CAJ | 학술논문

目的通过人格及精神障碍评估问卷了解医院就诊肠易激综合征(IBS)患者精神障碍的共病状况.方法顺序纳入2008年11月至2010年3月北京大学第三医院消化科门诊就诊、符合罗马Ⅲ标准的IBS患者83例,由经过培训的人员通过人格诊断问卷4(PDQ-4)、复合型国际诊断交谈(CIDI)表进行人格障碍、躯体形式障碍及其他精神障碍诊断.结果 83例IBS患者中男43例,女40例,年龄(38±14)岁.其中便秘型20例(24.1%)、腹泻型31例(37.3%)、混合型15例(18.1%)、未分型17例(20.5%).(1)62例(74.7%)患者被检出1型或多型人格障碍,性别差异无统计学意义,其中以强迫和回避为特征的焦虑-抑制类(C组)人格障碍最多(58例,69.9%).存在人格障碍者躯体形式障碍检出率为46.8%(29/62),高于无人格障碍者[19.0%(4/21),P=0.025].(2)IBS患者的CIDI-3.0精神障碍终生患病率44.6%(37例),显著高于对照组,性别差异无统计学意义.焦虑与心境障碍是最多见的精神障碍共病类型,分别为21例(25.3%)和19例(22.9%).物质滥用和依赖、间歇性暴发障碍分别检出9例(10.8%)和7例(8.4%).腹泻型IBS患者精神障碍共病率最高(58.1%,18/31),但不同IBS亚组之间精神障碍检出率差异无统计学意义.(3)IBS患者中33例(39.8%)存在躯体形式障碍,性别差异无统计学意义.各亚组间躯体形式障碍检出率差异无统计学意义.焦虑障碍同时合并躯体形式障碍者为61.9%(13/21),显著高于无焦虑障碍者[32.3%(20/62),P=0.016].结论综合医院消化科就诊的IBS患者精神障碍共病较为常见,尤其是焦虑障碍和心境障碍.存在人格偏离及焦虑障碍的IBS患者更容易出现躯体形式障碍,消化专业医师应对此有充分认识并予以恰当治疗建议.
목적 통과인격급정신장애평고문권료해의원취진장역격종합정(IBS)환자정신장애적공병상황.방법 순서납입2008년11월지2010년3월북경대학제삼의원소화과문진취진、부합라마Ⅲ표준적IBS환자83례,유경과배훈적인원통과인격진단문권4(PDQ-4)、복합형국제진단교담(CIDI)표진행인격장애、구체형식장애급기타정신장애진단.결과 83례IBS환자중남43례,녀40례,년령(38±14)세.기중편비형20례(24.1%)、복사형31례(37.3%)、혼합형15례(18.1%)、미분형17례(20.5%).(1)62례(74.7%)환자피검출1형혹다형인격장애,성별차이무통계학의의,기중이강박화회피위특정적초필-억제류(C조)인격장애최다(58례,69.9%).존재인격장애자구체형식장애검출솔위46.8%(29/62),고우무인격장애자[19.0%(4/21),P=0.025].(2)IBS환자적CIDI-3.0정신장애종생환병솔44.6%(37례),현저고우대조조,성별차이무통계학의의.초필여심경장애시최다견적정신장애공병류형,분별위21례(25.3%)화19례(22.9%).물질람용화의뢰、간헐성폭발장애분별검출9례(10.8%)화7례(8.4%).복사형IBS환자정신장애공병솔최고(58.1%,18/31),단불동IBS아조지간정신장애검출솔차이무통계학의의.(3)IBS환자중33례(39.8%)존재구체형식장애,성별차이무통계학의의.각아조간구체형식장애검출솔차이무통계학의의.초필장애동시합병구체형식장애자위61.9%(13/21),현저고우무초필장애자[32.3%(20/62),P=0.016].결론 종합의원소화과취진적IBS환자정신장애공병교위상견,우기시초필장애화심경장애.존재인격편리급초필장애적IBS환자경용역출현구체형식장애,소화전업의사응대차유충분인식병여이흡당치료건의.
Objective To assess the prevalence of psychiatric comorbidities in patients referred for irritable bowel syndrome(IBS)with questionnaires for mental disorders.Methods A total of 83 IBS patients at our hospital were enrolled and assessed with the Personality Diagnostic Questionnaire for DSM-IV,version 4(PDQ-4)and Composite International Diagnostic Interview,version 3.0 and 2.1(CIDI-3.0 & CIDI-2.1)by trained interviewers.Such items as personality dysfunction,mental disorder and somatization disorder were examined.Results The male-female ratio was 1.08/1.Their mean age was(38±14)years old.Among them,20 patients(24.1%)were constipation-predominant,31(37.3%)diarrheapredominant,15(18.1%)mixed and 17(20.5%)unclassified type.(1)Sixty-two(74.7%)patients scored positive for any personality dysfunction.There was no significant gender difference.The cluster C (anxious-fearful)personality disorder was most commonly found in IBS patients(n=58,69.9%).The prevalence of somatoform disorders plus personality dysfuntion was 46.8%(29/62).It was significantly higher than those without personality dysfunction[19.0%(4/21),P=0.025].(2)Thirty-seven patients (44.6%)had a lifetime CIDI-3.0 diagnosis.It was significantly higher than that in the general population.There was no gender difference.Anxiety and mood disorders were the most common types of psychiatric comorbidities[n=21(25.3%)and n=19(22.9%)respectively].The lifetime prevalence of alcohol or nicotine abuse and(or)dependence and intennittent explosive disorder were 10.8%(n=9)and 8.4%(n=7).Psychiatric comorbidities were most commonly found in diarrhea-predominant patients(58.1%).But there was no significant difference among the subgroups.(3)Thirty-three patients(39.8%)had somatoform disorders.Neither gender nor subgroup differencc wag observed.The IBS patients with anxiety disorders presented significantly more somatoform disorders than the remainders[61.9%(13/21)vs 32.3%(20/62),P=0.016 1.Conclusion Such psychiatric comorbidities as anxiety disorders and mood disorders are common in patients referred for IBS.The patients with personality dysfunction and(or)anxiety were more likely to suffer somatoform disorders.A gastroenterologist should grasp a thorough knowledge and make appropriate therapeutic recommendations for those patients.