Lead:
Some time ago I saw an article "After the turbinate surgery, she chose to commit suicide...", which reminded me of the Wenling murder case, this case has passed seven years, it seems to have faded out of people's sight, leaving only a tragedy in people's minds, but in-depth analysis of this case is not just a simple injury case, this article was written by a magazine four years ago, may be more sensitive topic, has not been officially published, I wanted to give up, but now every day in the clinic to see so many patients with physical symptom disorders can not be effectively treated, Some words are not said and are like fish in the throat.
Today, I will take out this article written four years ago to communicate and discuss with you, presumably it will cause some controversy, not even necessarily right, but at least let everyone look at the diagnosis and treatment of non-psychological specialty somatic symptom disorders in general hospitals from another angle, provide some different treatment ideas for reference, and hope that in the future, we can strive to do something to see if we can avoid similar tragedies.
With the acceleration of social development and transformation, people are under increasing pressure on the spiritual level, and there has been an explosive increase in mental illness, unconsciously, human society has stepped from the "era of infectious diseases" and "the era of physical diseases" to the "era of mental illness".
Five years ago, 22 departments of the state jointly issued the Guiding Opinions on Strengthening Mental Health Services, which pointed out that mental health has become a major public health problem affecting economic and social development. It is particularly noteworthy that the breadth and depth of the spread of mental illness has long broken through the traditional boundaries, which is not only limited to the field of psychiatry, but gradually becomes the most important disease in general hospitals, research shows that mental illness has accounted for one-third of the non-psychological specialist population in general hospitals, however, the huge contrast is that the society and the medical community are not ready to meet this severe challenge, sometimes it is not too much to describe it as helpless, and the consequences are extremely serious. This can be explained by the wide-ranging "Wenling Medical Murder Case" in 2013.
The case party male, 33 years old because of nasal discomfort, breathing difficulty to seek medical treatment, the doctor examination is believed that the patient's lower turbinate hypertrophy caused, given minimally invasive resection, but the symptoms did not improve after the operation, for this reason the doctor and the patient negotiated no less than 40 times in a year or so, at first the patient hoped that the doctor could find a way to find the cause, and even do surgery to relieve the symptoms, but were told that the operation was successful without re-operation.
Because the patient still feels nasal congestion and breathing difficulties after surgery, and even cannot sleep, the patient also made a two-end pen sleeve plugged in the nose to help breathe and sleep, in addition to the right side headache, sore throat, chest pain, so the patient went to Taizhou, Hangzhou, Shanghai and many hospitals for treatment.
Before the wenling operation, the patient had 8 times in the specialist clinic of the Eye, Ear and Throat Specialist Hospital on Fenyang Road in Shanghai, and all kinds of medical examinations were negative, almost all doctors and experts believed that the patient's nose problem could not cause these symptoms, the patient thought too much, but no doctor thought that the patient's symptoms were somatized symptoms caused by psychological disorders. Because the patient's nose is uncomfortable in Wenling local recommended surgery, but the patient does not believe in Wenling's technical level, hope to go to Shanghai surgery to solve the problem, but Shanghai experts feel that surgery is not necessary to solve the patient's problem, so did not give the patient surgery, but also can not solve the patient's symptoms, the patient in order to solve their symptoms finally agreed to Wenling surgery recommendations.
The patient's symptoms could not improve after surgery, repeated medical treatment, and always let the doctor explain the reason for his nose discomfort, and people felt that the patient was not mentally and psychologically wrong.
After the patient was forcibly sent to the psychiatric hospital for inpatient treatment, after hospitalization was diagnosed as "persistent delusional disorder", but the patient did not recognize, hospitalized for two months the patient's symptoms still did not alleviate, ten days after being discharged from the specialized hospital, the patient went to the Wenling First People's Hospital where he was originally operated on by a knife doctor, resulting in a shocking tragedy of one death and two injuries.
♂️ In his suicide note, the patient states:
In this way, he should expose the truth, wash away the shame he suffered in the process of medical treatment, give up who he is, he died without regrets, and the death penalty is also the best way for him to get rid of the unbearable pain caused by nasal diseases.
After the case occurred, the sad thing is that the society's understanding of it is still vague, in the analysis, it is more attributed to the problem of the medical system, it is a doctor-patient contradiction, there is no good communication with the patient, the explanation is not in place or the patient's personality problem, the patient's longest communication after the operation took an hour and a half, one said that the operation did not fail is successful, one said that I still feel that the operation was a failure, such communication obviously will not have results.
