Man's purgative passion

Overconcern with bowel function has been prevalent throughout history. Overuse of laxatives is persisting for a certain segment of the population even today. This paper attempts to put this practice into perspective by presenting a review of mankind's treatment and mistreatment of the GI system from the ancient Egyptians to modern times.

Depression and gastrointestinal illness: the joint use of biological and clinical criteria

Occurrence and characteristics of depression were investigated in 37 consecutive patients suffering from gastrointestinal illness. More than 40% of patients with an organic digestive disease and about a quarter of those with functional gastroenterological complaints were found to suffer from a major depressive disorder according to DSM-III criteria. The dexamethasone suppression test--a laboratory marker of the endogenous depressive state--supported clinical diagnosis in several cases, yet its routine use to screen depression is not warranted because of its poor specificity. The results should alert the physician to include clinical and biological criteria for depression in the diagnostic work-up for gastrointestinal illness.

Depressed women with panic attacks

Of a group of 288 depressed female inpatients, 43 (15%) had secondary panic attacks. Compared to other depressives, the subgroup with panic attacks had significantly higher frequencies of anorexia, weight loss, gastrointestinal disturbances, hypochondriasis, and psychomotor agitation, and significantly lower frequencies of melancholic symptoms, including loss of interest in usual activities, guilt feelings, delusional thinking, psychomotor retardation, and orientation or memory impairment. Patients with panic attacks were less likely to have a depressed parent and were more likely to be described as having been nervous, worrisome, sensitive, and sexually dysfunctional before the onset of depression. Phenomenologically, they resembled "anxious depressives" as described by other authors.

Specificity of psychological profiles of irritable bowel syndrome patients

The aim of the study was to investigate the specificity of psychological profiles in female Irritable Bowel Syndrome (IBS) patients by a comparison with a gastrointestinal patient control group and with a normal population control group. The results showed that the IBS patients scored significantly higher than the normal population sample on three test scales: Anxiety, Phobic and Somatisation. Our results thus support the conclusion of earlier authors that a moderate degree of psychoneurotic disorder exists amongst IBS patients. However, the patient control group also scored significantly higher than the normal control group on two factors (Phobic and Somatisation), and the comparison between the IBS group and the patient control group did not reveal any significant differences. It is suggested that attention to the psychological needs of both IBS and other gastrointestinal disease patients should form an important part of the management strategy, particularly in the former--where a consistently clear benefit for any particular therapy has yet to be shown.

Goal frustration and life events in the aetiology of painful gastrointestinal disorder

Life events and difficulties were recorded for the year preceding onset of abdominal pain in 135 consecutive referrals to three gastrointestinal clinics, and for the equivalent time period in a matched, healthy community comparison series. Fifty-six patients were found to have an organic gastrointestinal disorder. Severely threatening events and major difficulties known to play a critical aetiological role in clinical depression, occurred with much the same frequency during the 38 weeks before onset of non-organic ('functional') gastrointestinal disorder. There was no such relationship between the severity of threat and organic disorder. A measure of 'goal frustration' reflecting the degree to which the subjects aims and ambitions were insurmountably obstructed by the occurrence of the event, was significantly associated with organic disorder. This finding may explain the often reported association between life stress and organic gastrointestinal disorder.

Responsivity/nonresponsivity in psychosomatic disorders

Tested the hypothesis that gastrointestinal and dermatological symptoms are associated with differing psychological styles. Specifically, it was predicted that tendencies toward heightened environmental responsiveness and heightened experiences of urges and affects would be associated with gastrointestinal diseases, whereas affectively reduced environmental responsiveness and muted experiences of urges and affects would be associated with dermatological diseases. Forty adult male Ss, 20 in each disease category, were given an open-ended interview--the basis for the main test of the hypothesis, the Mayman Early Memory Test, and the TAT. Based on the interview material, coders classified the Ss as predicted at levels well beyond chance. Though the data from the other tests did not provide clear-cut evidence, they did offer tentative support for the hypothesis. S responses are presented that highlight the contrast between the two styles.

Anxiety related to medical disease

The presentations and treatment of anxiety as 1) a reaction to catastrophic illness, 2) an intrinsic symptom of a physical disorder, and 3) part of a chronic disease are reviewed. Educative and supportive psychotherapy in group settings is recommended, accompanied when indicated by the judicious short-term use of antidepressants or antianxiety agents such as the benzodiazepines or the new nonbenzodiazepine anxiolytics.

Organic and functional disorders in 2000 gastroenterology outpatients

To determine the relative frequency of different diseases and of functional gastrointestinal disorders among patients referred by general practitioners to a gastroenterology clinic, 2000 patients referred over a five-year period were studied. 980 had organic diseases, of which peptic ulcer, oesophagitis, and inflammatory bowel disease accounted for about half. 888 patients had functional disorders of the gastrointestinal tract, without any disease. Among these, various syndromes could be distinguished; abdominal pain with altered bowel habit (irritable bowel syndrome, spastic colon type) accounted for about half of these patients. More attention could profitably be directed towards understanding these common functional syndromes so that they can be more readily diagnosed and better managed.

Gastric stasis and vomiting: behavioral treatment

A patient is described in whom gastric stasis and vomiting of 28-yr duration were successfully treated with behavior therapy. Failure of conventional medical treatment in the face of continued vomiting led to consideration for surgery. The need for surgery was obviated by the successful application of exposure and response prevention, which resulted in a complete elimination of vomiting. Changes were produced, not only in the overt behavioral manifestation (vomiting) but in gastrointestinal motility as well. Although there was a lag, gastric emptying returned to normal. The improvements were maintained at over 1-yr follow-up study.

Disorders of the gastrointestinal tract in children: consultation-liaison experience

Disorders of the gastrointestinal tract are common in children. Fortunately, many are short-lived, related to infection, food intolerance, or specific etiology. Those that persist or recur require greater attention on the part of the physician and can require psychiatric consultation. The frequency of consultation will depend in large part on the psychosocial sophistication and philosophy of care of the referring physician. When consulted, the child psychiatrist can complement the medical care by examination in greater detail of the psychosocial environment of the child, the family, and by psychiatric evaluation of the child. Formulation of these factors may then point the way to more helpful management of the child and treatment. The most serious problems, such as regional ileitis and ulcerative colitis, require not only collaboration of pediatricians and child psychiatrist, but surgeons as well if patients are to receive optimum care.