強迫症疾患之症狀與共病

Symptomatology and Comorbidity in Obsessive-compulsive Patients

黃政昌(Cheng-Chang Huang) ； 林惠蓉(Heui-Jung Lin) ； 林家興(Chia-Hsin Lin) ； 湯華盛(Hwa-Sheng Tang)

《北市醫學雜誌》 5卷1期 (2008/02) Pp. 23-35

https://doi.org/10.6200/TCMJ.2008.5.1.03

摘要

目的：本研究主要想瞭解強迫症患者的臨床特徵，包括症狀表現與共病情形，以及人口學變項和二者之間的相互關係。方法：針對北區某精神科專科醫院的強迫症的門診患者130位，以「耶魯－布朗強迫症狀檢核表」、「MINI國際神經精神會談問卷」及「門診患者基本資料表」等三項工具，進行調查研究。結果：強迫思考以怕污染、傷害最多，強迫行為以清洗、檢查最多，進一步發現：男性在「性」和「精確」強迫思考上顯著多於女性；未婚者在「性」強迫思考上顯著多於已婚者；年齡愈低者愈容易出現「性」強迫思考；無職業者在「清洗」強迫行為上顯著多於有職業者；教育程度愈低者愈容易出現「清洗」的強迫行為；教育程度愈高者愈容易出現「計算」的強迫行為。共病疾患以輕鬱症、社交畏懼症、重鬱症、泛焦慮症為多。進一步發現：女性在「輕鬱症」和「泛焦慮症」的共病人數顯著高於男性；男性則在「恐慌症」的共病人數顯著高於女性；未婚者在「精神病性疾患」的共病人數顯著高於已婚者；無職業者在「社交恐懼症」的共病人數顯著高於有職業者；教育程度愈低者愈容易出現「社交恐懼症」的共病類別。結論：強迫症發病年齡主要分佈在12至34歲之間，生病時間相當長，平均是10年。強迫症的患者通常罹患一種以上的強迫思考或強迫行為症狀，強迫思考以怕污染、傷害最多，強迫行為以清洗、檢查最多，且有一半的患者會共病其他精神疾患，共病疾患以輕鬱症、社交畏懼症、重鬱症、泛焦慮症為多。高教育程度、已婚、就業，似乎是一種保護措施，會比教育程度低、未婚、無職業者，更少出現強迫症狀與共病數量。

關鍵字

強迫症 ； 門診患者 ； 臨床特徵 ； 強迫症狀類型 ； 共病性

並列摘要

Background & Purpose: The overall purpose of this project was to survey clinical features of outpatients with obsessive-compulsive disorders (OCD), including OCD symptom types, comorbidity, and relationships between demographic variables and symptom types or comorbidity. Methods: A total of 130 OCD outpatients participated in the study. In order to obtain the information on clinical features, all participants were invited to complete a set of inventories, including Yale-Brown Obsessive-Compulsive Scale (symptom checklist), Mini International Neuropsychiatric Interview (MINI) and Outpatients' demographic form. Results: The most popular obsessional thoughts were contamination and aggression, compulsive behaviors were cleaning and checking. Among the research participants, men, compared to women, appeared more sexual and symmetry/exactness obsessions. Single, compared to married, appeared more sexual obsessions. Younger OCD outpatients appeared more sexual obsessions than those of elder. Unemployed, compared to employed status, appeared more washing compulsions. OCD outpatients with higher level of educational background appeared more counting compulsions than those with lower level of educational background. The comorbid psychiatric disorders included dysthymia, social phobia, major depressions and generalized anxiety disorder were the most prevalent. Among the research participants, women, compared to men, had more the comorbidity of dysthymia and generalized anxiety disorder. Men, compared to women, had more the comorbidity of panic disorder. Single, compared to married, had more the comorbidity of psychotic disorder. Unemployed, compared to employed status, had more the comorbidity of social phobia. OCD outpatients with lower level of educational background appeared more the comorbidity of social phobia. Conclusions: The age range of onset for OCD was between ages 12 to 34. The average duration of sickness with OCD was 10 years. The most popular obsessional thoughts were contamination and aggression, compulsive behaviors were cleaning and checking. The comorbid psychiatric disorders included dysthymia, social phobia, major depressions and generalized anxiety disorder were the most prevalent. Higher levels of educational background, married, employed status were considered to be important protective factors.

並列關鍵字

obsessive-compulsive disorders ； outpatients ； clinical features ； OCD symptom types ； comorbidity