The most important point in this case is whether the symptoms of the patient's nose discomfort exist objectively? The answer is yes, this is the so-called somatic symptom disorder, it is a psychological disorder that is mainly characterized by various physical symptoms, mainly in the general hospital, that is to say, the patient's symptoms are not caused by physical diseases but psychological disorders, so nose surgery can not solve the patient's symptoms at all, unfortunately, both doctors and patients are actually unaware of this problem, this is a typical case of not understanding the somatic symptom disorder and eventually leading to tragedy.
And the diagnosis of the patient's "persistent delusional disorder" indirectly denies the existence of serious somatization symptoms of the patient in the murder case, it can be said that the patient's physical pain is not understood and accepted by anyone during the entire medical treatment process, so the patient believes that the negative results of repeated CT examinations are falsified, all the doctors are colluding to cover up the mistakes of the initial operation, it is prevarication and deception, and the patient's strong desire to recognize and solve these symptoms has been repeatedly frustrated, resulting in doubt and anger, This kind of cognition and behavior is not absurd in logical reasoning, close to normal thinking, which is also an important reason why patients in society and online will receive a considerable degree of sympathy after the event.
When these problems are recognized, it is not difficult to understand the patient's unbelievable killing behavior in broad daylight, and the subsequent refusal to identify the psychological mental disorder as an opportunity that can give the patient hope of survival, and face the death sentence without any guilt or remorse.
The diagnosis of "empty nose syndrome" after the occurrence of the case is still controversial in the industry, and it has been reported that patients with "empty nose syndrome" can alleviate the symptoms through relevant psychological treatment.
If this case is an isolated case, it is an ordinary doctor-patient dispute, we do not need to delve further, but in similar cases to this case, such as the "Wang Yingsheng Intentional Homicide Case" in Tianjin on November 29, 2012, and the "Wang Yunsheng Intentional Homicide Case" in Hengyang, Hunan Province on April 28, 2012, the doctors have similar logic, all of which are tragedies that occur because the symptoms are not lifted after treatment, so they do not believe in the results of treatment, and another feature is that such murders are generally in the daylight. In full view of the public, the harsh reality needs to re-understand this problem and find a solution, otherwise, Wenling's medical murder case will not be the first, nor will it be the last.
Here's a similar example:
The patient male 61 years old, due to too much work pressure, insomnia for more than ten years, has used a variety of sleeping pills such as: Zopiclon, Youpi clone, Snos, Anda, Shule Diazepam, Mi mengning, etc., generally three days effective after a week of failure, Shule Andepam once ate 5 tablets at most and did not see good results.
Long-term use of sleeping pills caused severe memory loss of patients, so patients sought TCM treatment, in a nationally renowned TCM hospital, supposedly the 4th generation of insomnia from the ancestral TCM family, but the effect was still not good.
In the end, the patient spent more than 30,000 yuan to buy a Japanese high-voltage potentiometer to treat insomnia, which was initially effective but also failed after 3 months.
Heart paralysis and tingling due to long-term insomnia, constant nightmares at night, polypiaturia, constipation or thinning, mouth ulcers, loss of teeth and hair, varicose veins in the lower extremities. In addition, the patient also has a particularly prominent five senses symptoms, every night the nasal cavity is dry like fire, has been in a country's most famous ear, nose and throat hospital for treatment, but the treatment effect is not satisfactory, and finally considered to be incurable, and said that this symptom to accompany the patient for life, the patient should drop glycerol every night to moisten the nasal cavity, dry symptoms can be slightly relieved, otherwise it is impossible to sleep, so the symptoms lasted for 8 years, the patient felt that the overall body is disordered, it is difficult to say anything, life is better than death.
Patients after chest tightness, palpitations, examination of coronary artery CT no problem, but there is a cardiac early Bo, paroxysmal atrial fibrillation, the slowest heartbeat at night 30 times / min, several hospitals have repeatedly recommended the placement of the pacemaker, so the patient to my (cardiology department installed pacemaker professional) to the doctor intends to place the pacemaker, I found that the patient's cardiac examination problems will not cause these symptoms of the patient, give the psychological scale examination, the patient's somatization symptoms self-assessment SSS48 points, for moderate somatization symptoms, However, the anxiety and depression self-assessment scale GAD-7 scale has 4 points and the PHQ-9 scale has 3 points, at least the scale shows that the patient has no anxiety and depression, which is a more typical somatic symptom disorder.
