本帖最後由 lsc0019 於 2009-11-8 23:55 編輯
作者：Pauline Anderson
出處：WebMD醫學新聞
October 22, 2009 — 一篇新研究不只確認精神異常與下泌尿道症狀(lower urinary tract symptoms，LUTS)之間的關係，也顯示這類症狀對於憂鬱、焦慮或有性創傷史婦女的生活品質有巨大影響。
該研究的第一作者、維吉尼亞聯邦大學醫學院泌尿科副教授Adam P. Klausner醫師表示，我們發現，對於有濫用藥物或精神病史的婦女，以及沒有這些病史的婦女來說，失禁類型或LUTS類型實際上是相同的；差異在於這些相同症狀對於生活品質的影響不同。
該研究線上發表於10月22日的泌尿學期刊。
該研究包括了轉診到退伍軍人一級照護門診進行LUTS頻尿、急尿或尿失禁評估的121名婦女。研究者蒐集有關精神共病症、性創傷史、年紀、種族、生產史等資料。這些婦女也完成兩份問卷：一份是LUTS的類型和嚴重度，一份是對於生活品質的影響。
研究者將結果和控制組的1,298名婦女的結果進行比較，控制組婦女來自同樣的一級照護門診但是沒有LUTS。
該研究顯示，LUTS婦女的精神共病症比率高於控制組： 64.5% vs 25.9% (P < .001)。
【性創傷比率高令人不安】
此外，LUTS的婦女幾乎半數(49.6%)有性侵害史，定義是被迫發生性關係，而此一比率在控制組為20.1% (P < .001)。Klausner醫師表示，性創傷的定義相當嚴謹且僅限於強暴。如果將定義廣泛納入其他類型的性侵害或甚至納入性騷擾的話，我們不知道是否有類似的結果。
加州史丹佛醫學院精神與行為科學教授David Spiegel醫師接受Medscape Psychiatry邀請發表評論時表示，這些比率之高，相當令人不安且困擾。
最常見的性創傷發生於服役時(35%)。Klausner醫師表示，退伍軍人事務部知道這件事情，因此他們進行篩檢，但是沒有足夠的管道來預防這個嚴重問題。
他表示，事實是，對於一般婦女，五分之一曾被強暴的報告也很嚴重，也需要後續探討。
雖然兩組的症狀嚴重度調查結果相似，但失禁影響(例如從事家務事的能力、開車或搭車到離家30分鐘路程處)之問卷的整體分數方面，有精神共病症與性創傷的病患分數高於沒有這些狀況者(11.05% vs 7.6%)。
【對於骨盆腔之關注】
Klausner醫師表示，雖然該研究並未確認原因，曾有性創傷的婦女比較會對骨盆腔有所關注，就像排球選手在手肘受傷之後，比賽時對於患部會比較注意一樣。我的假設是，因為婦女的尿道與陰道口位置相近，加上她們對此區域的特別關注，任何的異常，如失禁，對她們會有較多困擾。
Spiegel醫師同意這個假設：性傷害發生時，鄰近的泌尿道可能受到影響，甚至也受到傷害，所以可能是有傷害或者只是該區域與性創傷有關的累積關聯。
除了精神共病症之外，流產史也是與生活品質問卷分數較高有關的獨立風險因素。Klausner醫師表示，雖然研究者不知道原因為何，可能是與曾經流產有關的「精神包袱」。這會使得婦女比較注意骨盆腔，且因此比沒有流產過者對LUTS更敏感。
膀胱難排空的相關症狀、下腹或生殖器區域疼痛或不舒適等方面，50歲以下的婦女的分數較高。Klausner醫師表示，這和在一般族群研究所觀察到的結果(婦女通常在年紀大的時候比較會有膀胱過動症狀)相反。
這個發現可能可以反映出年輕婦女比較可能承認性侵害的事實。Klausner醫師表示，此結果清楚反映出，我治療的這些婦女中，性侵害和性創傷的高比率；不過，需要更多研究來釐清此關聯。
Spiegel醫師表示，LUTS婦女治療精神異常可能對改善她們的生活品質有很大的效果；因此，不要只是開立膀胱用藥就認為了事；應治療所有的共病狀況。
作者們皆宣告沒有相關財務關係。
J Urol. 線上發表於2009年10月22日。
Psychiatric Disorders, Sexual Trauma Linked to Urinary Tract Symptoms
By Pauline Anderson
Medscape Medical News
October 22, 2009 — A new study not only confirms the relationship between psychiatric disorders and lower urinary tract symptoms (LUTS) but also shows that the effect of such symptoms on quality of life is more dramatic in women with depression, anxiety, or a history of sexual trauma.
