Kilinçarslan Sinem, Evrensel Alper
PhD, Psychologist.
MD, Asst. Prof., Psychiatrist. Uskudar University, Department of Psychiatry. Istanbul, Turkey.
Actas Esp Psiquiatr. 2020 Jan;48(1):1-7. Epub 2020 Jan 1.
Over the past decade, evidence that supports the relationship between intestinal microbiota and the brain has been obtained. Ageing, stress, nutrition and medicines can alter the composition of bacteria in the intestinal microbiota. This condition, called dysbiosis, can be repaired through prebiotics, probiotics or fecal microbiota transplantation (FMT). FMT is effective in the treatment of inflammatory bowel diseases (IBD). Information on FMT's use with psychiatric disorders is limited. This study aims to investigate changes in the severity of depression, anxiety and obsession of patients who received FMT for the treatment of inflammatory bowel diseases.
This study was conducted with 10 patients with IBD who underwent FMT between March and September 2017. FMT was performed by an experienced gastroenterologist. The patients completed the Beck Depression Inventory (BDI), Symptom Checklist-90-Revised (SCL-90-R) and Maudsley Obsessive Compulsive Inventory (MOCI) before FMT and again at 1 month after FMT.
Significant decreases were found in BDI (Z=2.49, p=0.013), SCL-90-R (Z=-2.09, p=0.037) and MOCI (Z=2.08, p=0.037) scores after 1 month of FMT. Although the SCL-90-R anxiety subscale scores decreased, this decrease was not statistically significant (Z=-1.55, p=0.121).
The severity of anxiety, depression and obsession in IBD patients decreased after FMT. The decrease in psychiatric symptoms may result from the direct neuropsychiatric effect of FMT (primary effect), but also the improvement of gastrointestinal symptoms (secondary effect). Another possibility is that this result is independent of these two conditions. Therefore, the results of our study are not sufficient to establish a cause-effect relationship. More randomised controlled trials with larger samples from patients with anxiety or depression but without comorbid physical illnesses are needed to generalise these results.
在过去十年中，已获得支持肠道微生物群与大脑之间关系的证据。衰老、压力、营养和药物会改变肠道微生物群中的细菌组成。这种情况称为生态失调，可通过益生元、益生菌或粪便微生物群移植（FMT）来修复。FMT在治疗炎症性肠病（IBD）方面有效。关于FMT用于精神疾病的信息有限。本研究旨在调查接受FMT治疗炎症性肠病的患者在抑郁、焦虑和强迫症状严重程度上的变化。
本研究对2017年3月至9月间接受FMT的10例IBD患者进行。FMT由一位经验丰富的胃肠病学家实施。患者在FMT前以及FMT后1个月时分别完成贝克抑郁量表（BDI）、症状自评量表-90修订版（SCL-90-R）和莫兹利强迫观念及强迫行为量表（MOCI）。
FMT 1个月后，BDI（Z=2.49，p=0.013）、SCL-90-R（Z=-2.09，p=0.037）和MOCI（Z=2.08，p=0.037）评分显著下降。虽然SCL-90-R焦虑分量表评分有所下降，但这种下降无统计学意义（Z=-1.55，p=0.121）。
IBD患者在接受FMT后，焦虑、抑郁和强迫症状的严重程度降低。精神症状的减轻可能源于FMT的直接神经精神效应（主要效应），也可能是胃肠道症状的改善（次要效应）。另一种可能性是，这一结果独立于这两种情况。因此，我们的研究结果不足以确立因果关系。需要更多来自焦虑或抑郁但无合并躯体疾病患者的大样本随机对照试验来推广这些结果。
