触发调查法评价肠易激综合征患者的焦虑

V. V. Chuhunov, A. D. Horodokin, V. Ye. Kazakov, O. V. Havrish
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引用次数: 0

摘要

肠易激综合征(IBS)是最常见的心身疾病之一,影响了近10%的普通人群。尽管它与今天相关,但没有统一的方法来理解其发病机制,它可以被认为是一种复杂的躯体形式反应(基于与焦虑和抑郁状况的极高合并症的论点)或作为一种功能障碍(基于刻板的临床表现)。将肠易激综合征理解为一种心身疾病,并结合了精神病理发生机制,似乎在临床方面具有最大的前景。对肠易激综合征的心理和行为成分的研究为了解如何为肠易激综合征患者提供高质量的医疗服务提供了一个有前途的领域。的目标。目的:对混合型肠易激综合征患者的焦虑诱因进行系统分析和评价。材料和方法。在2022-2023年期间进行了一项前瞻性研究,包括100名主要诊断为肠易激综合征的患者。IBS类型分布如下:IBS- d型67例(ICD-10: K58.1), IBS- c型12例(ICD-10: K58.2), IBS- m型21例(ICD-10: K58.3)。他们都自愿参加了肠易激综合症社区支持小组的封闭式在线调查。IBS组患者平均年龄38.5±6.1岁。对照组由100名没有胃肠道病理诊断(或任何与胃肠道相关的不适)的健康志愿者组成。健康志愿者的平均年龄为29.5±4.2岁。本研究采用了以下方法:记忆法、精神诊断法和统计学方法。结果。为了从结构上评估肠易激综合征患者的焦虑触发因素,我们设法将23个单独的触发因素分为3类(社交活动违规、饮食习惯和饮食限制、健康问题)。每个类别都与特定精神障碍的特征有关:违反社交活动-社交焦虑障碍;饮食习惯和饮食限制——回避型和限制性食物摄入障碍;健康问题——疑病症。根据李克特量表收集焦虑水平评分,分为5个等级:“0”级无焦虑(平静状态);“1”——轻度焦虑(轻微紧张);“2”-中度焦虑(紧张);“3”-严重但可控的焦虑(非常紧张或感到恐惧);“4”——无法控制的焦虑(恐慌)。每个诱因的焦虑水平分布被确定并在健康和IBS个体之间进行比较。结论。对社交活动违规触发因素的分析表明,正式环境和社交情境的复杂性在增加焦虑水平方面占主导地位。对与饮食习惯和饮食限制相关的触发集的分析表明,正式的环境、复杂的社会活动和违反饮食习惯也倾向于诱发更强烈的焦虑。对健康担忧触发组的分析显示,腹部的感觉引起了最强烈的焦虑,以及对可能被误诊为肠易激综合征的担忧。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Trigger survey approach to the evaluation of anxiety in patients with irritable bowel syndrome
Irritable bowel syndrome (IBS) is one of the most common psychosomatic conditions affecting near 10 % of general population. Despite its relevance for today, there is no a unified approach to understanding its pathogenesis, it could be recognized as a complex somatoform reaction (based on the argument of extremely high comorbidity with anxiety and depressive conditions) or as a functional disorder (based on stereotypical clinical manifestations). The understanding of IBS as a psychosomatic condition as one that has combined psychopathogenesis seems to have the greatest perspectives in a clinical way. The study on psychological and behavioral components of IBS presents a promising area to understand ways of providing high-quality medical care for IBS patients. Aim. To systematize and evaluate the triggers of anxiety in patients with mixed form of irritable bowel syndrome. Materials and methods. A prospective study was conducted over a period of 2022–2023 including 100 patients with the main diagnosis of IBS. A distribution of IBS forms was as follows: 67 individuals with IBS-D (ICD-10: K58.1), 12 individuals with IBS-C (ICD-10: K58.2), 21 individuals with IBS-M (ICD-10: K58.3). They all were enrolled in the study as voluntary participants in a closed-ended online survey for IBS community support group. A mean age of IBS group was 38.5 ± 6.1 years. The comparison group was presented by 100 healthy volunteers without diagnosed pathology of gastrointestinal (GI) tract (or any GI-associated complains). A mean age of healthy volunteers was 29.5 ± 4.2 years. The study relied on the following methods: anamnestic, psychodiagnostic and statistical. Results. To structurally evaluate triggers of anxiety in patients with IBS we managed to distribute 23 separate triggers in 3 categories (social activity violations, eating habits and diet restrictions, health concerns). Each category was associated with features of a specific mental disorder: social activity violations – social anxiety disorder; eating habits and diet restrictions – avoidant and restrictive food intake disorder; health concerns – hypochondriasis. Anxiety level rating was collected according to the Likert scale in 5 ranks: “0” no anxiety (calm state); “1” – mild anxiety (slightly nervous); “2” – moderate anxiety (nervous); “3” – severe but controlled anxiety (very nervous or experiencing fear); “4” – uncontrolled anxiety (panicking). A distribution of anxiety levels for each trigger was determined and compared between healthy and IBS individuals. Conclusions. The analysis of the trigger set for social activity violations has shown a dominance of the formal setting and complexity of social situations in increasing the level of anxiety. The analysis of the trigger set related to eating habits and diet restrictions has shown that the formal setting, complicated social activity, and diet violations also tended to induce more intensive anxiety. The analysis of the health concern trigger set has revealed that sensations in the abdomen caused the most intensive cases of anxiety along with concerns about possible misdiagnosis of IBS.
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