精神科門診初診主訴失眠患者的診斷分析

Diagnostic Categories in First-visit Psychiatric Outpatients with Insomnia

莊慧馨(Hui-Hsin Chuang) ； 邱南英(Nan-Ying Chiu) ； 胡淑惠(Shu-Hui Hu)

《The Changhua Journal of Medicine》 9卷s期 (2004/12) Pp. 254-260

摘要

背景及目的：國內外研究報告顯示，精神科患者的失眠盛行率高，本研究擬探討精神科初診主訴失眠患者的精神科診斷。
方法：收集民國91年3月到5月至中部一家醫學中心精神科門診求醫的初診個案，將有失眠主訴者為研究對象，經過會談、填寫問卷、調查失眠的情形，用聯合國世界衛生組織的國際疾病分類第十版(ICD-10)中的精神與行為障礙的分類作診斷，將失眠情形與初診的精神科診斷作分析。
結果：初診病人共557人，有失眠主訴者為404人（佔72.5%)，男性176人（佔男性患者的69.6%）、女性228人（佔女性患者的75.0%），年齡分佈為13至90歲。精神科診斷方面：鬱症發作、復發性鬱症、持久情感障礙症及其他情感障礙症為43.3%，精神作用物質引起的精神疾病與行為障礙為11.4%，焦慮疾患為10.9%，精神分裂症、準精神分裂症與妄想性疾患為7.4%，器質性精神疾患為6.2%，嚴重壓力的反應與適應障礙症為5.0%。失眠型態的分佈：困難入睡者為64.8% ，頻醒為33.8%，早醒為24.2%。
結論：失眠為精神科門診初診個案的常見主訴，有失眠主訴的患者其精神科的診斷以鬱症發作、復發性鬱症、持久情感障礙症及其他情感障礙症最多，精神作用物質引起的精神疾病與行為障礙居次，第三為焦慮疾患，其中失眠型態又以困難入睡為最多。

關鍵字

失眠 ； 精神科門診 ； 精神科診斷

並列摘要

Background and purpose: The purpose of this study was to investigate the psychiatric diagnostic categories of first-visit patients with insomnia in a psychiatric outpatient department.
Methods: All new patients with an insomnia complaint attending the outpatient department of psychiatry in a medical center in central Taiwan from March 2002 to May 2002 participated in the study. After an interview and questionnaires were completed and sleep patterns assessed. diagnoses were made according to lCD-10. The psychiatric categories of insomniacs and noninsomniacs were compared by using the x^2 test. An analysis of psychiatric diagnoses and sleep patterns was also performed.
Results: A total of 404 out of 557 first-visit psychiatric outpatients were included (176 males and 228 females; age range 13-90 years). Among the insomniacs, depressive episode, recurrent depressive disorder, or persistent mood disorders were found in 43.3%; 11.4% had mental and behavioral disorders due to psychoactive substance use were found; 10.9% had phobic anxiety disorders, other anxiety disorders, or obsessive-compulsive disorder; 7.4% had schizophrenia, schizotypal, or delusional disorders; 6.2% had organic mental disorders; and 5.0% were reacting to severe stress or had adjustment disorders. In the insomnia pattern, 64.8% had difficulty falling asleep, 33.8% had frequent nocturnal awakening, and 24.2% had early morning awakening.
Conclusion: Insomnia was the most conmon chief complaint among new patients presenting to psychiatric outpatient departments. Among the insomniacs, the most common psychiatric diagnoses were depressive episode, recurrent depressive disorder, and persistent mood disorders; the second most common were mental and behavioral disorders due to psychoactive substance use; the third were phobic anxiety disorders, other anxiety disorders, or obsessive-compulsive disorder. Difficulty falling asleep was the most conmon pattern identified.

並列關鍵字

insomnia ； mental illness ； psychiatric outpatient