"We found that the type of incontinence or the type of [LUTS] was actually the same between women who had a history of abuse or a psychiatric history and those who didn't," said the study's lead author Adam P. Klausner, MD, associate professor, Division of Urology, Virginia Commonwealth University School of Medicine, Richmond. "What was different was the quality of life impact from the same type of symptoms."
The study was published online October 22 in the Journal of Urology.
The study included 121 women in a Veterans Affairs primary care clinic who were referred for evaluation of LUTS such as frequency, urgency, or incontinence. Researchers collected information on psychiatric comorbidities, history of sexual trauma, age, race, and obstetric history. The women also completed 2 questionnaires — one on the type and severity of LUTS and the other on its effect on their quality of life.
The researchers compared the results with a control population of 1298 women from the same primary care practice who did not have LUTS.
The study showed that women in the LUTS clinic had higher rates of psychiatric comorbidities compared with control participants: 64.5% vs 25.9% (P < .001).
Disturbingly High Rates of Sexual Trauma
In addition, almost half (49.6%) of the participants in the LUTS clinic group had a history of sexual assault, defined as being forced to have sex against their will, compared with 20.1% in the control group (P < .001). "The definition of sexual trauma was very strict and was limited to rape," noted Dr. Klausner. "We don't know if similar results would have been found if the definition was broadened to include other forms of sexual assault or even sexual harassment."
These rates are "disturbingly high" and "troubling," commented David Spiegel, MD, professor, psychiatry and behavioral science, Stanford School of Medicine, California, when approached by Medscape Psychiatry for comment on the study.
The most common setting for sexual trauma was during active military service (35%). "The Department of Veterans Affairs knows about this, and that's why they're screening for it, but there has not been enough progress in preventing this terrible problem," said Dr. Klausner.
The fact that about 1 in 5 women in the general population report having been raped is also significant and should be explored further, he said.
Although scores in the symptom severity survey were similar between the 2 groups, total scores for the incontinence effect questionnaire — things like the ability to do household chores or to travel by car/bus more than 30 minutes from home — were higher in patients with psychiatric comorbidities and sexual trauma compared with patients with neither of these conditions (11.05% vs 7.6%).
Pelvic Focused
Although the study did not determine why this is, women who have had sexual trauma may become "pelvic focused," just as a volleyball player who injures an elbow would become focused on that area during games, said Dr. Klausner. "My hypothesis is that because the urethra and the vaginal orifice are in the same spot in women, anything that's abnormal, for instance, incontinence, is going to bother them more because they're so focused on that area."
Dr. Spiegel agrees with this hypothesis: "The urinary tract is proximate to and sometimes involved in sexual trauma, so it could be that it's damaged or simply that symptoms in that region store up associations to sexual trauma."
In addition to psychiatric comorbidities, a history of miscarriage was also an independent risk factor for higher scores on the questionnaire regarding effect on quality of life. Although the researchers do not know the reason for this, there could be "psychiatric overlay" involved in having a miscarriage, said Dr. Klausner. "This could cause women to be more focused on the pelvis and therefore react more forcibly to [LUTS] than a woman who has not had a miscarriage."
Age younger than 50 years was associated with higher scores on symptoms relating to difficulty emptying bladder and pain or discomfort in lower abdomen or genital area. This, said Dr. Klausner, is the opposite of what is normally observed in a population study; women usually get more, not fewer, symptoms of an overactive bladder as they age.
This finding might reflect the fact that younger women are more likely to admit to sexual abuse. "It clearly reflects the high prevalence of abuse and sexual trauma in the women that I treat; however, more research is required to clarify the associations," said Dr. Klausner.
Treating psychiatric disorders in women with LUTS may go a long way toward improving their quality of life, said Dr. Spiegel. "So don't just sort of give a drug for the bladder and think you're done; treat all the comorbid conditions."
The authors have disclosed no relevant financial relationships.
J Urol. Published online October 22, 2009. |
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