When he told the patient that these symptoms were caused by psychological disorders, the patient was very surprised, he admitted that he had a lot of work pressure before, so he retired at the age of 53, so that after 7-8 years, the external pressures that had affected his emotions did not exist, and there should be no psychological disorders; and the patient had seen countless doctors for so many years, and none of the doctors thought that there were psychological problems, but simply thought that insomnia or physical diseases caused these symptoms. Based on the conditions shown on the scale and the patient explaining what somatic symptom disorder is, the patient eventually agrees to be treated with anti-anxiety-depressive drugs.
After four months of treatment including drug adjustment, the patient's symptoms improved significantly, and the scale was evaluated again, with an SSS scale of 24 points (normal 20 points), and a GAD and PHQ score of 0.
In the patient's own language, it is described as "as if reversing the situation, I am back to the adolescence of my 20s, I can sleep until dawn (even if I can fall asleep many times at night), I can take a nap without affecting night sleep, the heart seems to have been replaced, I can hardly feel the previous pain, and what is more wonderful is that 8 years of dry nose disease is basically cured, and various other symptoms have been reduced differently." ”
The experience of the diagnosis and treatment of this case is that in the process of diagnosis and treatment, there is no diagnosis of anxiety and depression as usually emphasized, but the relationship between emotions and symptoms is explained to the patient, and then the treatment drug is selected and adjusted through the scale evaluation, and the patient's chronic disease is finally cured for many years.
Figure 1
Patients were treated with anti-anxiety and depression drugs for four months and after
Comparison of somatization symptoms on the self-assessment scale
Figure 2
Patients are treated with anti-anxiety-depressive drugs for four months and after
Comparison of PHQ-9 and GAD-7 scales
Here is another example of a timely recognition and treatment of somatic symptom disorders that avoids a possible case of injury.
A 37-year-old male patient, who used to be full of respect for doctors, would side with doctors in doctor-patient disputes reported by the media.
Patients are small business owners, work pressure, resulting in dizziness, chest tightness and other physical discomfort, occasionally in the health center to measure high blood pressure, patients think it is very serious and very nervous, the result of each time to the hospital patient blood pressure will be very high, due to the fear of anxiety patients appear more physical symptoms, do a variety of examinations did not find a problem.
In this process the patient had several episodes of panic disorder, due to the prominent chest tightness chest pain heart disease symptoms, the patient was recommended to do three coronary CT examinations in three years, the results did not find a problem, so far the patient thinks that the doctor is to make money and not to treat him well, when he tells the doctor about his pain, the doctor always has an absent-minded expression, he even feels that those doctors will look at him with a contemptuous look, and each visit is a humiliation for him.
In this understanding, the patient's emotions become more and more irritable and angry, and at this time, there are media reports on doctor-patient disputes, and the patient completely stands against the doctor, and even says that there is an impulse to kill the doctor.
After the patient's symptoms were assessed by the somatized symptom self-assessment scale as 40 points, the ZUNG anxiety and depression self-assessment scale evaluated SDS 36 points, SAS 40 points (Figure 3); diagnosed as somatic symptom disorder, although the patient could not accept the diagnosis of psychological disorder at first, but with the help of objective evidence on the scale, the patient finally accepted the diagnosis of psychological disorder and was willing to accept anti-anxiety and depression drug treatment.
After nine months of treatment, the patient's symptoms were fully relieved Somatized symptoms Self-assessment scale was 22 points, PHQ-9 was 0 points, GAD-7 was 4 points (Figure 4), and then the cause of psychological disorders hidden in the patient's mind was analyzed, and appropriate psychological counseling was done, which further opened the patient's heart knot.
With the psychological disorder being cured, the patient's antagonistic emotions completely disappear, and trust and respect for the doctor are restored.
In a sense, this case reveals that if we do not pay attention to the diagnosis and treatment of somatic symptom disorders, it may cause social problems, and the timely identification and treatment of somatic symptom disorders will effectively avoid tragedies similar to the Wenling murder case.
