Life events, psychiatric illness and the irritable bowel syndrome.

Abstract

SUMMARY The frequency, severity, and characteristics of psychiatric illness and stressful life situations were assessed in 134 patients aged 18-60 years referred to a gastrointestinal clinic by their general practitioner. A functional disorder of the gastrointestinal tract was established in 72%. A formal psychiatric assessment in 64 randomly selected patients revealed a previous or current psychiatric disorder in 54% of the functional group and 12.5% of the organic group. Stressful life events before referral were assessed by a modification of the Bedford College methodology. Anxiety provoking life situations were found in 30%, a proportion which was not significantly different in the two groups. Psychiatric illness episodes and/or anxiety provoking situations, preceded the onset of bowel symptoms in two-thirds of the functional group, however, but in none of the organic group. Life situations alone did not appear to be associated with functional disorders unless they provoked an anxiety state.Functional disorders of the gastrointestinal tract are the most common of all gastrointestinal disorders and account for 50% of referrals to a gastrointestinal clinic. ' The majority of such patients have an irritable bowel syndrome characterised by abdominal pain associated with a change in bowel habit in the absence of demonstrable organic disease. In a randomly selected normal population, one-third regularly experienced similar gastrointestinal symptoms two-thirds of whom admitted to abdominal pain associated with a change in bowel habit.2 Despite the frequency of gastrointestinal symptoms in an apparently healthy population, less than a quarter consult their general practitioner because of these symptoms.2 If these symptoms are widely prevalent yet do not precipitate requests for consultation, the implication is that patients seeking advice do so either because the severity of symptoms is greater or there is a reduced tolerance due to other factors -for example, psychiatric illness or psychosocial distress.34This study was undertaken to assess the frequency, severity and characteristics of psychiatric illness and stressful life situations in patients referred to a

New insights into the psychosocial aspects of irritable bowel syndrome

“…Stressful events appear to be most harmful when they result in development of a formal psychiatric illness such as anxiety or depression. In a study of 134 patients referred to a gastroenterology clinic, psychiatric illness or anxiety-provoking situations preceded the onset of bowel symptoms in two thirds of the functional patients and in none of an organic disease control group [19]. However, stress was not followed by the onset of bowel symptoms unless provoked by an anxiety disorder.…”

Fatty acid profile and affective dysregulation in irritable bowel syndrome

“…The prevalence of affective dysregulation in IBS patients seen in a gastroenterologic setting is estimated between 40 and 90% (7)(8)(9)(10). Chronic modulation of serotonergic activity has been widely applied in the treatment of both affective disorders and IBS.…”

Psychosomatic Syndromes, Somatization and Somatoform Disorders

“…Nu merous studies found that patients with IBS who are seeking medical treatment have high er distress scores on distress scales and psy chological inventories measuring psychopa thology than patients with gastrointestinal diseases of organic origin and normal controls [58, 99, 100], They have substantially more psychiatric disorders than other patients [101,102], Intestinal motility increases in patients with IBS as well as in normal subjects after emotional stress [103]. A large proportion of patients with IBS report stressful events such as losses preceding either the onset or the exacerbation of symptoms [104].…”