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Fresán A, González-Castro TB, Pool-García S, Tovilla-Zárate CA, Sánchez de la Cruz JP, López-Narváez ML, Castillo-Avila RG, Ramos-Méndez MÁ. Chronic Pain and Depression are Increased in Outpatient Adults with Somatic Symptoms from Secondary Health Care Services. Pain Manag Nurs 2023:S1524-9042(23)00032-2. [PMID: 36890094 DOI: 10.1016/j.pmn.2023.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 12/13/2022] [Accepted: 02/11/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Somatic symptom disorder is described as excessive thoughts, feelings, or behaviors related to physical symptoms. The presence of somatic symptoms has been associated with depression, alexithymia, and the presence of chronic pain. Individuals with somatic symptom disorder are frequent attenders of primary health care services. AIM We focused on investigating if the presence of psychological symptoms, alexithymia, or pain could be risk factors for somatic symptoms in a secondary health care service. METHODS A cross-sectional and observational study. A total of 136 Mexican individuals who regularly attend a secondary health care service were recruited. The Visual Analogue Scale for Pain Assessment, the Symptom Checklist 90, and the Patient Health Questionnaire-15 were applied. RESULTS Of all the participants, 45.2% showed somatic symptoms. We observed that these individuals more frequently presented with complaints of pain (χ2 = 18.4, p < .001), as well as more severe (t = -4.6, p < .001), and prolonged (χ2 = 4.9, p = 0.02). They also exhibited higher severity in all psychological dimensions assessed (p < .001). Finally, cardiovascular disease (t = 2.52, p = .01), pain intensity (t = 2.94, p = .005), and SCL-90 depression (t = 7.58, p < .001) were associated with somatic symptoms. CONCLUSIONS In this study, we observed a high frequency of somatic symptoms in outpatients attending secondary health care services. They may be accompanied by comorbid cardiovascular conditions, higher pain intensity, and other mental health-related symptoms, which may aggravate the general clinical picture presented by the patient seeking health care. The presence and severity of somatization should be taken into consideration in the first and second level health care services for an early mental state evaluation and treatment of these outpatients to have a better clinical assessment and health outcome.
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Affiliation(s)
- Ana Fresán
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz, Ciudad de México, México
| | - Thelma Beatriz González-Castro
- Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Jalpa de Méndez, Jalpa de Méndez, Tabasco, México
| | - Sherezada Pool-García
- Hospital General de Comalcalco "Dr. Desiderio G. Rosado Carbajal", Secretaría de Salud, Comalcalco, Tabasco, México
| | - Carlos Alfonso Tovilla-Zárate
- Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Comalcalco, Comalcalco, Tabasco, México.
| | - Juan Pablo Sánchez de la Cruz
- Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Comalcalco, Comalcalco, Tabasco, México
| | - María Lilia López-Narváez
- Hospital Chiapas Nos Une Dr. Gilberto Gómez Maza, Secretaría de Salud de Chiapas, Tuxtla Gutiérrez, Chiapas, México
| | - Rosa Giannina Castillo-Avila
- Universidad Juárez Autónoma de Tabasco, División Académica de Ciencias de la Salud, Villahermosa, Tabasco, México
| | - Miguel Ángel Ramos-Méndez
- Universidad Juárez Autónoma de Tabasco, División Académica de Ciencias de la Salud, Villahermosa, Tabasco, México
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Creed F. Risk Factors for Self-reported Irritable Bowel Syndrome With Prior Psychiatric Disorder: The Lifelines Cohort Study. J Neurogastroenterol Motil 2022; 28:442-453. [PMID: 35799238 PMCID: PMC9274465 DOI: 10.5056/jnm21041] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 08/15/2021] [Accepted: 11/24/2021] [Indexed: 11/25/2022] Open
Abstract
Background/Aims The role of psychiatric disorder in irritable bowel syndrome (IBS) is not clear. This study aims to assess whether individuals who have psychiatric disorder prior to IBS onset differ in their risk factors from the remainder. Methods The prospective, population-based Lifelines cohort study includes 132 922 adults without prior IBS or taking IBS medication at baseline. Baseline data included socio-demographic status, physical and psychiatric disorders, psycho-social and behavioral variables. At follow-up (mean 2.4 years later) new onsets of IBS were recorded by self-report. The predictors of new onsets of IBS were assessed using logistic regression; participants with and without prior psychiatric disorders were analyzed separately. Results At follow-up 1507 (1.1%) participants reported new onset IBS. Of these, 27% reported prior psychiatric disorder. Predictors of IBS in this group were 2 or more psychiatric disorders (OR, 2.74; 95% CI, 1.3-5.6), female sex, proton pump inhibitors, numerous bodily symptoms, impaired sleep, low BMI and negative health perception. These variables, except psychiatric disorders and BMI, also predicted IBS in those without prior psychiatric disorder but, in this group, gallstones, asthma, fibromyalgia, reported allergies, impairment through bodily pain, and frequent healthcare were also predictors. Conclusions Despite its limitations this study suggests that prior psychiatric disorder is an important risk factor in a quarter of IBS onsets. Negative health perception and multiple bodily symptoms are associated with all IBS onsets in line with the cognitive-behavior model of IBS. Prior psychiatric disorder may predict an optimal response to psychiatric treatment. Further studies could usefully study mechanisms linking IBS to prior psychiatric disorder.