Figure 3
Comparison of self-assessment scales of somatization symptoms before and after treatment
Figure 4
The patient's before and after treatment ZUNG scale and
PhQ-9 and GAD-7 scale evaluation
Although there is no investigation of the incidence of somatic symptom disorders in general hospitals, according to previous studies of somatic form disorders, the incidence of somatic symptom disorders in the general population is 4% to 6%, and the incidence of somatic symptom disorders in primary care is 5% to 35%. At the same time, we can also see from the anxiety and depression survey that the impact of somatization of psychological disorders on medical treatment can be seen.
According to one survey, of the 5,993 residents aged 15 to 75 who could represent the demographic characteristics of Finland, 557 (9.3%) had developed depression in the 12 months prior to the survey, but only 151 (27%) had seen depressive symptoms, of the 406 patients who did not see a doctor, 84% did not admit to having a psychological disorder, and 65% of the patients had visited in the past 1 year for various symptoms rather than depression.
The results of the 2008 mainland epidemiological survey showed that the total prevalence of depression and/or anxiety disorders in outpatients in general hospitals was as high as 19.97%, involving neurology, gastroenterology, obstetrics and gynecology, cardiovascular medicine, and the most noteworthy thing was that 76.09% of the patients were not identified as psychological disorders, but were treated according to the accompanying somatic symptoms according to the undergraduate physical diseases, and only 8.2% of the patients were recommended to go to the psychiatric department.
Most patients with mental disorders who go to general hospitals do not realize that their problems are caused by anxiety and depression, and most patients in the early stages of psychological disorders can show a variety of symptoms of discomfort in the multi-part system of the body, such as chest tightness when experiencing unpleasant emotions, tachycardia and palpitations when there is anxiety, and insomnia when feeling worried.
However, in most cases, people believe that when encountering psychological disorders, their feelings are limited to emotional experiences such as sadness, upset, nervousness, worry and fear, or more thought, and do not recognize that psychological disorders can cause various symptoms of physical discomfort, and that due to the existence of psychological disorders, there is a deep-rooted prejudice against psychological disorders in society, making people more willing to forgive and accept the unbearable avoidance of life pressure due to physical diseases rather than psychological disorders. Therefore, the somatization of psychological disorders is a manifestation caused by personal or social repression, a transfer and replacement of psychological disorders, in other words, the complaint is about physical symptoms, the expression is social and psychological problems, and the sadness that cannot be shed will definitely be expressed with physical discomfort symptoms.
In general hospitals, how to diagnose this type of psychological disorder has always plagued the medical community, from a long time ago "neurasthenia", experienced "autonomic dysfunction", "cardiac neurosis", "depression allele", "hidden depression", "somatic form disorder", "chronic fatigue syndrome", "clinical medicine can not explain the symptoms", or "anxiety and depression state", etc., it can be said that there is no single diagnosis of the disease in history can make the industry so entangled, let alone give appropriate treatment.
Because the above diagnostic names are not ideally used in general hospitals, at the annual meeting of the American Psychiatric Association (APA) in May 2013, the latest "Manual for the Diagnosis and Statistics of Mental Disorders" was released, 5th edition (DSM-5), which designated the psychological disorders in general hospitals that are mainly manifested by physical symptoms as somatic symptom disorders, and the renamed somatic symptom disorders include somatization disorders, hypochondria in the previous "Diagnostic and Statistical Manual of Mental Illness" 4th edition (DSM-4), Pain disorders and undifferentiated somatoform disorders are combined because their core symptoms are highly correlated, and there is a lot of overlap between them, and the naming of the diagnosis adds complexity in clinical practice and does not help much in treatment.
Somatic symptom disorder is characterized by the patient has very painful or causes significant functional impairment of somatic symptoms, or may have or do not have a medical condition that has been diagnosed, manifested by concerns about somatic diseases, as well as excessive time or energy spent on seeking medical treatment, persistently high levels of anxiety about health conditions or physical symptoms and inappropriate and persistent suspected thinking, that is, the diagnostic criteria for somatic symptom disorders require cognitive distortions in addition to the fact that the patient should have somatic symptoms as in the past In essence, it reflects that while the patient is in long-term physical pain, his thinking, feelings, and behaviors will be troubled.
It is worth noting and noting that the manual emphasizes that most of these patients first appear in the general medical system, rather than in psychiatry, and from the above clinical characteristics of these somatic symptom disorders, the patients in wenling homicide cases are more in line with the diagnosis of somatic symptom disorders.
