sanna Heering,et al. Psychophysiological correlates of generalized anxiety disorder with or without comorbid depression, International Journal of Psychophysiology, 2010,1,20
31. Ya S. McIntyre, Jakub Z. Konarski, Deborah A. Mancini,. et al. Improving outcomes in depression: A focus on somatic symptoms.Journal of Psychosomatic Research, 2006,60(3) :279-282
32.姚芳传,多伦多述情障碍量表,心理卫生评定量表手册,(增订版),中国心理卫生杂志社,1999,378-381
33.路敦跃,防御方式问卷,心理卫生评定量表手册,(增订版),中国心理卫生杂志社,1999,115-120
34.张亚林,杨德森,生活事件量表,心理卫生评定量表手册,(增订版),中国心理卫生杂志社,1999,101-106
35.肖水源,社会支持评定量表,心理卫生评定量表手册,(增订版),中国心理卫生杂志社,1999,127-131
36.姜乾金,特质应对方式问卷,心理卫生评定量表手册,(增订版),中国心理卫生杂志社,1999,120-122
37.费立鹏等,家庭环境量表中文版,心理卫生评定量表手册,(增订版),中国心理卫生杂志社,1999,134-142
38.李凌江,杨德森,生活质量综合评定问卷,心理卫生评定量表手册,(增订版),中国心理卫生杂志社,1999,88-100
39. Rupert Conrad, Ingo Wegener, Katrin Imbierowicz, et al. Alexithymia, temperament and character as predictors of psychopathology in patients with major depression, Psychiatry Research, 2009,165(1-2):137-144
40. Jiri Modestin, Roman Furrer, T. Malti. Study on alexithymia in adult non-patients, Journal of Psychosomatic Research, 2004, 56(6):707-709
41. Kirsi Honkalampi, Jukka Hintikka, Antti Tanskanen, et al. Depression is strongly associated with alexithymia in the general population, Journal of Psychosomatic Research, 2000,48(1): 99-104
42. Kemal Sayar, Laurence J. Kirmayer, Suzanne S. Taillefer. Predictors of somatic symptoms in depressive disorder, General Hospital Psychiatry, 2003,25(2):108-114
43. Motan I.,Gencoz T..The relationship between the dimensions of alexithymia and the intensity of depression and anxiety, Turk Psikiyatr Dergisi, 2007, 18(4):333-43
44. S. Saarij?rvi, J. K. Salminen, T. B. Toikka..Alexithymia and depression: A 1-year follow-up study in outpatients with major depression, Journal of Psychosomatic Research, 2001,51(6):729-733
45.肖勃,谢文娇,张帆,焦虑症与抑郁症患者心理防御方式社会支持和家庭功能研究,中国行为医学科学,2006,15(9)797-799
46.张英辉,抑郁症患者防御方式及其家庭生活质量研究,临床精神医学,2009,19(1)44-45
47.杨文,赵勇,卢晓波,生活事件对女性抑郁症患者的影响,临床精神医学杂志,2007,17(3)177-178
48. Miranda Olff. Stress, depression and immunity: the role of defense and coping styles, Psychiatry Research, 1999,85(1): 7-15
49. Richard J. Budd, Rachel Pugh..Tinnitus coping style and its relationship to tinnitus severity and emotional distress, Journal of Psychosomatic Research, 1996,41(4): 327-335
50.李道林,刘谷行,陈振华,伴躯体症状抑郁症的综合式家庭治疗疗效观察,中国临床心理学杂志,1996,4(3):160-161
51. Bair MJ,Kroenke K,Sutherland JM, et al. Effects of depression and pain severity on satisfaction in medical outpatients:analysis of the medical outcomes study, Rehabil Res Dev , 2007;44:143-52
52. Vieta.E.,Sanchez-Moreno.J.,Zaragoza.S.. Subsyndromal depressive symptoms in patients with bipolar and unipolar disorder during clinical remission, Affect Disord, 2008,107:169-174
53. I.A. Dan, M. Grimberg, A. Varghes..The treatment of depression with somatic pain, European Psychiatry, 2008,23(2): S284
54. Hyo-Jung Park. Heart Rate Variability as a Measure of Disease State in Irritable Bowel Syndrome, Asian Nursing Research, 2008,2(1) :5-16
55. Bicakova-Rocher,A.Gorceix,A.Reinberg,et al,Temperature rhythm of patients with major affective dosorder :reduced circadian period length, Chronobiol.Int, 1996,13: 47-57
56. Richard J. Budd, Rachel Pugh .Tinnitus coping style and its relationship to tinnitus severity and emotional distress, Journal of Psychosomatic Research, 1996,41(4): 327-335
