自我腹部按摩与便秘体操对精神分裂症患者便秘及服药依从性的影响

目的探讨自我腹部按摩与便秘体操对精神分裂症患者便秘及服药依从性的影响。方法采用随机数字表将90例常发生便秘的精神分裂症患者分为3组,A组为常规护理组,B组为便秘体操组,C组为自我腹部按摩组,各30例。观察并记录三组病人的排便情况、练习依从性和服药依从性。结果入组后2周末、8周末,B、C两组均较A组便秘发生率降低、服药依从性升高,差异有统计学意义(P0.05)。但8周末B组的便秘发生率较2周末升高,服药依从性降低(P0.05)。结论自我腹部按摩和便秘体操对改善精神分裂症患者便秘和提高服药依从性均有效。但前者效果可能优于后者。     

护理程序在住院精神分裂症患者药物治疗中的应用效果评价

目的 探讨精神科药物治疗护理程序在住院精神分裂症患者药物治疗中的应用效果.方法 对我院收治的53例住院精神分裂症患者采用精神科药物治疗护理程序开展护理,并进行自身对照研究,采用PANSS量表评定精神症状,ITAQ量表评定自知力,并分析依从性与服药意愿.结果 治疗后第4周末与入组时比较,PANSS总分、ITAQ评分、服药依从率、愿意服药率差异具有统计学意义(P＜0.05).治疗后第8周末与第4周末比较,ITAQ总分、服药依从率、愿意服药率差别有统计学意义(P＜0.05).第8周时,服药依从率与愿意服药率差异无统计学意义(P＞0.05).结论 精神科药物治疗护理程序对提高患者的服药依从性及自知力有积极作用.     

精神分裂症后抑郁的人际心理治疗疗效观察

目的 探讨人际心理治疗在精神分裂症后抑郁的疗效。方法 将82例精神分裂症后抑郁患者随机分为研究组（药物合并人际心理治疗）40例和对照组（单纯药物治疗）42例,观察12周,于治疗前后采用汉密尔顿抑郁量表（HAMD）评定临床疗效。结果 治疗后第4、8、12周末HAMD量表评分与治疗前比较均显著降低（P〈0.05或P〈0.01）。两组在治疗后第8、12周末研究组HAMD量表评分均低于对照组（P〈0.05）。两组治疗后12周末依从每日服药量例数、每日服药次数例数、每日服药时间例数及坚持服药总例数较治疗前均显著增加（P﹤0.01）。两组患者治疗前依从每日服药量例数、每日服药次数例数、每日服药时间例数及坚持服药总例数评定差异无统计学意义（P〉0.05）。治疗后第12周末研究组依从每日服药量例数、每日服药次数例数、每日服药时间例数及坚持服药总例数上均高于对照组（P〈0.05,P〈0.01）。结论 人际心理治疗能够有效地改善精神分裂症后抑郁患者的抑郁情绪,提高其服药依从性。     

阿立哌唑治疗利培酮所致男性精神分裂症患者泌乳素升高的疗效分析

目的 探讨阿立哌唑治疗利培酮所致男性精神分裂症患者泌乳素升高的疗效及安全性。 方法 60例患者使用利培酮治疗4周末随机分配为研究组（利培酮+阿立哌唑）和对照组（利培酮）各30例， 观察至8 周末。在基线、第4 周末、第8 周末监测两组患者的泌乳素（PRL）水平，并进行阳性与阴性症状 量表（PANSS）和UKU 不良反应量表评估。结果 使用利培酮治疗4 周末，两组患者PRL水平均显著升 高（P＜ 0.01）。第8 周末研究组PRL水平与自身相比显著降低（P＜ 0.01），且与对照组比较差异有统计学 意义（P＜ 0.01）；两组患者PANSS 评分均较前显著降低（P＜ 0.01），但两组间PANSS 评分差异无统计学意 义。两组均多见的不良反应有男性乳房发育、乏力、思睡、静坐不能、肌张力障碍、震颤，但上述不良反 应发生率组间比较差异均无统计学意义（P＞0.05）。结论 利培酮可导致男性精神分裂症患者PRL增加， 合并使用阿立哌唑可显著降低利培酮所致的男性精神分裂症患者PRL增高，但未增加不良反应发生率。     

