Yan Xiu-Juan, Li Wen-Ting, Chen Xin, Wang Er-Man, Liu Qing, Qiu Hong-Yi, Cao Zhi-Jun, Chen Sheng-Liang
Xiu-Juan Yan, Wen-Ting Li, Xin Chen, Er-Man Wang, Qing Liu, Hong-Yi Qiu, Zhi-Jun Cao, Sheng-Liang Chen, Division of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai 200001, China.
World J Gastroenterol. 2015 Apr 21;21(15):4652-9. doi: 10.3748/wjg.v21.i15.4652.
To explore whether clinician-patient communication affects adherence to psychoactive drugs in functional dyspepsia (FD) patients with psychological symptoms.
A total of 262 FD patients with psychological symptoms were randomly assigned to four groups. The patients in Groups 1-3 were given flupentixol-melitracen (FM) plus omeprazole treatment. Those in Group 1 received explanations of both the psychological and gastrointestinal (GI) mechanisms of the generation of FD symptoms and the effects of FM. In Group 2, only the psychological mechanisms were emphasized. The patients in Group 3 were not given an explanation for the prescription of FM. Those in Group 4 were given omeprazole alone. The primary endpoints of this study were compliance rate and compliance index to FM in Groups 1-3. Survival analyses were also conducted. The secondary end points were dyspepsia and psychological symptom improvement in Groups 1-4. The correlations between the compliance indices and the reductions in dyspepsia and psychological symptom scores were also evaluated in Groups 1-3.
After 8 wk of treatment, the compliance rates were 67.7% in Group 1, 42.4% in Group 2 and 47.7% in Group 3 (Group 1 vs Group 2, P = 0.006; Group 1 vs Group 3, P = 0.033). The compliance index (Group 1 vs Group 2, P = 0.002; Group 1 vs Group 3, P = 0.024) with the FM regimen was significantly higher in Group 1 than in Groups 2 and 3. The survival analysis revealed that the patients in Group 1 exhibited a significantly higher compliance rate than Groups 2 and 3 (Group 1 vs Group 2, P = 0.002; Group 1 vs Group 3, P = 0.018). The improvement in dyspepsia (Group 1 vs Group 2, P < 0.05; Group 1 vs Group 3, P < 0.05; Group 1 vs Group 4, P < 0.01) and psychological symptom scores (anxiety: Group 1 vs Group 2, P < 0.01; Group 1 vs Group 3, P < 0.05; Group 1 vs Group 4, P < 0.01; depression: Group 1 vs Group 2, P < 0.01; Group 1 vs Group 3, P < 0.01; Group 1 vs Group 4, P < 0.01) in Group 1 were greater than those in Groups 2-4. The compliance indices were positively correlated with the reduction in symptom scores in Groups 1-3.
Appropriate clinician-patient communication regarding the reasons for prescribing psychoactive drugs that emphasizes both the psychological and GI mechanisms might improve adherence to FM in patients with FD.
探讨医患沟通是否会影响伴有心理症状的功能性消化不良（FD）患者对精神活性药物的依从性。
将262例伴有心理症状的FD患者随机分为四组。第1 - 3组患者给予氟哌噻吨美利曲辛（FM）加奥美拉唑治疗。第1组患者接受关于FD症状产生的心理和胃肠道（GI）机制以及FM作用的解释。第2组仅强调心理机制。第3组患者未得到FM处方的解释。第4组患者仅给予奥美拉唑。本研究的主要终点是第1 - 3组对FM的依从率和依从指数。还进行了生存分析。次要终点是第1 - 4组消化不良和心理症状的改善情况。同时评估了第1 - 3组依从指数与消化不良和心理症状评分降低之间的相关性。
治疗8周后，第1组的依从率为67.7%，第2组为42.4%，第3组为47.7%（第1组与第2组比较，P = 0.006；第1组与第3组比较，P = 0.033）。第1组FM治疗方案的依从指数（第1组与第2组比较，P = 0.002；第1组与第3组比较，P = 0.024）显著高于第2组和第3组。生存分析显示，第1组患者的依从率显著高于第2组和第3组（第1组与第2组比较，P = 0.002；第1组与第3组比较，P = 0.018）。第1组消化不良（第1组与第2组比较，P < 0.05；第1组与第3组比较，P < 0.05；第1组与第4组比较，P < 0.01）和心理症状评分（焦虑：第1组与第2组比较，P < 0.01；第1组与第3组比较，P < 0.05；第1组与第4组比较，P < 0.01；抑郁：第1组与第2组比较，P < 0.01；第1组与第3组比较，P < 0.01；第1组与第4组比较，P < 0.01）的改善程度大于第2 - 4组。第1 - 3组依从指数与症状评分降低呈正相关。
关于开具精神活性药物原因的适当医患沟通，若同时强调心理和GI机制，可能会提高FD患者对FM的依从性。