57. Rabins P.V.,Harvis K.,Koven S..High fatality rates of late-life depression associated with cardiovascular diaease, Affect,Disord, 1985,9:165-167
58. Pagani M,Montano N,et al.Sympathovagal balance:a reappraisal, Circulation, 1998, 98(23):2640-2643
59. Marcus W. Agelink, Cavit Boz, Heiko Ullrich. Relationship between major depression and heart rate variability.: Clinical consequences and implications for antidepressive treatment, Psychiatry Research, 2002,113(1-2):139-149
60. Nahshoni E.,Aizenberg D.,Sigler M., et al. Heart rate variability in elderly patients before and after electroconvulsive therapy, American Journal of Geriatric Psychiatry, 2001,9:225-260
61. Rottenbergm.J.,Cardiac vagal control in depression:a critical analysis, Biological Psychology, 2007,74: 200-211
62. Oliver M. Coronary flow reserve and the curve,Br Med J, 1998,297:1607
63.卜力,李凌,李占江,老年抑郁症的临床特点,首都医科大学学报,2006,27(3)410-413
64. Schubert, M. Lambertz, R.A. Nelesen, Effects of stress on heart rate complexity—A comparison between short-term and chronic stress, Biological Psychology, 2009, 80(3) :325-332
65. Ahrens T.,Deuschle M., Krumm, et al. Pituitary-adrenal and sympathetic nervous system responses to stress in women remitted from recurrent major depression, Psychosomatic Medicine, 2008,70(4):461-7
66. Zhibin Li, Harold Snieder, Shaoyong Su. A longitudinal study in youth of heart rate variability at rest and in response to stress, International Journal of Psychophysiology, 2009,73(3):212-217.
67. Therese A. Keary, Joel W. Hughes, Patrick A. Palmieri,Women with posttraumatic stress disorder have larger decreases in heart rate variability during stress tasks, International Journal of Psychophysiology, 2009,73(3): 257-264
1. Kirmayer LJ,Robbins JM,Dworkind M,et al.Somatization and the recognition of depression and anxiety in primary care, Am J Psychiatry,1993,150:734
2.季建林,张虹,抑郁症躯体症状及其相关因素分析[J],中国心理卫生杂志,2002,16(9),605-608
3.许毅,蔡巍等,文化程度及生活地域对常见精神疾病知晓率及就医方式的影响[J],中国预防医学杂志,2005,39(4),237-240
4. Cheung FM. Psychological symptoms among Chinese in urban Hong Kong, Social Science &Medicine,1982,16(14):1339-44
5.王丹芬,雷晓明等,中国人的抑郁症及其社会文化思考[J],中国全科医学,2004,7(5),315-317
6. Gulec H.Sayar K.,Ozkorumak E.,Somatic symptoms of depression, Turk Psikiyatri Dergisi, 2005,16(2):90-6
7. Honkalampi K.Hintikka J.Tanskanen A.Lehtonen J.Viinamaki H.Depression is strongly associated with alexithymia in the general population, Journal of Psychosomatic Research, 2000,48(1):99-104
8. Bodini B.,Mandarelli G.,Tomassini V., et al. Alexithymia in multiple sclerosis:relationship with fatigue and depression, Acta Neurologica Scandinavica, 2008,118(1):18-23
9. De Gucht V.,Heiser W.Alexithymia and somatization:quantitative review of the literature, Journal of Psychosomatic Research, 2003,54(5):425-34
10. Sayar K.Kirmayer LJ.Taillefer SS.Predictors of symptoms in depressive disorder, General Hospital Psychiatry, 2003,25(2):108-14
11. Mattila AK.Kronholm E.Jula A.Salminen JK. Alexithymia and somatization in general population, Psychosomatic Medicine, 2008 ,70(6):716-22
12. Motan I.Gencoz T.The relationship between the dimensions of alexithymia and the intensity of depression and anxiety, Turk Psikiyatri Dergisi, 2007,18(4):333-43
13.张付全,唐秋萍等,述情障碍与躯体化[J],国际精神病学杂志,2005,32(3),184-186
14. Duddu V.Isaac MK.Chaturvedi SK.Somatization,somatosensory amplification, attribution styles and illness behaviour:a review, International Review of Psychiatry, 2006,18(1):25-33