氟哌啶醇、利培酮及齐拉西酮对精神分裂症患者血清催乳素及认知功能影响的对照研究

目的 探讨氟哌啶醇、利培酮及齐拉西酮对精神分裂症患者血清催乳素及认知功能的影响.方法 选取精神分裂症患者120例,随机分为3组,分别予以氟哌啶醇、利培酮、齐拉西酮进行干预治疗.于治疗前及治疗后第4、8、12周末分别进行阳性和阴性综合征量表（PANSS）、精神分裂症认知功能评定量表（SCoRS）评定,并测定血清催乳素（PRL）水平.结果 （1）3组PANSS评分治疗后各时点均较治疗前下降（P＜0.01）.（2）3组患者各时点男性PRL水平均较治疗前升高（P＜0.01）,治疗后12周末齐拉西酮组PRL水平低于利培酮组（P＜0.05）;女性患者中氟哌啶醇组从第8周始、利培酮组从第4周始,PRL水平均较治疗前升高（P＜0.05）,治疗后第12周末齐拉西酮组PRL水平均低于氟哌啶醇组与利培酮组（P＜0.05）.（3）3组患者治疗后各时点SCoRS评分较治疗前下降（P＜0.01）,治疗后各时点SCoRS评分齐拉西酮组低于氟哌啶醇组（P＜0.05,P＜0.01）.结论 氟哌啶醇、利培酮、齐拉西酮均可造成催乳素水平增高.齐拉西酮影响相对较小,对女性患者催乳素水平影响更小.利培酮、齐拉西酮对患者认知功能改善显著优于氟哌啶醇.     

急性脑卒中与便秘57例分析

目的 探讨急性脑卒中与便秘的关系。方法 57例脑卒中患者分成动脉粥样硬化血栓性脑梗死（ATI）组23例；腔隙性梗死（LI）组23例；脑出血（ICH）组11例，观察各组便秘发生率并进行比较。结果 脑卒中者第1周便秘发生率50.88％，显著高于正常老年人对照组（P〈0．05）。基底节区脑卒中者便秘发生率57．1％，明显高于非基底节卒中者（P〈0.05）。结论 脑卒中患者急性期常发生便秘，基底节区脑卒中者便秘发生率较非基底节区脑卒中者高。     

氨磺必利治疗精神分裂症阴性症状的对照研究

目的 探讨氨磺必利治疗精神分裂症（Schizophrenia）阴性症状的疗效和不良反应.方法 将60例符合中国精神障碍分类与诊断标准第3版（CCMD-3）并以阴性症状为主的精神分裂症患者,随机分为氨磺必利组（研究组）和舒必利组（对照组）,疗程12周,用阴性症状量表（SANS）、临床总体印象量表（CGI）减分率评定疗效,用治疗中需处理的不良反应症状量表（TESS）评定药物不良反应,分别于治疗前、治疗后第2、4、6、12周末各评定1次.结果 治疗后第12周末研究组显效率83.3％,有效率93.3％;对照组显效率56.6％,有效率80％,两组显效率、有效率比较均有显著性差异（P＜0.05）.SANS总分研究组治疗后第4、6、12周末与治疗前比较明显降低（P＜0.05）,对照组治疗后第6、12周末与治疗前比较明显降低（P＜0.05）;SANS总分治疗后第6、12周末研究组评分显著低于对照组（P＜0.05）.CGI总分研究组治疗后第6、12周末与治疗前比较明显降低（P＜0.05）,且研究组评分显著低于对照组（P＜0.05）;CGI总分对照组治疗后第12周末与治疗前比较明显降低（P＜0.05）.两组不良反应发生率分别为研究组16.7％和对照组30.0％,两组比较有显著性差异（P＜0.05）.研究组月经改变和泌乳的发生率明显低于对照组（P＜0.05）.结论 氨磺必利对精神分裂症阴性症状的疗效优于舒必利,不良反应较小,服药依从性好,可作为治疗以阴性症状为主的精神分裂症的一线药物.     

