Psychosomatic disorder and psychosis

The relationship between schizophrenia and irritable bowel syndrome (IBS)

Irritable bowel syndrome (IBS) has been reported in 10-22% of adults. Amongst patients seeking medical attention for IBS 70-90% may have psychiatric co-morbidity, most commonly major depression. In contrast, few studies have looked at the prevalence of IBS in psychiatric patients. To our knowledge, there are no studies assessing the prevalence of IBS in patients with schizophrenia. Using a semistructured clinical interview to study the prevalence of IBS, we compared 47 patients with schizophrenia to an age-matched control group (n = 40) of patients who were seeking treatment in a primary care physicians office for other medical illnesses. IBS was diagnosed according to the criteria of Drossman et al. Nineteen percent (n = 9) of the patients with schizophrenia met criteria for IBS in contrast to 2.5% (n = 1) of the control group (p = 0.012). Schizophrenic patients seldom complain of gastrointestinal symptoms until specifically asked. Therefore, it may be important to inquire about gastrointestinal symptoms prior to initiating pharmacotherapy in order to differentiate side effects from a prior existing condition. Prospective studies should address the question whether remission of psychosis leads to improvement or resolution of IBS.

Stressors, stress and stress consequences during long-duration manned space missions: a descriptive model

Keeping crew members in good health is a major factor in the success or failure of long-duration manned space missions. Among the many possible agents that can affect the crew's general well-being, stress is certainly one of the most critical because of its implications on human health and performance, both physical and mental. Nevertheless, very few studies have been performed on this fundamental issue and none of them has addressed it in its entirety, considering its diverse physical and psychological aspects. In this work, a descriptive model is proposed to expound the mechanism and sequence of events which mediate stress. A critical analysis of the information provided by past manned spaceflights and by dedicated research performed in analogous environments is presented, and an extrapolation of the available data on human stress in such extreme conditions is proposed. Both internal and external stressors have been identified, at physical and psychosocial levels, thus providing the basis for their early detection and preventive reduction. The possible negative consequences of stress that may lead to disease in crewmembers are described. Finally, the most effective instruments which may be of help in reducing space-related human stress and treating its negative consequences are suggested.

Psychosomatic patients in a psychiatric clinic

This study reports lifetime prevalence of certain "psychosomatic disorders" in psychiatric patients in India. The "psychosomatic disorders" studied were peptic ulcer, bronchial asthma, rheumatoid arthritis, ischemic heart disease and irritable bowel syndrome. One percent of psychiatric patients had these psychosomatic illnesses. Ten of the fifteen cases had two psychosomatic illnesses. Patients with psychosomatic disorders were significantly more often older in age (p = 0.003) and from an urban background (p = 0.05) as compared to other psychiatric patients. Depression was the commonest diagnosis, and was significantly (p = 0.01) more often diagnosed in the psychosomatic patients. Psychosis was not diagnosed in patients with psychosomatic disorders. This article emphasizes the need for identifying concomitant psychosomatic problems in psychiatric patients for their appropriate management.

Chronic pain in a psychiatric clinic

Prevalence rate of chronic pain in a psychiatric outpatient clinic has been evaluated in this study and characteristics of chronic pain patients have been compared with non-pain psychiatric patients. Chronic pain was reported by 14.37% of psychiatric patients. Of these, 43% had dysthymic disorder, 20% had anxiety states and 20% somatoform disorders. As compared to the control group, chronic pain patients belonged more often to the middle age group (p less than 0.05), were more frequently females (p less than 0.001), married (p less than 0.02) and from an urban habitat. There is a marked difference in the diagnostic breakdown between the two groups with a predominance of dysthymic and anxiety disorders in pain patients. Very few chronic pain patients had psychosis. Major depression was found in equal proportions in pain and non-pain patients. The study identifies variables which differentiate chronic pain patients from other psychiatric patients.

Somatic illness in manic-depressive and schizophrenic patients

The study compared the presence of somatic illnesses in manic-depressive (n = 100) and schizophrenic patients (n = 156) in the out-patient psychiatric clinics of three general hospitals. The average age of manic-depressive and schizophrenic patients was 40.7 yr and 39.8 yr respectively and did not differ significantly. The sample consisted of both sexes. Among the manic-depressive patients there were 46 males and 54 females. The schizophrenic sample consisted of 84 (54%) males and 72 (46%) females. The result showed that there was a greater rate of the occurrence of physical illnesses in manic-depressive patients as compared to the schizophrenic patients in respect to all the surveyed systemic disorders except for the gastrointestinal diseases. The cardiovascular, neurological and endocrinological diseases were more frequent in the manic-depressives than in the schizophrenic patients.

Schizophrenia and psychosomatic illness

In order to explore the possibility of a mutually exclusive relationship between schizophrenia and certain psychosomatic disorders, 354 adult schizophrenic patients, both acute and chronic, were studied with regard to lifetime prevalence of peptic ulcer, bronchial asthma, neurodermatitis and rheumatoid arthritis. Significant evidence to support the hypothesis of mutual exclusivity was found only in the case of peptic ulcer in the overall sample. Prevalence was higher in younger, more acute patients than in older, chronic patients, but this finding was difficult to interpret. Parallel enquiry into the prevalence of schizophrenia and the same disorders among close family members of the patients yielded inconclusive results.