15. Stahl SM.The psychopharmacology of painful physical symptoms in depression, Clin Psychiatry, 2002,63:5.
16. Stahl SM,Briley M. Understanding pain in depression, Hum Psychopharmacol Clin Exp, 2004,19:9-13.
17. Blackburn-Munro G.Hypothalamo-pituitary-adrenal axis dysfunction as a contribuyory factor to chronic pain and depression, Curr Pain Headache Reports, 2004,8:116-124
18. Matzinger P. The danger model: a renewed sense of self, Science, 2002 ,296(5566):301-5
19. Watkins LR,Hutchinson MR,Ledebocr A,et a1.Glia as the“bad guys”:Implications for improving clinical pain control and the clinical utility ofopioids, Brain,Behavior,and Immunity,2007,21(2):131
20. Pace rw r.Hu F.Miller AH.Cytokine—efects on glucocorticoid receptor function:Relevance to glucocorticoid resistance and the pathophysiology and treatment of major depression, Brain,Behavior,and Immunity,2007, 21(1):9
2. Currie SR,Wang J.Chronic back pain and major depression in the general Canadian population. Pain , 2004,107:54-60
3. Hideyo Sugahara, Mariko Akamine, Tetsuya Kondo, et al. Somatic symptoms most often associated with depression in an urban hospital medical setting in Japan, Psychiatry Research, 2004,126(2) :151-158
4. Sartotius N,Ustun TB. In international study of psychological problems in primary care:preliminary report from the WHO.Collaborative Project on Psychological Problem in General Health Care, Arch Gen Psychiatry, 1993,50:819-24
5. Hsu.S.C.,Wang.S.J.,Liu.C.Y., et al.The impact of anxiety and migraine on quality of sleep in patients with major depressive disorder, Psychiatry, 2009,50:151-157
6. Nierenbery.A.A.,Predictors of response to antidepressants gerenal principles and clinical implications.Psychiatr, Clin North Am, 2003,26:345-352
7. Gertraud Hanel, Peter Henningsen, Wolfgang Herzog, et al. Depression, anxiety, and somatoform disorders: Vague or distinct categories in primary care? Results from a large cross-sectional study, Journal of Psychosomatic Research, 2009,67(3): 189-197
8.王瑞,毕晓莹,陆峥,综合医院常见躯体形式障碍临床特点及规律的横断面研究,上海精神医学杂志,2009,21(3)177-179
9. Gulec H, Sayar K, Ozkorumak E.Somatic symptoms of depression,Turk Psikiyatri Dergisi, 2005,16(2):90-96
10. Phoebe E. Bailey, Julie D. Henry.Alexithymia, somatization and negative affect in a community sample, Psychiatry Research, 2007,150(1):13-20
11. S. Berthoz, S. Consoli, F. Perez-Diaz. Alexithymia and anxiety: compoundedrelationships? A psychometric study, European Psychiatry, 1999,14(7): 372-378
12. Toft T,Fink P,Oemboel E, et al.Mental disorders in primary care :prevalence and co-morbidity among disorders.Results from the functional illness in primary care(FIP) study, Psycho Med, 2005,35;1179-84
13. Nahshoni E., Aravot D., Aizenberg D., et al, Heart rate variability in patients with major depression, Psychosomatics, 2004 ,45(2):129-34
14. Udupa K., Sathyaprabha TN., Thirthalli J., et al, Alteration of cardiac autonomic functions in patients with major depression: a study using heart rate variability measures, Journal of Affective Disorders, 2007 ,100(1-3):137-41
15. Carney RM., Freedland KE.. Depression and heart rate variability in patients with coronary heart disease, Cleveland Clinic Journal of Medicine, 2009. 2:S13-7
16. Licht CM., de Geus EJ., van Dyck R., et al, Association between anxiety disorders and heart rate variability in The Netherlands Study of Depression and Anxiety, Psychosomatic Medicine, 2009 ,71(5):508-18