奥氮平与阿立哌唑对首发精神分裂症糖脂代谢影响的对照研究

目的 研究阿立哌唑、奥氮平对首发精神分裂症患者血糖及血脂代谢的影响.方法 随机将61例首发精神分裂症患者分为奥氮平组和阿立哌唑组,比较治疗前及治疗后第6周末两组患者身高、体质量、血糖（FBG）、胰岛素（INS）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）、甘油三酯（TG）、总胆固醇（TC）变化.结果 治疗后第6周末奥氮平组FBG、INS、IRI、LDL、TG、TC、体质量及BMI均较治疗前明显升高（P＜0.05,P＜0.01）,治疗后第6周末奥氮平组上述指标较阿立哌唑组高（P＜0.05）.结论 与奥氮平相比,阿立哌唑对首发精神分裂症患者FBG及血脂代谢影响较轻.     

电针结合重复经颅磁刺激治疗抑郁症的疗效

目的 观察电针结合重复经颅磁刺激（rTMS）治疗抑郁症的疗效及安全性.方法 将75例抑郁症患者随机分为帕罗西汀组（A）、电针结合rTMS组（B）和帕罗西汀十电针结合rTMS组（C）,每组25例,持续治疗3周.于治疗前及治疗后第2、3周末用汉密尔顿抑郁量表（HAMD）评定疗效,并且以治疗不良反应量表（TESS）评估不良反应.结果 A组显效率为56％,B组为52％,C组为68％,3组比较差异无统计学意义（x2=1.512,P＞0.05）;经过2周治疗,C组患者的HAMD评分较治疗前比较差异有统计学意义（P＜0.05）;治疗3周末,各组患者的HAMD评分均较组内治疗前比较差异均有统计学意义（P＜0.05）,同时,C组评分显著低于A组,差异有统计学意义（P＜0.05）;B组不良反应发生率为24％,与A组（40％）和C组（44％）比较差异均无统计学意义（P＞0.05）.结论 电针结合rT-MS组治疗抑郁症的疗效与单纯用帕罗西汀相似,而且与帕罗西汀联合应用的起效速度更快.     

二甲双胍对奥氮平所致精神分裂症患者体质量增加的影响

目的 验证二甲双胍预防奥氮平引起精神分裂症患者的体质量增加和糖代谢紊乱的效果.方法 将37例未服过抗精神病药的精神分裂症患者,随机分为奥氮平(15 mg/d)联合二甲双胍组(750 ms/d;A组,18例)和奥氮平(15 mg/d)联合安慰剂组(B组,19例),治疗12周.于治疗前和治疗第4周末、8周末及12周末测定空腹血糖、胰岛素(INS)、身高、体质量、腰围、臀围,计算体质量指数(BMI)、腰臀比(WHR)、胰岛素抵抗指数(IRI)及治疗12周末体质量增加大于7%的比率.用阳性症状量表(SAPS)、阴性症状量表(SANS)于治疗前和治疗12周末评定疗效.结果 治疗12周末,A、B两组的体质量、BMI、WHR及B组患者的空腹INS和IRI较治疗前均升高(P＜0.05).治疗第8,12周末,B组的体质量、BMI、空腹INS和IRI的变化值高于A组(P＜0.05).B组体质量增加大于7%的比率(63%,12例)高于A组(17%,3例;P＜0.01).A、B两组的SAPS及SANS评分均显著低于治疗前(均P＜0.05),但组间差异均无统计学意义(P＞0.05).结论 二甲双胍能有效减轻奥氮平引起的体质量增加和糖代谢紊乱.     