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Affiliation(s)
- Francis Creed
- Neuroscience and Mental Health, University of Manchester, UK
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3
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Maroti D, Ek J, Widlund RM, Schubiner H, Lumley MA, Lilliengren P, Bileviciute-Ljungar I, Ljótsson B, Johansson R. Internet-Administered Emotional Awareness and Expression Therapy for Somatic Symptom Disorder With Centralized Symptoms: A Preliminary Efficacy Trial. Front Psychiatry 2021; 12:620359. [PMID: 33679478 PMCID: PMC7928393 DOI: 10.3389/fpsyt.2021.620359] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/20/2021] [Indexed: 01/04/2023] Open
Abstract
Background: There is growing evidence that trauma, psychosocial conflict, and difficulties with emotional processing contribute to centralized somatic symptoms. Emotional Awareness and Expression Therapy (EAET) was developed to address these factors and reduce symptoms, and EAET has shown efficacy in face-to-face formats. No trial of an internet-delivered EAET (I-EAET) exists, however, so we developed such an intervention and conducted an uncontrolled feasibility and potential efficacy trial of I-EAET for patients with Somatic Symptom Disorder (SSD) with centralized symptoms (SSD-CS). Method: After screening potential participants, a sample of 52 patients (50 women, two men; age M = 49.6, SD = 11.9) diagnosed with SSD-CS initiated treatment. I-EAET consisted of nine weekly modules focused on psychoeducation, emotional awareness and exposure, and anxiety regulation with self-compassion. Therapists communicated with each patient by email for about 20 min per week during treatment, answering questions and giving feedback on homework assignments. Patients completed measures of somatic symptoms, depression, anxiety, trauma-related symptoms, and functional disability before treatment and again at post-treatment and 4-month follow-up. Results: A large reduction in somatic symptoms (PHQ-15) occurred pre-to post-treatment (d = 1.13; 95% CI: 0.84-1.47) which was fully maintained at 4-month follow-up (d = 1.19; 95% CI: 0.88-1.56). Twenty-three percent of the patients at post-treatment and 27% at follow-up achieved a 50% or greater reduction in somatic symptoms, and about 70% achieved a minimally important clinical difference. In addition, at post-treatment, there were small to medium reductions (d's from 0.33 to 0.72) in anxiety (GAD-7), depression (PHQ-9), trauma-related symptoms (PCL-5), and functional disability (Sheehan Disability Scale). For all of these secondary outcomes, improvements were slightly to substantially larger at follow-up than at post-treatment (d's from 0.46 to 0.80). Conclusion: I-EAET appears to be a feasible treatment for adults with SSD and centralized symptoms, resulting in substantial and durable improvement not only in somatic symptoms but in other psychiatric symptoms and functioning. Controlled trials are needed determine the effects of I-EAET specifically and how this approach compares to face-to-face EAET and to other internet-delivered treatments, such as cognitive-behavioral interventions. Research should also identify treatment responders and mechanisms of change in EAET. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT04122846.