17.汤毓华,汉密顿抑郁量表,心理卫生评定量表手册,(增订版),中国心理卫生杂志社,1999,220-223
18.汤毓华,汉密顿焦虑量表,心理卫生评定量表手册,(增订版),中国心理卫生杂志社,1999,253-255
19. J. Thuile, C. Even, F. Rouillon, et al. Severe depression without ICD-10 somatic syndrome does exist: clinical characteristics and diagnostic efficiency of somatic symptoms, European Neuropsychopharmacology, 2006,16(4): S285-S286
20. Stansfield S,Rasul F. Psychosocial factors depression and illness, Depression and physical illness, 2007,19-49
21. George I., Papakostas, Timothy Petersen, John Denninger, et al. Somatic symptoms in treatment-resistant depression, Psychiatry Research, 2003,118(1):39-45
22. Katrin Barkow, Reinhard Heun, T. Bedirhanüstün, et al, Identification of somatic and anxiety symptoms which contribute to the detection of depression in primary health care, European Psychiatry, 2004,19(5): 250-257
23. Bernhard T. Baune, Riccardo N. Caniato, Miguel A. Garcia-Alcaraz, et al, Combined effects of major depression, pain and somatic disorders on general functioning in the general adult population, Pain, 2008,138(2):310-317
24. Mutsuhiro Nakao, Eiji Yano.Reporting of somatic symptoms as a screening marker for detecting major depression in a population of Japanese white-collar workers, Journal of Clinical Epidemiology, 2003,56(10): 1021-1026
25.季建林,张虹,抑郁症躯体症状及其相关因素分析[J],中国心理卫生杂志,2002,16(9),605-608
26. Mutsuhiro Nakao, Eiji Yano. Prediction of major depression in Japanese adults: Somatic manifestation of depression in annual health examinations, Journal of Affective Disorders, 2006,90(1):29-35
27. Sullivan MJ,Reesor K,Mikail S, et al. The treatment of depression in chronic low back pain:review and recommendations, Pain, 1992, 50:5-13
28. J. Wright, I.J. Deary, P.R. Geissler.Depression, hassles and somatic symptoms in mandibular dysfunction syndrome patients, Journal of Dentistry, 1991,19(6):352-356
29. Ulrike Willinger, Sabine V?lkl-Kernstock, Harald Nikolaus Aschauer.Marked depression and anxiety in patients with functional dysphonia, Psychiatry Research, 2005,134(1):85-91
30. Stefan G. Hofmann, Stefan M. Schulz, Sanna Heering,et al. Psychophysiological correlates of generalized anxiety disorder with or without comorbid depression, International Journal of Psychophysiology, 2010,1,20
31. Ya S. McIntyre, Jakub Z. Konarski, Deborah A. Mancini,. et al. Improving outcomes in depression: A focus on somatic symptoms.Journal of Psychosomatic Research, 2006,60(3) :279-282
32.姚芳传,多伦多述情障碍量表,心理卫生评定量表手册,(增订版),中国心理卫生杂志社,1999,378-381
33.路敦跃,防御方式问卷,心理卫生评定量表手册,(增订版),中国心理卫生杂志社,1999,115-120
34.张亚林,杨德森,生活事件量表,心理卫生评定量表手册,(增订版),中国心理卫生杂志社,1999,101-106
35.肖水源,社会支持评定量表,心理卫生评定量表手册,(增订版),中国心理卫生杂志社,1999,127-131
36.姜乾金,特质应对方式问卷,心理卫生评定量表手册,(增订版),中国心理卫生杂志社,1999,120-122
37.费立鹏等,家庭环境量表中文版,心理卫生评定量表手册,(增订版),中国心理卫生杂志社,1999,134-142
38.李凌江,杨德森,生活质量综合评定问卷,心理卫生评定量表手册,(增订版),中国心理卫生杂志社,1999,88-100
39. Rupert Conrad, Ingo Wegener, Katrin Imbierowicz, et al. Alexithymia, temperament and character as predictors of psychopathology in patients with major depression, Psychiatry Research, 2009,165(1-2):137-144
40. Jiri Modestin, Roman Furrer, T. Malti. Study on alexithymia in adult non-patients, Journal of Psychosomatic Research, 2004, 56(6):707-709
41. Kirsi Honkalampi, Jukka Hintikka, Antti Tanskanen, et al. Depression is strongly associated with alexithymia in the general population, Journal of Psychosomatic Research, 2000,48(1): 99-104
42. Kemal Sayar, Laurence J. Kirmayer, Suzanne S. Taillefer. Predictors of somatic symptoms in depressive disorder, General Hospital Psychiatry, 2003,25(2):108-114