Neuropeptides in idiopathic chronic constipation (slow transit constipation)

Tissue specimens from the large bowel of 18 patients with long-standing slow transit constipation were investigated to determine the distribution and density of several neuropeptides and amines in the enteric nerve system, and also of endocrine cells in comparison to normal individuals. CGRP (calcitonin gene-related peptide), galanin, glucagon, GRP (gastrin-releasing peptide), metenkephalin, motilin, neuropeptide Y (NPY), PACAP, peptide YY (PYY), serotonin, somatostatin, substance P and VIP were studied by immunohistochemistry. Tissue concentrations of VIP, substance P and galanin were also measured by radioimmunoassay. Significantly increased VIP, SP and galanin contents were found in specimens from the ascending colon. Levels of VIP and galanin were also increased in the transverse colon. Immunohistochemistry revealed only marginal changes with an increased density of PACAP nerve fibres in the smooth muscle and of VIP and PACAP nerves in the myenteric plexus of the transverse colon. In the descending colon substance P and NPY immunoreactivity were also increased in the myenteric plexus while the density of VIP nerve fibres was reduced in the mucosa/submucosa. The frequency of PYY-containing cells and the 5-HT-containing cells in the ascending colon was significantly increased in the constipated patients.     

Biomarkers to distinguish functional constipation from irritable bowel syndrome with constipation

Treatments for functional constipation (FC) and irritable bowel syndrome with constipation (IBS‐C) differ, but symptom criteria do not reliably distinguish between them; some regard FC and IBS‐C as parts of a single constipation spectrum. Our goal was to review studies comparing FC and IBS‐C to identify possible biomarkers that separate them. A systematic review identified 15 studies that compared physiologic tests in FC vs IBS‐C. Pain thresholds were lower in IBS‐C than FC for 3/5 studies and not different in 2/5. Colonic motility was decreased more in FC than IBS‐C for 3/3 studies, and whole gut transit was delayed more in FC than IBS‐C in 3/8 studies and not different in 5/8. Pelvic floor dyssynergia was unrelated to diagnosis. Sympathetic arousal, measured in only one study, was greater in IBS‐C than FC. The most reliable separation of FC from IBS‐C was shown by a novel new magnetic resonance imaging technique described in this issue of the journal. These authors showed that drinking one liter of polyethylene glycol laxative significantly increased water content in the small intestine, volume of contents in the ascending colon, and time to first evacuation in FC vs IBS‐C; and resulted in less colon motility and delayed whole gut transit in FC compared to IBS‐C. Although replication is needed, this well‐tolerated, non‐invasive test promises to become a new standard for differential diagnosis of FC vs IBS‐C. These data suggest that FC and IBS‐C are different disorders rather than points on a constipation spectrum.     

Biofeedback therapy in fecal incontinence and constipation

Abstract  We examine the collected evidence for efficacy of biofeedback therapy (BFT) in incontinence and constipation by means of meta-analysis of randomized controlled trials. PubMed search was performed to identify treatment trials that match quality criteria (adequate control groups, randomization). They were entered into meta-analyses using fixed effect models and computing odds ratio (OR) and 95% confidence interval (CI) of treatment effects. For constipation, eight BFT trials were identified. In four trials, electromyographic (EMG) BFT was compared to non-BFT treatments (laxatives, placebo, sham training and botox injection), while in the remaining four studies EMG BFT was compared to other BFT (balloon pressure, verbal feedback) modes. Meta-analyses revealed superiority of BFT to non-BFT (OR: 3.657; 95% CI: 2.127–6.290, P  < 0.001) but equal efficacy of EMG BFT to other BF applications (OR: 1.436; CI: 0.692–3.089; P  = 0.319). For fecal incontinence, a total of 11 trials were identified, of which six compared BFT to other treatment options (sensory training, pelvic floor exercise and electrical stimulation) and five compared one BFT option to other modalities of BFT. BFT was equal effective than non-BFT therapy (OR: 1.189, CI: 0.689–2.051, P  = 0.535). No difference was found when various modes BFT were compared (OR: 1.278, CI: 0.736–2.220, P  = 0.384). Included trials showed a substantial lack of quality and harmonization, e.g. variable endpoints and missing psychological assessment across studies. BFT for pelvic floor dyssynergia shows substantial specific therapeutic effect while BFT for incontinence is still lacking evidence for efficacy. However, in both conditions the mode of BFT seems to play a minor role.     