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Affiliation(s)
- Daniel Maroti
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Josefine Ek
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | | | - Howard Schubiner
- Department of Internal Medicine, Ascension Providence-Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI, United States
| | - Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, MI, United States
| | - Peter Lilliengren
- Department of Health Care Sciences, St. Lukas Educational Institute, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Indre Bileviciute-Ljungar
- Department of Clinical Sciences, Karolinska Institutet and Multidisciplinary Pain Unit, St Göran Hospital, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Robert Johansson
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Psychology, Stockholm University, Stockholm, Sweden
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4
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Zamani M, Alizadeh-Tabari S, Zamani V. Systematic review with meta-analysis: the prevalence of anxiety and depression in patients with irritable bowel syndrome. Aliment Pharmacol Ther 2019; 50:132-143. [PMID: 31157418 DOI: 10.1111/apt.15325] [Citation(s) in RCA: 216] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/25/2019] [Accepted: 05/08/2019] [Indexed: 12/09/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a common and potential disabling functional gastrointestinal disorder. Studies have revealed a possible association between IBS and psychological problems, such as anxiety and depression. Existing systematic reviews have addressed only the levels of anxiety or depression in patients with IBS. AIM To investigate systematically the prevalence of anxiety or depression in IBS patients METHODS: A literature search was conducted using the related keywords from the bibliographic databases of Embase, PubMed, Scopus, Web of Science and POPLINE published until 1 January 2019 with no language restriction. Studies reporting the prevalence of anxiety/depressive symptoms/disorders in adult (≥15 years) IBS patients were evaluated. The pooled prevalence, odds ratio (OR) and 95% CI were calculated using stata software. RESULTS A total of 14 926 articles were initially screened, and finally 73 papers were included. The prevalence rates of anxiety symptoms and disorders in IBS patients were 39.1% (95% CI: 32.4-45.8) and 23% (95% CI: 17.2-28.8) respectively. The ORs for anxiety symptoms and disorders in IBS patients compared with healthy subjects were 3.11 (95% CI: 2.43-3.98) and 2.52 (95% CI: 1.99-3.20) respectively. The prevalence estimates of depressive symptoms and disorders in IBS patients were 28.8% (95% CI: 23.6-34) and 23.3% (95% CI: 17.2-29.4) respectively. The ORs for depressive symptoms and disorders in IBS patients compared to healthy subjects were 3.04 (95% CI: 2.37-3.91) and 2.72 (95% CI: 2.45-3.02) respectively. CONCLUSION Patients with IBS have a three-fold increased odds of either anxiety or depression, compared to healthy subjects.
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Affiliation(s)
- Mohammad Zamani
- Student Research Committee, School of Medicine, Babol University of Medical Sciences, Babol, Iran.,Cancer Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | | | - Vahid Zamani
- Vice-Chancellery for Health, Babol University of Medical Sciences, Babol, Iran
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5
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Daphna-Tekoah S, Lev-Wiesel R, Israeli D, Balla U. A Novel Screening Tool for Assessing Child Abuse: The Medical Somatic Dissociation Questionnaire-MSDQ. JOURNAL OF CHILD SEXUAL ABUSE 2019; 28:526-543. [PMID: 30893027 DOI: 10.1080/10538712.2019.1581868] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 11/20/2018] [Accepted: 12/19/2018] [Indexed: 06/09/2023]
Abstract
Somatic dissociation is known to be associated with childhood abuse, particularly with childhood sexual abuse (CSA). Currently, the diagnosis of CSA is hampered by the lack of a validated questionnaire. While some questionnaires are excellent research tools, there is no suitable applied measure for the assessment of distress due to CSA. The current study's objective was to validate a novel questionnaire, designated the Medical Somatic Dissociation Questionnaire-MSDQ, for evaluating somatic dissociation in the healthcare system setting. A total of 541 adults, 160 (30%) male and 381 (70%) female, of average age 35 years were recruited from the general population via the Internet. The Life Events Checklist for DSM-5 (LEC-5) was used for screening subjects for reporting a history of CSA. Our examination of the MSDQ indicated powerful internal consistency, reliability, and convergent validity of the instrument, with high correlations between the MSDQ and the SDQ-20 and also between the MSDQ and psychological symptomatology. In addition, there was known-groups validity when differences between adults who experienced CSA and those who did not were compared. Importantly, the MSDQ can be easily integrated into the evaluation process performed by medical professionals in the diagnosis of adult patients with apparently unexplained symptomatology.