43. Motan I.,Gencoz T..The relationship between the dimensions of alexithymia and the intensity of depression and anxiety, Turk Psikiyatr Dergisi, 2007, 18(4):333-43
44. S. Saarij?rvi, J. K. Salminen, T. B. Toikka..Alexithymia and depression: A 1-year follow-up study in outpatients with major depression, Journal of Psychosomatic Research, 2001,51(6):729-733
45.肖勃,谢文娇,张帆,焦虑症与抑郁症患者心理防御方式社会支持和家庭功能研究,中国行为医学科学,2006,15(9)797-799
46.张英辉,抑郁症患者防御方式及其家庭生活质量研究,临床精神医学,2009,19(1)44-45
47.杨文,赵勇,卢晓波,生活事件对女性抑郁症患者的影响,临床精神医学杂志,2007,17(3)177-178
48. Miranda Olff. Stress, depression and immunity: the role of defense and coping styles, Psychiatry Research, 1999,85(1): 7-15
49. Richard J. Budd, Rachel Pugh..Tinnitus coping style and its relationship to tinnitus severity and emotional distress, Journal of Psychosomatic Research, 1996,41(4): 327-335
50.李道林,刘谷行,陈振华,伴躯体症状抑郁症的综合式家庭治疗疗效观察,中国临床心理学杂志,1996,4(3):160-161
51. Bair MJ,Kroenke K,Sutherland JM, et al. Effects of depression and pain severity on satisfaction in medical outpatients:analysis of the medical outcomes study, Rehabil Res Dev , 2007;44:143-52
52. Vieta.E.,Sanchez-Moreno.J.,Zaragoza.S.. Subsyndromal depressive symptoms in patients with bipolar and unipolar disorder during clinical remission, Affect Disord, 2008,107:169-174
53. I.A. Dan, M. Grimberg, A. Varghes..The treatment of depression with somatic pain, European Psychiatry, 2008,23(2): S284
54. Hyo-Jung Park. Heart Rate Variability as a Measure of Disease State in Irritable Bowel Syndrome, Asian Nursing Research, 2008,2(1) :5-16
55. Bicakova-Rocher,A.Gorceix,A.Reinberg,et al,Temperature rhythm of patients with major affective dosorder :reduced circadian period length, Chronobiol.Int, 1996,13: 47-57
56. Richard J. Budd, Rachel Pugh .Tinnitus coping style and its relationship to tinnitus severity and emotional distress, Journal of Psychosomatic Research, 1996,41(4): 327-335
57. Rabins P.V.,Harvis K.,Koven S..High fatality rates of late-life depression associated with cardiovascular diaease, Affect,Disord, 1985,9:165-167
58. Pagani M,Montano N,et al.Sympathovagal balance:a reappraisal, Circulation, 1998, 98(23):2640-2643
59. Marcus W. Agelink, Cavit Boz, Heiko Ullrich. Relationship between major depression and heart rate variability.: Clinical consequences and implications for antidepressive treatment, Psychiatry Research, 2002,113(1-2):139-149
60. Nahshoni E.,Aizenberg D.,Sigler M., et al. Heart rate variability in elderly patients before and after electroconvulsive therapy, American Journal of Geriatric Psychiatry, 2001,9:225-260
61. Rottenbergm.J.,Cardiac vagal control in depression:a critical analysis, Biological Psychology, 2007,74: 200-211
62. Oliver M. Coronary flow reserve and the curve,Br Med J, 1998,297:1607
63.卜力,李凌,李占江,老年抑郁症的临床特点,首都医科大学学报,2006,27(3)410-413
64. Schubert, M. Lambertz, R.A. Nelesen, Effects of stress on heart rate complexity—A comparison between short-term and chronic stress, Biological Psychology, 2009, 80(3) :325-332
65. Ahrens T.,Deuschle M., Krumm, et al. Pituitary-adrenal and sympathetic nervous system responses to stress in women remitted from recurrent major depression, Psychosomatic Medicine, 2008,70(4):461-7
66. Zhibin Li, Harold Snieder, Shaoyong Su. A longitudinal study in youth of heart rate variability at rest and in response to stress, International Journal of Psychophysiology, 2009,73(3):212-217.