DSM-5 somatic symptom disorder may be a turning point in redefining the psychological disorder in general hospitals, the manual no longer emphasizes the diagnosis of psychological disorders or anxiety and depression in general hospital patients, weakening the label of mental illness, because the diagnosis of anxiety and depression in general hospitals will bring great confusion to patients, and the stigma and stigma of mental illness make it difficult for patients to accept the diagnosis of anxiety and depression, and somatization is in a sense a fig leaf for patients with these psychological disorders.
At this stage of the general hospital, it is emphasized that the diagnosis of anxiety and depression is unwilling to be patients, because the stigma will occur in most mental disorders, these patients are more willing to choose to use medical conditions rather than psychological problems to attribute their symptoms, so it is sometimes extremely difficult to make a diagnosis of anxiety and depression in the general hospital, and will encounter great resistance, even if some doctors try to make a relevant correct diagnosis clinically, they will still be categorically rejected or even attacked by patients. Think of a diagnosis of a psychological disorder as an insult to him and question your ability to see a doctor. Therefore, the naming of somatic symptom disorders is better related to the manifestations of non-psychological specialty psychological disorders in general hospitals.
So what is the relationship between somatic symptom disorder and depression?
The author believes that there is a continuous spectrum of development and evolution between them, that is, psychological disorders are not anxiety and depression at the beginning, and the process of a psychological disorder patient from a general hospital to a psychopsychiatric specialty can be divided into four stages:
1️⃣ Somatization symptom stage;
2️⃣ Anxiety stage;
3️⃣ Anxiety-depressive stages;
4️⃣ Depressive stage.
It can be considered that somatic symptom disorder is the early stage of psychological disorder, just as a cold is the early stage of infection, and then pneumonia, which goes down to become bacteremia until sepsis.
Identifying and diagnosing somatic symptom disorders in general hospitals is a challenge for both doctors and patients.
✅ On the one hand, patients often refuse that their symptoms are caused by psychological disorders and are reluctant to go to a psychopsychiatric specialty for diagnosis and treatment.
✅ On the other hand, non-psychologists often worry about missing physical diseases, pay more attention to the diseases in the profession, and lack relevant psychological medical knowledge, even if they have the heart, they are powerless.
From the early cardiac neurosis to the current somatic symptom disorder, it is always extremely common to not be recognized and diagnosed in general hospitals, patients travel all day long in various departments of general hospitals, spending a lot of time, energy and cost to try to find the cause of their discomfort symptoms, and doctors also try to help these patients to find the cause, but often from the perspective of physical diseases, in exchange for constant disappointment.
Even more worrying is the specious so-called positive results detected, whether or not they can fully explain their symptoms and are treated, but do not achieve the desired effect of symptom relief. It is these huge troubles that make it difficult for patients with somatic symptom disorders in general hospitals, which not only increases the economic burden of patients, aggravates the already tense doctor-patient contradictions, but also continuously wastes a lot of social medical resources.
Lack of effective tools to identify somatic symptom disorders is one of the most important factors in the current diagnosis and mistreatment of somatic symptom disorders, general hospitals rely on various laboratory tests to diagnose diseases, and psychological disorder recognition is currently mainly dependent on personal experience and knowledge, which will make general hospitals accustomed to and various examinations to diagnose diseases of non-psychological specialists, in the identification and diagnosis of somatic symptom disorders at a loss, often can not distinguish whether the patient's symptoms are caused by somatic organic diseases or psychological disorders.
In addition to interviews, one of the best ways to identify psychological disorders is to apply psychological scales, just like the thermometer for infections, the sphygmomanometer for hypertension, and the psychological scale is a "test sheet" for psychological disorders. Perhaps it is a professional problem, the psychological scale is not important relative to the psychopsychiatry specialty, the patient who goes to the psychopsychiatric specialty to receive the diagnosis of psychological disorders and anti-anxiety and depression drug treatment will not have a problem, and for patients with somatic symptom disorders who are not treated by non-psychological specialties, the scale is extremely important, which is the objective basis for the patients in general hospitals to accept the diagnosis of psychological disorders and receive anti-anxiety and depression drugs.
At present, the most commonly used at home and abroad is the Hamilton Anxiety and Depression Rating Scale, SCL-90 Symptom Self-Assessment Scale and Zeng Anxiety and Depression Self-Assessment Scale, which is compiled by foreign countries in the 60s and 70s of the last century, may not have great problems in the application of psychopsychiatry, but there are no small problems in the application of somatic symptom disorders in general hospitals, these scales are mainly based on mental emotions, including PHQ-9 and CAD-7 recommended by the recent psychology community for general hospitals. These scales are suitable for screening patients with more simple anxiety-depressive disorders, while general hospital somatic symptom disorders are mainly manifested as various physical discomfort symptoms.
