心理障礙病患之顳顎關節症狀的相關因素之探討

摘要研究背景 : 顳顎關節症候群(Temporomandibular disorder, TMD)。包含了許多臨床問題如咀嚼肌疼痛和顳顎關節疼痛或關節聲響等。國內外已有許多文獻探討在不同族群之顳顎關節症候群的盛行率，病因包括焦慮、憂鬱、以及軀體化症等心理層面及治療方式都有做出詳盡的研究或結論，但是對憂鬱症、焦慮症的病人出現TMD症狀的研究報告卻付之闕如。研究目的：探討精神科門診憂鬱症與焦慮症患者其憂鬱指數或心理狀態和 TMD的相關性。進一步調查與研究精神科病人的顳顎關節症狀的盛行率，與基本人口變項的相關性。研究方法：於民國93年6月至民國94年1月間，選取南部某大學附設醫院精神科門診病人經診察為憂鬱症或焦慮症且正在服藥中的成年人，共73個病例數。經病人同意後先填寫基本資料、精神評估問卷(包含貝氏憂鬱量表第二版以及中國人健康量表)，再由牙醫師進行顱顎機能障礙問卷及臨床檢查。研究結果： 73 位受檢者中有TMD者共35位(48.0%)，無TMD者有38(52.0%)。年齡層以20-29歲的比例最高，佔31.4%，最少的是50-59歲，17-19歲，以及60歲以上佔5.7%，年齡與TMD兩者有顯著差異(P=0.018)。其餘性別、職業、教育程度、婚姻都未達顯著差異。有TMD病患組比無TMD病患組有較高的憂鬱狀態以及有較高的精神心理偏差(P<0.05)。另外比較有肌肉症狀組與有關節症狀組發現，在有肌肉症狀組有較高的憂鬱狀態。而有關節症狀組與憂鬱狀態較無相關。研究結論：精神科之憂鬱症或焦慮症患者其顳顎關節症狀組比無顳顎關節症狀組有較高的精神心理偏差憂鬱狀態，而這些顳顎關節症狀病人，出現肌肉性疼痛的情形時，會和憂鬱與心理障礙呈現正相關性，但如果僅有呈關節症狀，則沒有和憂鬱或心理障礙有相關性。

關鍵字

貝氏憂鬱量表；顳顎關節症狀；心理偏差

並列摘要

Abstract Background : Temporomandibular disorder(TMD) is a collective term encompassing a number of clinical of problems that involve the masticatory muscle and temporomandibular joint(TMJ) pain or TMJ sound. Lots of research about the prevalence, etiology and treatment concepts of TMD has been proposed elaborately, even about psychopathology(ex. anxiety, depression, somatoform….etc.). However, the research involved in patients with anxiety and depression in the psychiatric clinic probably has TMD symptom is scarce. Purpose: The study explores the related factors of TMD in the patients with psychological distress especially from the psychiatric clinic. Method: The subjects comprised of 73 patients with depression or anxiety Purposively sampling in psychiatric clinic in a Southern Medical University during June, 2004 to January, 2005. All patients had been given with psychotropics , antidepressant and anriolytics for more than three months and all were in maintenance dose. They greed to perform the questionnaires about dental ,medical history and psychology.( Beck Depression Inventory , Chinese Health Questionnaire) .The questionnaire of TMD and clinical examination is evaluated by dentist. Result: The subjects comprise of 35 TMD patients (48.0%) and 38 non-TMD patients(52.0%). The prevalence of 20-29 ages group is the highest(31.4%);the lowest is the 50-59;17-19;60+ ages group(12.5%) and there are statistically significant between TMD and age group, but no statistically significant for gender, occupation, level of education and marriage. TMD group has higher depression scores and psychological distress than non-TMD group with statistically significant. Compared muscle origin group with joint origin group, muscle group has higher depression scores than joint origin group with statistically significant. Conclusion The TMD group in psychiatric clinic has higher depression scores and psychological distress than the counterpart non-TMD group. The patients with muscle-origined symptom is related to depression and psychological distress; however, the patient with joint-origined symptom is not related to depression and psychological distress.