67. Therese A. Keary, Joel W. Hughes, Patrick A. Palmieri,Women with posttraumatic stress disorder have larger decreases in heart rate variability during stress tasks, International Journal of Psychophysiology, 2009,73(3): 257-264
1. Kirmayer LJ,Robbins JM,Dworkind M,et al.Somatization and the recognition of depression and anxiety in primary care, Am J Psychiatry,1993,150:734
2.季建林,张虹,抑郁症躯体症状及其相关因素分析[J],中国心理卫生杂志,2002,16(9),605-608
3.许毅,蔡巍等,文化程度及生活地域对常见精神疾病知晓率及就医方式的影响[J],中国预防医学杂志,2005,39(4),237-240
4. Cheung FM. Psychological symptoms among Chinese in urban Hong Kong, Social Science &Medicine,1982,16(14):1339-44
5.王丹芬,雷晓明等,中国人的抑郁症及其社会文化思考[J],中国全科医学,2004,7(5),315-317
6. Gulec H.Sayar K.,Ozkorumak E.,Somatic symptoms of depression, Turk Psikiyatri Dergisi, 2005,16(2):90-6
7. Honkalampi K.Hintikka J.Tanskanen A.Lehtonen J.Viinamaki H.Depression is strongly associated with alexithymia in the general population, Journal of Psychosomatic Research, 2000,48(1):99-104
8. Bodini B.,Mandarelli G.,Tomassini V., et al. Alexithymia in multiple sclerosis:relationship with fatigue and depression, Acta Neurologica Scandinavica, 2008,118(1):18-23
9. De Gucht V.,Heiser W.Alexithymia and somatization:quantitative review of the literature, Journal of Psychosomatic Research, 2003,54(5):425-34
10. Sayar K.Kirmayer LJ.Taillefer SS.Predictors of symptoms in depressive disorder, General Hospital Psychiatry, 2003,25(2):108-14
11. Mattila AK.Kronholm E.Jula A.Salminen JK. Alexithymia and somatization in general population, Psychosomatic Medicine, 2008 ,70(6):716-22
12. Motan I.Gencoz T.The relationship between the dimensions of alexithymia and the intensity of depression and anxiety, Turk Psikiyatri Dergisi, 2007,18(4):333-43
13.张付全,唐秋萍等,述情障碍与躯体化[J],国际精神病学杂志,2005,32(3),184-186
14. Duddu V.Isaac MK.Chaturvedi SK.Somatization,somatosensory amplification, attribution styles and illness behaviour:a review, International Review of Psychiatry, 2006,18(1):25-33
15. Stahl SM.The psychopharmacology of painful physical symptoms in depression, Clin Psychiatry, 2002,63:5.
16. Stahl SM,Briley M. Understanding pain in depression, Hum Psychopharmacol Clin Exp, 2004,19:9-13.
17. Blackburn-Munro G.Hypothalamo-pituitary-adrenal axis dysfunction as a contribuyory factor to chronic pain and depression, Curr Pain Headache Reports, 2004,8:116-124
18. Matzinger P. The danger model: a renewed sense of self, Science, 2002 ,296(5566):301-5
19. Watkins LR,Hutchinson MR,Ledebocr A,et a1.Glia as the“bad guys”:Implications for improving clinical pain control and the clinical utility ofopioids, Brain,Behavior,and Immunity,2007,21(2):131
20. Pace rw r.Hu F.Miller AH.Cytokine—efects on glucocorticoid receptor function:Relevance to glucocorticoid resistance and the pathophysiology and treatment of major depression, Brain,Behavior,and Immunity,2007, 21(1):9