Prevalence and Psychiatric Referrals of Mental Disorders in Hospitalized Cancer Patients

癌症住院患者之精神疾病與精神科轉介

李明濱(Ming-Been Lee) ； 李宇宙(Yue-Joe Lee) ； 邱震寰(Cheng-Huang Chiu) ； 廖士程(Shih-Cheng Liao) ； 吳佳璇(Chia-Hsuan Wu) ； 曾美智(Mei-Chih Tseng)

《北市醫學雜誌》 1卷1期 (2004/01) Pp. 63-74

https://doi.org/10.6200/TCMJ.2004.1.1.11

摘要

背景：多年來癌症已名列台灣地區十大死因之第一位，且居高不下，與癌症相關之心理及精神問題早已引起醫界之注意，台灣地區相關之精神醫學研究卻仍相當有限。目的：本研究之目的在於探討癌症患者之精神問題及其精神科照會轉介。方法：本研究為某一醫學中心非精神科病房住院患者精神疾病橫斷面流行病學研究之一部分。作者針對某一醫學中心所有急性住院病人，除了急診處，加護病房、小兒科、健康檢查病房、產科病房外，共計759名完成研究面談與問卷評量，佔預估床位之94.8%。作者選取其中142位癌症診斷之患者，與其餘617位非癌症患者，進行比較研究。所有參與研究之病人，均接受精神科專科醫師之診斷面談，並填寫下列各項精神病理評量表：簡式精神症狀評量表（BSRS-50）、性格評量表（MPI）以及家庭功能評量表（Family APAGAR lndex）。結果：研究發現癌症患者符合臨床精神科診斷（DSM III-R）的比率為23.9%，與非癌症之22.5%相仿。癌症患者之精神科診斷分佈，主要為適應障礙（52.9%），其次為重鬱症（14.7%）及器質性精神疾患（8.8%）。就臨床症候群而言，有精神科診斷的個案中，61.7%有憂鬱症候群，35.2%有焦慮症候群，亦即79.3%的個案表現為憂鬱或焦慮症候群。癌症患者轉介精神科照會的比率為12.7%，顯著高於非癌症患者之5%。而就有精神科診斷的個案而言，癌症組中有35.3%轉介精神科照會，而非癌症組則僅有19.4%，顯示精神科照護溝通仍有改善空間。是否轉介與精神症狀嚴重度並不相關，提示醫師對具情緒障礙之癌症患者較難以處理，特別是癌症患者或家屬的溝通。性格因素仍是影響精神疾患的重要成因。結論：本研究提示癌症與非癌症患者之精神病理表現及精神科診斷分佈並無差異，唯前者轉介精神科照會的比率較高，其確實原因有待進一步研究。作者建議應透過教育訓練，增進非精神科醫師對癌症併發精神疾患之診斷敏感度，並強化其精神科照護能力。而如何強化與癌症患者的溝通是醫學教育的重要議題。

關鍵字

癌症 ； 精神疾病 ； 精神科照會 ； 心理社會功能

並列摘要

Background: Cancer has become the leading cause of death in many countries, and its co-morbid psychologic problems present a challenge to medical professionals. In Taiwan, little research has been conducted on these psychologic problems. Objectives: To examine the prevalence of mental disorders and the frequency of psychiatric referral in hospitalized cancer patients. Methods: The present study was a cross-sectional epidemiologic survey of psychiatric comorbidity in 759 medical inpatients. Psychiatrists conducted in-depth interviews to make a psychiatric diagnosis, and standardized self-report scales were used to assess the subjects’ psychologic distress (Brief Symptom Rating Scale, BSRS-50), personality traits (Maudsley Personality lnventory, MPI), and family function (Family APGAR lndex). We compared 142 subjects with cancer to 617 subjects who had other medical diagnoses. Results: Off the cancer patients, 23.9% had a DSM III-R defined psychiatric diagnosis, which included adjustment disorders (53%), major depression (14.7%), and organic mental disorders (9%). Approximately 80% of those subjects with a psychiatric diagnosis suffered from depression, anxiety, or both. The prevalence of psychiatric disorders and the severity of the psychologic distress in the cancer patients were not statistically different than those in the non-cancer patients. However, the psychiatric referral rate of the cancer patients (12.7%) was significantly higher than the rate of the non-cancer patients (5%). The referral rate was not significantly related to the severity of psychopathology. The cancer patients with a positive psychiatric diagnosis scored significantly higher in neuroticism and significantly lower in extroversion on the MPI. Conclusion: The psychopathology of the cancer inpatients was similar to that of the non-cancer inpatients; however, the rate of psychiatric referral in the cancer patients was significantly higher. Addressing the psychologic needs of the cancer patients may have been more difficult for the non-psychiatric physicians; thus, the rate of referral was higher for these patients.

並列關鍵字

cancer ； psychiatric disorders ； psychiatric consultation ； psychosocial function