A Comparison Of The Clinical Features, The Charateristics Of Regional Cerebral Blood Flow, The Use And Cost Of Medical Investigations And The Treatment In Patients With Somatization Disorder And Undifferentiated Somatoform Disorder

【Objective】To investigate the clinical features,the charateristics of regional cerebral blood flow(rCBF),and the use and cost of medical investigations and related impact factors in patients with somatization disorder and undifferentiated somatoform disorder.To compare the efficacy and safety of venlafaxine and sertraline in the treatment of somatization disorder and undifferentiated somatoform disorder.【Methods】Subjects were 115 patients,who should meet CCMD-3 diagnostic criteria of somatization disorder and undifferentiated somatoform disorder.The study was mianly consisted of the following three parts.(1)The subjects were assessed by Self-edited past medical investigation inventory,Self-edited Self-rating Somatic Symptom List,Symptom Checklist 90(SCL-90),Hamilton Anxiety Scale(HAMA) and Hamilton Depression Scale(HAMD).(2)The SPECT were performed in 35 subjects with somatization disorder and undifferentiated somatoform disorder to explore the charateristics of regional cerebral blood flow(rCBF).(3)Twenty-six subjects were treated with venlafaxine in a regimen of 75～225mg/d,and 26 subjects were treated with sertraline in a regimen of 150～100mg mg/d.HAMA,CGI and TESS were used to measure the efficacy and safety for 12 weeks.【Results】The study yielded the following results.(1)The total number of involved systems was from 3 to 6 and the average was 4.2±0.9.The total number of involved symptoms was 62 and the average number was 12.4±6.6.The most common symptoms were skin symptoms,neurological symptoms,gastrointestinal symptoms, respiratory and cardiovascular symptoms.Depression,anxiety and hostile are frequently present.The total number and the total scores of somatic symptoms were positively correlated with the total scores of HAMA,the somatic anxiety factor scores and the mental anxiety factor scores(P＜0.01).But they had no correlation with the total scores of HAMD(P＞0.05).(2)35 subjects were carded the SPECT.14 subjects(40.0%) of them showed the lower rCBF,in which 9 subjects has the lower rCBF in temporo-parietal lobe.The clinical features showed no difference between the SPECT positive group and negative group(P＞0.05).In the SPECT positive group, the systematic classifications in patients with the low-rCBF temporo-parietal lobe were not siginificantly different from that in patients with the other low-rCBF positions(P＞0.05).(3)Before the definition of the diagnosis,the total cost of medical investigations was from72 to 10948 yuan and the median was 1068.0 yuan.The total frequency range of medical investigations was from 1 to 53 times and the average frequency was 11.3±8.5 times.The number of investigation items was from 1 to 13 and the average was 6.0±2.5.The total frequency range of repeated items was from 0 to 44 times and the median was 3.0 times.The number of repeated items was from 0 to 9 and the median was 2.0.The most common investigations were ordinary blood test,B-ultrasonic,CT,ordinary urine test,X-ray,ordinary biochemical test,MRI, ECG and ordinary feces test.The investigation frequency was positively correlated with the course,the number of consulted departments and the total scores of HAMD (P＜0.05).The investigation cost was positively correlated with the investigation frequency(P＜0.01).(4)47 subjects fulfilled the whole study(22 in venlafaxine group and 25 in sertraline group).At the end of the study,the scores of HAMA-SOM of venlafaxine group and sertraline group were significantly lower.The mean decreasing scores of HAMA-SOM of venlafaxine group and sertraline group were[(1.9±2.1) vs (3.2±2.5),P＞0.05].The response rate was 59.1%in venlafaxine group and 60.0%in sertraline group,and there was no difference between the two groups(P＞0.05).The side effect rate was 40.0%in venlafaxine group and 28.0%in sertraline group,which showed no difference between the two groups(P＞0.05).【Conelusions】(1)The involved systems in somatization disorder were multiple, and the symptoms were various.Therefore,the disorder was prone to inappropriate medical diagnoses.The disorder was comorbidded with anxiety disorders and depression disorders.The number and the severity of somatic symptoms were positively correlated with the severity of anxious symptoms.(2)The dysfunction of regional cerebral blood flow may exist in partial patients with somatization disorder and undifferentiated somatoform disorder,but it was not specific.(3)The medical investigations in somatization disorder and undifferentiated somatoform disorder had a large variety and many repead items,which led to the waste of the medical resourses. This phenomenon should be emphasized.(4)The total efficacy of venlafaxine in treating somatization disorder and undifferentiated somatoform disorder was similar to sertraline.Both of them were effective and safe.