In addition, the traditional psychological scale of psychological disorders is also more complex and difficult to remember, especially his evaluation scale makes it quite difficult for general hospital doctors with relatively lack of psychological knowledge to grasp, and what is more difficult is that patients with psychological disorders in general hospitals often take a denial attitude towards their psychological disorders because of the stigma of psychological disorders, so it is often not easy to accept such a mental emotion-based scale, so that these scales are less operable in clinical application in general hospitals, and are only used in research articles.
According to the characteristics of psychological disorders in general hospitals are manifested by somatization symptoms, in 2010, the author compiled a self-assessment scale for identifying somatized symptoms of psychological disorders, and the design concept of this scale coincides with the concept of "somatic symptom disorders" in DSM-5 released in 2013, focusing on both the patient's somatization symptoms and the expression of psychological emotions, and the subsequent somatization scale PHQ-15, only somatic symptoms project, no emotional psychological expression, Therefore, a comprehensive assessment of somatic symptom disorders cannot be achieved.
The somatization symptom self-assessment scale consists of a total of 20 questions, of which the somatization symptoms project accounts for 50%, accounting for half of the scale items, and the rest are anxiety accounting for 20%, depression accounting for 20%, and anxiety depression accounting for 10%.
Each question is divided into four levels according to the severity of the symptoms, and patients can generally complete it in about 5 minutes, with a positive critical score of 36/37 points.
In clinical practice, according to the score of the scale, the somatic symptom disorder can be divided into three grades: mild, moderate and severe, with mild 30-39 points, moderate 40-59 points, and severe 60 points or more.
Stratification of disease severity favors the choice of therapeutic drugs:
For example, mild can choose delixin, cyclic ketones;
Moderately selectable 5-HT reuptake inhibitors;
Dual inhibitors of 5-HT and NE reuptake can be selected above severe.
The scale can help non-psychologists to identify somatic symptom disorders in a timely and early manner, shorten the patient consultation time, and can also fully reflect the patient's target symptoms and the severity of the disease, the scale can make patients feel understood and accepted, can correctly understand the disease state, effectively build a bridge of mutual trust and communication between doctors and patients, help doctors better judge and choose the appropriate treatment drug, can also repeat the score during treatment to help observe the treatment effect, and can also assess whether there are residual symptoms of treatment in the later stage of treatment. Determine when to reduce and discontinue the drug; through the scale, patients can also carry out self-management of chronic diseases, and fully complete the treatment course to reduce the recurrence of the disease.
This scale has good reliability and validity through research and testing, the scale is simple and easy to understand, easy to be accepted by patients with somatic symptom disorders, and easy to be mastered by non-psychologists in general hospitals. In the 2014 Chinese Expert Consensus on Psychological Prescription for Cardiovascular Patients and the Expert Consensus on the Diagnosis and Treatment of Anxiety, Depression and Somatization Symptoms in General Hospitals published in the Chinese Journal of Cardiovascular Diseases in 2014, this scale is used as a recommended scale for identifying, screening and evaluating somatic symptom disorders.
Somatic symptom disorder also has positive significance for the early identification and treatment of psychological disorders in general hospitals, and once identified in treatment, it can shorten the time and reduce the use of drugs, just like the treatment of cold stages of infection is much easier. The next question is who will treat somatic symptom disorders, and at present, there is disagreement that in theory, this is a psychological disease that should be treated by psychological specialists, but almost all patients with somatic symptom disorders are treated in general hospitals non-psychopsychiatry, and the biggest obstacle to effective treatment is not diagnosis and treatment technology but labeling problems. At the same time, these patients will also be accompanied by real medical diseases or some specious test results, such as a patient with palpitations and chest tightness tested to have premature beats, myocardial bridges, to deal with and determine whether these symptoms are caused by physical diseases or somatic symptom disorders, it is obviously easier and more convincing for cardiologists.