Plecanatide for the treatment of chronic idiopathic constipation and irritable bowel syndrome with constipation: Post hoc analyses of placebo-controlled trials in adults with severe constipation

Background

Patients with chronic idiopathic constipation (CIC) and irritable bowel syndrome with constipation (IBS-C) often experience severe symptoms. The current aim was to evaluate plecanatide in adults with CIC or IBS-C with severe constipation.

Methods

Data were analyzed post hoc from randomized, placebo-controlled trials (CIC [n = 2], IBS-C [n = 2]) of plecanatide 3 mg, 6 mg, or placebo administered for 12 weeks. Severe constipation was defined as no complete spontaneous bowel movements (CSBMs) and an average straining score ≥3.0 (CIC; 5-point scale) or ≥8.0 (IBS-C; 11-point scale) during a 2-week screening. Primary efficacy endpoints were durable overall CSBM responders (CIC: ≥3 CSBMs/week, plus increase from baseline of ≥1 CSBM/week, for ≥9 of 12 weeks, including ≥3 of the last 4 weeks) and overall responders (IBS-C: ≥30% reduction from baseline in abdominal pain and ≥1 CSBM/week increase for ≥6 of 12 weeks).

Key Results

Severe constipation was observed in 24.5% (646/2639) and 24.2% (527/2176) of CIC and IBS-C populations, respectively. The CIC durable overall CSBM response rate (plecanatide 3 mg, 20.9%; plecanatide 6 mg, 20.2%; placebo, 11.3%) and IBS-C overall response rate (plecanatide 3 mg, 33.0%; plecanatide 6 mg, 31.0%; placebo, 19.0%) were significantly greater with plecanatide versus placebo (p ≤ 0.01 for all). Median time to first CSBM in CIC and IBS-C populations were significantly shorter with plecanatide 3 mg versus placebo (p = 0.01 for both).

Conclusions and Inferences

Plecanatide was effective in the treatment of severe constipation in adults with CIC or IBS-C.     

Chronic constipation: advances in management

Only a relatively small percentage of clinically constipated patients seek medical attention and most can be managed satisfactorily with conservative measures. This review mainly addresses those patients who have refractory or difficult-to-manage functional constipation who are referred to gastrointestinal specialists. Areas of review include insights into pathophysiology, the utility of diagnostic testing and the author's opinions concerning available pharmacologic agents, the role of behavioural therapies and the indications for surgical interventions in this heterogeneous group of patients.     

Dyspepsia and constipation in patients with schizophrenia spectrum disorders

Constipation and dyspepsia are disturbing gastrointestinal symptoms that are often ignored in research on physical comorbidities of schizophrenia. The aim was to assess dyspepsia and constipation in a sample of outpatients with schizophrenia spectrum psychoses. A general practitioner performed a thorough physical health check for 275 outpatients and diagnosed constipation and dyspepsia. This study assessed the possible contribution of several sociodemographic, lifestyle, and clinical variables to constipation and dyspepsia using logistic regression analysis. This study also assessed whether these symptoms were associated with abnormal laboratory findings. The prevalence of constipation was 31.3%, and of dyspepsia 23.6%. Paracetamol (OR =3.07, 95% CI =1.34–7.02) and clozapine use (OR =5.48, 95% CI =2.75–10.90), older age (OR =1.04, 95% CI =1.01–1.06), and living in sheltered housing (OR =2.49, 95% CI =1.16–5.33) were risk factors for constipation. For dyspepsia the risk factors were female sex (OR =2.10, 95% CI =1.15–3.83), non-steroidal anti-inflammatory drugs (OR =2.47, 95% CI =1.13–5.39), and diabetes medication (OR =2.42, 95% CI =1.12–5.25). Patients with dyspepsia had lower haemoglobin and haematocrit and higher glucose values than those without dyspepsia. Patients with constipation had lower thrombocyte values than patients without constipation. However, these findings were explained by factors pre-disposing to constipation and dyspepsia. Clozapine use markedly increases the risk of constipation and may lead to life-threatening complications. In addition, analgesics and diabetes medication were related to gastrointestinal symptoms. These medications and their association to gastrointestinal symptoms should be kept in mind when treating patients with schizophrenia.