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慢性特发性便秘:一项心理学探究。

Chronic idiopathic constipation: a psychological enquiry.

作者信息

Dykes S, Smilgin-Humphreys S, Bass C

机构信息

Department of Psychological Medicine, John Radcliffe Hospital, Oxford, UK.

出版信息

Eur J Gastroenterol Hepatol. 2001 Jan;13(1):39-44. doi: 10.1097/00042737-200101000-00007.

DOI:10.1097/00042737-200101000-00007
PMID:11204807
Abstract

BACKGROUND

Intractable idiopathic constipation in women is often associated with psychosocial problems.

AIMS

To determine the past and current psychological factors associated with slow and normal transit constipation.

PATIENTS

Twenty-eight consecutive patients referred for biofeedback treatment were interviewed before the procedure. All were women. Transit studies revealed that 12 had slow transit constipation (STC) and 16 had normal transit constipation (NTC).

METHODS

Patients were assessed for evidence of previous and current psychiatric diagnoses using a standardized diagnostic interview schedule. A full family and social history was noted. Self-rating scales were used to measure psychological distress, abnormal attitudes to eating and current psychosocial functioning.

RESULTS

The mean age of the 28 patients was 38.2 years (SD = 10.8) with a mean duration of symptoms of 17.5 years (SD = 16.9). Seventeen (61%) had a current psychiatric disorder and 18 (64%) a previous episode of psychiatric illness. The mean age of the 16 NTC patients was 38.4 years (SD = 10.1) with a mean duration of symptoms of 12.4 years (SD = 15.9). By contrast, the 12 STC patients had a much longer mean duration of constipation (24.3 years; SD = 16.4), a mean age of 37.9 years (SD = 12.1), with half having an onset in childhood. The STC patients reported more psychosocial distress on the rating scales than those with NTC, and only one did not experience some form of adverse life event or gynaecological procedure in the 6 months before the onset of constipation. Eleven (39%) of the 28 women had had a hysterectomy at a mean age of 36 years, but only four (14%) reported a history of sexual abuse. Of the nine (32%) patients who reported markedly distorted attitudes to food, six had NTC and three had STC.

CONCLUSIONS

Of consecutive patients undergoing psychological assessment for intractable constipation, three fifths had evidence of current, and two thirds a previous, affective disorder. One third reported distorted attitudes to food. Although STC is a chronic disorder accompanied by high rates of psychological distress, it does not appear to be associated with gross functional impairment. We suggest that patients who present to surgical departments with chronic intractable constipation should routinely have a psychological assessment.

摘要

背景

女性顽固性特发性便秘常与心理社会问题相关。

目的

确定与慢传输型便秘和正常传输型便秘相关的既往及当前心理因素。

患者

对28例连续接受生物反馈治疗的患者在治疗前进行访谈。所有患者均为女性。传输研究显示,12例为慢传输型便秘(STC),16例为正常传输型便秘(NTC)。

方法

使用标准化诊断访谈量表评估患者既往及当前精神疾病诊断的证据。记录完整的家庭和社会史。使用自评量表测量心理困扰、对饮食的异常态度及当前心理社会功能。

结果

28例患者的平均年龄为38.2岁(标准差=10.8),平均症状持续时间为17.5年(标准差=16.9)。17例(61%)有当前精神疾病,18例(64%)有既往精神疾病发作史。16例NTC患者的平均年龄为38.4岁(标准差=10.1),平均症状持续时间为12.4年(标准差=15.9)。相比之下,12例STC患者的便秘平均持续时间长得多(24.3年;标准差=16.4),平均年龄为37.9岁(标准差=12.1),其中一半在儿童期发病。STC患者在量表上报告的心理社会困扰比NTC患者更多,并且在便秘发作前6个月,只有1例未经历某种形式的不良生活事件或妇科手术。28例女性中有11例(39%)平均在36岁时接受了子宫切除术,但只有4例(14%)报告有性虐待史。在报告对食物态度明显扭曲的9例(32%)患者中,6例为NTC,3例为STC。

结论

在接受顽固性便秘心理评估的连续患者中,五分之三有当前情感障碍的证据,三分之二有既往情感障碍的证据。三分之一报告对食物态度扭曲。虽然STC是一种伴有高心理困扰率的慢性疾病,但似乎与严重功能损害无关。我们建议,因慢性顽固性便秘到外科就诊的患者应常规进行心理评估。

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