Somatic symptom disorders can occur in various departments of general hospitals, patients with these problems are recommended to psychological specialists for diagnosis and treatment, theoretically speaking, psychological specialists need to master the knowledge of various specialties to be convincing, in order to make patients believe that symptoms have nothing to do with these results of examination, it is obviously not easy to do so, and it is obviously much more feasible to let the various departments of general hospitals only master the diagnosis and treatment of one physical symptom disorder. Therefore, the non-psychopsychiatric specialties in general hospitals should be turned into the main battlefield for the diagnosis and treatment of somatic symptom disorders, and the doctors of each department should deal with them themselves instead of relying on psychopsychiatry, only in this way can we fundamentally reverse the passive situation of a large number of missed diagnosis and mistreatment of somatic symptom disorders.
It should be noted that the diagnosis and treatment of somatic symptom disorders should avoid being "spiritual", the purpose of patients with somatic symptom disorders is to solve physical symptoms rather than psychological problems, only by solving the patient's physical symptoms can we better solve the patient's psychological problems, the reverse order will make the treatment deadlock, the key problem of wenling murder case lies in this. In addition, it needs to be recognized that non-psychological specialists are accustomed to the symptoms of physical diseases related to the lesions found in their examination, when eliminating these intuitive lesions can alleviate the symptoms, and the symptoms caused by somatic symptom disorders whose lesions cannot be seen or touched, it is easy for non-psychological specialists to be confused and confused, but the symptoms caused by these symptoms are also pathologically based, caused by serotonin, dopamine and norepinephrine transmitter disorders in the brain, and these transmitters can be adjusted with drug treatment to fully eliminate these symptoms. The use of related anti-anxiety and depression drugs is not difficult to grasp with the help of scales.
At present, for somatic symptom disorders, it seems to be like a hundred years ago cold fever, then is a major disease that threatens human beings, it seems to be helpless, with the invention of the thermometer and antibiotics, the identification and treatment of cold fever has become a breeze, the thermometer can know whether the patient has fever, according to the degree of fever measured by the thermometer to judge the severity of the cold, help choose oral antibiotics or intravenous antibiotics, and then use the thermometer to judge whether the treatment is effective. If the somatic symptom disorder is compared to a cold, the somatization symptom self-assessment scale can be used as a "thermometer" to identify the somatic symptom disorder, which can easily determine whether the patient has a somatic symptom disorder, and then judge the severity of the disorder according to the scale and then choose the appropriate treatment drug, and then judge the treatment effect according to the scale.
Specifically, the process of diagnosis and treatment of somatic symptom disorders in non-psychological specialties in general hospitals is as follows:
1️⃣To rule out symptoms caused by somatic diseases based on symptom characteristics, signs, and related tests.
2️⃣The treatment of medical diseases is still ineffective.
3️⃣ Related interviews and self-assessment scales (SSS), PHQ-9, and GAD-7 scales are given to determine the presence and severity of psychological disorders.
4️⃣ Combined with the results of the scale evaluation, the appropriate anti-anxiety and depression drug treatment is selected, and the efficacy is followed up with the scale to observe the efficacy.
5️⃣Deservable referral with poor treatment or severe anxiety-depressive tendencies.
Through the above process, so that the diagnosis and treatment of physical symptom disorders become relatively simple and easy, just like the cold is as easy to grasp, it should be emphasized that non-psychological specialties need to diagnose and treat psychological disorders need to be limited to the stage of somatic symptom disorders, and try not to involve serious anxiety and depression stages, to do something, bringing about the learning curve of mastering the diagnosis and treatment of psychological disorders is easier and faster, and can also avoid unnecessary risks in the process of diagnosing and treating psychological disorders.
It is foreseeable that somatic symptom disorder has become or will become one of the major diseases affecting human beings, which is the inevitable development of the times, and we should take precautions and actively seek effective and simple ways to solve it.
Although the current policies and regulations do not stipulate that non-psychological specialists in general hospitals have the responsibility and obligation to see somatic symptom disorders, seeing and not looking at them are purely personal behaviors, but in view of the severe reality of somatic symptom disorders, non-psychological specialists in general hospitals cannot take care of themselves and hang high, from the perspective of doctors' responsibilities, humanistic care and overall medicine, they should assume the historical responsibility of diagnosing and treating somatic symptom disorders, and also hope to introduce relevant policies and regulations as soon as possible. The diagnosis and treatment of somatic symptom disorders has become a routine project of non-psychological specialties in general hospitals, and only in this way can we fundamentally solve the stubborn disease of somatic symptom disorders and prevent the Wenling killing incident from repeating.
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Expert of this article: Mao Jialiang Chief Physician of the Department of Cardiology, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine