Doctors Speak: A Qualitative Study of Physicians' Prescribing of Antidepressants in Functional Bowel Disorders.
Doctors Speak: A Qualitative Study of Physicians' Prescribing of Antidepressants in Functional Bowel Disorders.
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医生发言：功能性肠道疾病医生开抗抑郁药的定性研究。
DOI：
10.1007/s11013-022-09795-0
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Ongaro G
中科院分区：
文献类型：
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作者：
Ongaro G
三环类抗抑郁药(TCA)经常用于治疗慢性功能性疼痛障碍。尽管作用机制针对痛觉，但对被概念化为“功能性”障碍的TCA患者进行治疗可以促进这些患者的污名化，因为这暗示了该障碍的心理层面。这项研究的目标是了解医生如何在面对这一挑战时开出TCA。我们采访了11名三级护理诊所的胃肠病专家，他们专门研究功能性胃肠疾病，如肠易激综合征。我们发现，受访医生(1)意识到为医学状况服用抗抑郁药物会带来耻辱，(2)强调生物作用机制，而不是心理作用机制，(3)尽管专注于生物机制，但他们仍以高度关注期望心理的方式开出TCA，做出具体努力，将患者的期望调整为现实，并重新构建可能令人沮丧的信息，(4)要求患者坚持服用TCA，尽管存在常见且有时令人不舒服的副作用。在这种共同决策的背景下，医生描述了治疗功能障碍复杂性所需的细微差别的理解和行为，并强调了牢固的患者-提供者关系的重要性。
Tricyclic antidepressants (TCAs) are frequently prescribed for chronic functional pain disorders. Although the mechanism of action targets pain perception, treating patients with TCAs for disorders conceptualized as “functional” can promote stigmatization in these patients because it hints at psychological dimensions of the disorder. The goal of this study was to understand how physicians prescribe TCAs in the face of this challenge. We interviewed eleven gastroenterologists in tertiary care clinics specializing in functional gastrointestinal disorders, such as irritable bowel syndrome. We found that the physicians interviewed (1) were aware of the stigma attached to taking antidepressants for a medical condition, (2) emphasized biological, as opposed to psychological, mechanisms of action, (3) while focusing on biological mechanisms, they nevertheless prescribed TCAs in a way that is highly attentive to the psychology of expectations, making specific efforts to adjust patients’ expectations to be realistic and to reframe information that would be discouraging and (4) asked patients to persist in taking TCAs despite common and, at times, uncomfortable side effects. In this context of shared decision making, physicians described nuanced understanding and behaviours necessary for treating the complexity of functional disorders and emphasized the importance of a strong patient-provider relationship.