ABSTRACT
Background/Aims@#Stigma related with antidepressants is prevalent in patients with functional dyspepsia. It affects medication compliance and efficacy.Herbal medicine acquired a deep-rooted cultural identity in relieving dyspeptic symptoms in Asians. The research was designed to compare the effectiveness of Zhizhu Kuanzhong capsules (ZZKZ) versus doxepin hydrochloride (doxepin) on alleviating stigma and medication nonadherence among patients with refractory FD (rFD). @*Methods@#Patients with rFD from February 2021 to February 2022 were randomly allocated to receive either doxepin (n = 56) or ZZKZ (n = 57) combined with omeprazole for 4 weeks. Medication possession ratio (MPR), the disease- and medication-associated stigma were analyzed. The scales were utilized to assess dyspeptic symptoms (Leeds Dyspepsia Questionnaire) and psychological conditions (Generalized Anxiety Disorder Questionnaire and Patient Health Questionnaire). @*Results@#The MPR values for ZZKZ were significantly higher than those for doxepin (P < 0.001). The stigma scores decreased in ZZKZ group while increased in doxepin group compared to baseline after treatment. The proportion of patients showing ZZKZ-associated stigma was significantly lower than doxepin-associated stigma (P < 0.001). The MPR values were negatively correlated with posttreatment stigma scores in both groups (P < 0.001). Dyspeptic symptoms and psychological condition were improved in both groups after treatment, with no significant difference on post-treatment Leeds Dyspepsia Questionnaire, Generalized Anxiety Disorder Questionnaire, or Patient Health Questionnaire scores between 2 groups. @*Conclusion@#ZZKZ is superior to doxepin in alleviating stigma and medication non-adherence, with comparable efficacy in improving dyspeptic symptoms and psychological condition of patients with rFD.
ABSTRACT
Background/Aims@#Antidepressants are effective in patients with functional dyspepsia (FD). However, stigma associated with FD and antidepressants may affect treatment adherence. This study aims to explore possible communication strategies to alleviate stigma and improve adherence in patients with FD. @*Methods@#In this randomized, single-center, and single-blind trial, 160 patients with FD initiating antidepressant treatment were recruited. Different communication strategies were performed when prescribing antidepressants. Participants in Group 1 were told that brain is the “headquarters” of gut, and that antidepressants could act as neuromodulators to relieve symptoms of FD through regulating the functions of gut and brain. Participants in Group 2 were told that antidepressants were empirically effective for FD. Stigma scores, medication-related stigma, treatment compliance, and efficacy were analyzed. @*Results@#After 8-week antidepressant treatment, the proportion of patients with FD with decreased stigma scores in Group 1 was significantly higher than in Group 2 (internalized stigma: 64.10% vs 12.00%; perceived stigma: 55.13% vs 13.33%; P < 0.01). Medication-related stigma was lower in Group 1 than in Group 2 (P < 0.05 for 3 of 4 questions). Concurrently, patients in Group 1 had better treatment compliance (0.71 ± 0.25 vs 0.60 ± 0.25, P < 0.01) and efficacy. In Group 1, participants with decreased post-treatment stigma scores showed better treatment compliance and efficacy than those with non-decreased scores. Decrease in stigma scores positively correlated with treatment compliance. @*Conclusion@#Improving knowledge of patients with FD of the disease and antidepressants via proper communication may be an effective way to alleviate stigma and promote adherence.
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the association of erectile dysfunction (ED) with metabolic syndrome ( MS) and the total testosterone ( tT) level in young and middle-aged men.</p><p><b>METHODS</b>This study included 154 organic ED outpatients aged 20 -59 years and 103 age-matched men with normal sexual life. We obtained their waist circumference ( WC) , blood pressure ( BP) , fasting blood glucose ( FBG) , triglyceride ( TG) , high density lipoprotein ( HDL) , tT, IIEF -5 score, erectile function indexes and other relevant variables, and compared them between the ED and non-ED groups as well as between the ED patients with MS and those without MS.</p><p><b>RESULTS</b>The prevalence of MS was significantly higher in the ED patients than in the non-ED males ( 40. 9 vs 17.4%, P < 0. 01). Statistically significant differences were found between the ED and non-ED groups in WC ( [90. 80 ±4. 90] vs [87. 70 ±4. 60] em, P <0.01), SBP ([134.40±14.40] vs [129.90±12.40] mmHg, P<O.OS), DBP ([86.20±7.80] vs [83.60±8.60] mmHg, P <0.05), FBG ( [5.48 ±1.02] vs [5. 11 ±0. 91] mmol, P <0. 01), HDL ( [ 1.12 ±0. 27] vs [ 1. 26 ±0. 29] mmol, P < 0. 01) , and tT ( [ 15. 98 ± 6. 55] vs [ 17. 95 ± 7. 39] mmol, P < 0. 05) , as well as between the ED patients with MS and those without MS in such erectile function indexes as tT ( [ 14.49 ±6. 23] vs [ 17.01 ±6. 60] mmol, P <0. 05), erectile penile circumference ( [9. 67 ± 1.09] vs [10.16 ± 1.01] cm, P <0. 01), erectile penile length ( [ 10.40 ± 1. 20] vs [ 10.79 ± 1. 07] cm, P <0. 05), glans temperature ( [ 31. 33 ± 0. 65] vs [ 31. 80 ± 0. 82] °C , P < 0. 01) , and mean axial hardness of the penis ( [ 332. 60 ± 137. 90] vs [ 419. 20 ± 145. 80] g, P < 0. 01 ) . WC was significantly correlated with the incidence of ED ( P < 0. 01 ) .</p><p><b>CONCLUSION</b>The prevalence of MS is significantly higher in young and middle-aged ED patients than in normal males, and MS is associated with a lower testosterone level and poorer erectile performance. Central obesity is closely correlated with ED in young and middle-aged men.</p>