Predictors of premature antidepressant discontinuation in functional gastrointestinal disorders.
Predictors of premature antidepressant discontinuation in functional gastrointestinal disorders.
复制标题
功能性胃肠道疾病过早停用抗抑郁药的预测因素。
DOI：
10.1097/psy.0b013e318031391d
复制
发表时间：
2007
影响因子：
3.3
通讯作者：
Clouse,RayE
中科院分区：
文献类型：
--
作者：
Sayuk,GregoryS;Elwing,JillE;Lustman,PatrickJ;Clouse,RayE
目的：确定导致过早停用抗抑郁药物的因素，这将有助于设计功能性胃肠道疾病患者的治疗策略。抗抑郁药越来越多地用于治疗功能性胃肠道疾病患者；患者对治疗方案的依从性较差，特别是在开始抗抑郁药物后不久，这种情况很常见，并且会影响治疗的成功。方法：回顾了 172 名门诊患者的临床记录，这些患者参加了大学诊所，并服用了抗抑郁药物来控制其功能性胃肠道症状。使用生存分析方法来确定过早停用抗抑郁药（开始使用后 6 个月内）的独立预测因素。使用逻辑回归分析来查看相同的预测因素是否会导致副作用或治疗反应不佳。结果：41 名 (23.8%) 受试者出现过早停用抗抑郁药的情况。躯体化特征（状态或特质）和抑郁症或焦虑症病史是过早停药的最显着预测因素（均 p≤.01）。年龄增长和女性性别也是独立的预测因素（均 p<.05）。躯体化特征和精神疾病均与治疗反应不佳有关，而躯体化特征最一致地与抗抑郁药物的副作用相关。结论：近四分之一因功能性胃肠道疾病而接受抗抑郁药物治疗的门诊患者未能维持治疗。躯体化特征和抑郁或焦虑病史通过预测副作用、治疗反应不佳和过早停用抗抑郁药物对治疗产生最显着的干扰。管理算法应包括针对具有这些治疗依从性差风险因素的患者的具体策略。
Objectives:To identify factors responsible for premature antidepressant discontinuation that would assist in designing management strategies for patients with functional gastrointestinal disorders. Antidepressants are being used increasingly to manage patients with functional gastrointestinal disorders; poor patient adherence to treatment regimens, particularly in the period shortly after antidepressant initiation, is common and interferes with success.Methods:Clinical records were reviewed from 172 outpatients who attended a university-based practice and who had been prescribed antidepressants to manage their functional gastrointestinal symptoms. Survival analysis methods were used to determine independent predictors of premature antidepressant discontinuation (within 6 months of initiation). Logistic regression analyses were used to see if the same predictors were responsible for side effects or poor treatment response.Results:Premature antidepressant discontinuation occurred in 41 (23.8%) subjects. Somatization features (state or trait) and history of depression or an anxiety disorder were the most significant predictors of premature discontinuation (p≤. 01 for each). Advancing age and female sex also were independent predictors (p<. 05 for each). Somatization features and psychiatric illness were each linked to poor treatment response, whereas somatization features most consistently were associated with antidepressant side effects.Conclusions:Failure to maintain treatment occurs in nearly a quarter of outpatients given antidepressants for functional gastrointestinal disorders. Somatization features and history of depression or anxiety most significantly interfered with treatment by predicting side effects, poor treatment response, and premature antidepressant discontinuation. Management algorithms should include specific strategies targeted at patients with these risk factors for poor treatment adherence.