Psychiatric illness and irritable bowel syndrome: a comparison with inflammatory bowel disease
Article Abstract:
It is estimated that between 13 and 52 percent of all new patients attending gastroenterology clinics have irritable bowel syndrome. Previous studies have associated irritable bowel syndrome with a high incidence of coexisting mental disorders. However, the methodologies used in these studies have been flawed by the lack of structured psychiatric interviewing, control groups, or the use of inappropriate controls, which make the results inconclusive. This study was performed to investigate the association between irritable bowel syndrome and psychiatric illness using an improved methodology. The experimental group consisted of 28 patients diagnosed with irritable bowel syndrome; a control group of 19 individuals diagnosed with inflammatory bowel disease was also assessed. All patients were evaluated using the NIMH Diagnostic Interview Schedule (DIS) Version III-A in the abridged form, along with other diagnostic measurements. Criteria from the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised, were also used to investigate symptoms for a wide variety of psychiatric disorders such as anxiety, depression, and phobia. Patient interviews were also conducted and the interviewers were unaware of the gastrointestinal complaints of the patient. The results revealed that when compared with the patients with inflammatory bowel disease, the patients with irritable bowel syndrome had significantly more diagnoses of major depression, along with a number of disorders, including somatization, panic, generalized anxiety, and phobic disorders. Patients with irritable bowel syndrome had a 93 percent lifetime prevalence of a mental disorder and a 61 percent prevalence of depression. These patients had more physical symptoms that could not be medically explained and were generally more sensitive to psychological stress than the individuals with inflammatory bowel disease. It is concluded, based on these results, that evaluation of patients with irritable bowel syndrome should probably include a formal psychiatric evaluation, and administration of psychiatric treatment, if necessary. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Psychiatry
Subject: Psychology and mental health
ISSN: 0002-953X
Year: 1990
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Allergic to life: psychological factors in environmental illness
Article Abstract:
In recent years, there have been a growing number of reported cases of ''environmental illnesses.'' Many of these complaints involve perceived adverse reactions to common substances such as petroleum products, synthetic fabrics, and food additives, at levels that are below concentrations that are believed to be toxic. The symptoms reported range from physical disabilities to neuropsychiatric complaints, and patients often believe their reaction involves a immunologic response to toxins in the environment. It has been proposed that this range of complaints may constitute a new type of somatoform disorder. To more fully explore the psychological aspects of these environmental illnesses, an outbreak of chemical-induced illness occurring at an aerospace plant was evaluated. Diagnostic interviews were conducted and standardized self-report measures were performed in a population of 37 plastics workers. Testing emphasized psychopathology and somatization. Twenty-three workers did not have environmental illnesses; 13 workers reported symptoms of environmental illness, and one worker did not complete the testing. All 13 symptomatic workers scored significantly higher on the test than those who did not report symptoms. A prior history of anxiety or depressive disorders was associated with the symptomatic group. Fifty-four percent of the symptomatic workers had a history of psychiatric problems, compared with only 4 percent of the workers who did not suffer from symptoms. The findings suggest that the development of environmental illness after occupational exposure to chemicals is significantly influenced by psychological factors. The results do not support the immunologic explanation for these symptoms. However, there may be a subgroup of individuals with underlying psychiatric disorders who are predisposed to somatic syndromes. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Psychiatry
Subject: Psychology and mental health
ISSN: 0002-953X
Year: 1990
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Irritable bowel syndrome and psychiatric illness
Article Abstract:
Irritable bowel syndrome (IBS) has been defined as a condition involving three complaints, comprising abdominal pain that is relieved by defecating, disturbed defecation, and bloating. Although the disorder represents between 15 and 52 percent of new referrals to gastroenterologists, its diagnostic validity remains questionable. The syndrome is very often accompanied by such psychiatric symptoms as mood, anxiety, and somatization disorders. A review of studies concerning the coexistence of gastrointestinal and psychiatric symptoms was performed. Analysis of the results supports the hypothesis that IBS is a somatic (bodily) expression of psychiatric illness, rather than the competing hypothesis, namely that the accompanying psychiatric illnesses are a consequence of prolonged physical discomfort. In a study of 13 patients with IBS and 10 patients with inflammatory bowel disease, 85 percent of the IBS patients had a history of anxiety, compared with only 20 percent of the controls. The authors speculate that the bowel motility disorders associated with IBS may be the consequence of abnormalities of interaction between the so-called 'third-division' of the autonomic nervous system, the enteric nervous system. The link between the psychiatric disorder and IBS may be the locus ceruleus (in the brain), because of its nervous connections to the gut. Psychiatrists involved in the treatment of IBS are advised to pay close attention to family history, and should focus their efforts on alleviation of symptoms rather than cure. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Psychiatry
Subject: Psychology and mental health
ISSN: 0002-953X
Year: 1990
User Contributions:
Comment about this article or add new information about this topic:
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