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Affiliation(s)
- Shir Daphna-Tekoah
- a Kaplan Medical Center , Rehovot , Israel
- b Faculty of Social-Work , Ashkelon Academic College , Ashkelon, Israel
- c Emili Sagol Creative Arts Therapies Research Center , Mount Carmel , Haifa , Israel
| | - Rachel Lev-Wiesel
- c Emili Sagol Creative Arts Therapies Research Center , Mount Carmel , Haifa , Israel
| | - David Israeli
- a Kaplan Medical Center , Rehovot , Israel
- d Faculty of Medicine , The Hebrew University , Jerusalem, Israel
| | - Uri Balla
- a Kaplan Medical Center , Rehovot , Israel
- c Emili Sagol Creative Arts Therapies Research Center , Mount Carmel , Haifa , Israel
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Boeckxstaens GE, Drug V, Dumitrascu D, Farmer AD, Hammer J, Hausken T, Niesler B, Pohl D, Pojskic L, Polster A, Simren M, Goebel-Stengel M, Van Oudenhove L, Vassallo M, Wensaas KA, Aziz Q, Houghton LA. Phenotyping of subjects for large scale studies on patients with IBS. Neurogastroenterol Motil 2016; 28:1134-47. [PMID: 27319981 DOI: 10.1111/nmo.12886] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 05/17/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a complex condition with multiple factors contributing to its aetiology and pathophysiology. Aetiologically these include genetics, life-time events and environment, and physiologically, changes in motility, central processing, visceral sensitivity, immunity, epithelial permeability and gastrointestinal microflora. Such complexity means there is currently no specific reliable biomarker for IBS, and thus IBS continues to be diagnosed and classified according to symptom based criteria, the Rome Criteria. Carefully phenotyping and characterisation of a 'large' pool of IBS patients across Europe and even the world however, might help identify sub-populations with accuracy and consistency. This will not only aid future research but improve tailoring of treatment and health care of IBS patients. PURPOSE The aim of this position paper is to discuss the requirements necessary to standardize the process of selecting and phenotyping IBS patients and how to organise the collection and storage of patient information/samples in such a large multi-centre pan European/global study. We include information on general demographics, gastrointestinal symptom assessment, psychological factors, quality of life, physiological evaluation, genetic/epigenetic and microbiota analysis, biopsy/blood sampling, together with discussion on the organisational, ethical and language issues associated with implementing such a study. The proposed approach and documents selected to be used in such a study was the result of a thoughtful and thorough four-year dialogue amongst experts associated with the European COST action BM1106 GENIEUR (www.GENIEUR.eu).
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Affiliation(s)
- G E Boeckxstaens
- Translational Research Center for Gastrointestinal Disorders, KULeuven & Department of Gastroenterology and Hepatology, University Hospital Leuven, Leuven, Belgium
| | - V Drug
- Gastroenterology Department, University Hospital "St Spiridon", Gr. T.Popa University of Medicine and Pharmacy, Iasi, Romania
| | - D Dumitrascu
- 2nd Medical Dept., Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - A D Farmer
- Wingate Institute of Neurogastroenterology, Barts and The London School of Medicine and Dentistry, London, UK.,Department of Gastroenterology, University Hospitals of North Midlands, Stoke on Trent, UK
| | - J Hammer
- Medizinische Universität Wien, Universitätsklinik für Innere Medizin 3, Vienna, Austria
| | - T Hausken
- Department of Medicine, Unit of Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - B Niesler
- Department of Human Molecular Genetics, University of Heidelberg, Heidelberg, Germany
| | - D Pohl
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - L Pojskic
- Institute for Genetic Engineering and Biotechnology, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - A Polster
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M Simren
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Goebel-Stengel
- Department of Internal Medicine, Martin-Luther-Krankenhaus, Berlin, Germany
| | - L Van Oudenhove
- Translational Research Center for Gastrointestinal Disorders, KULeuven & Department of Gastroenterology and Hepatology, University Hospital Leuven, Leuven, Belgium
| | - M Vassallo
- Department of Medicine, Mater Dei Hospital, Tal-Qroqq, Malta
| | - K-A Wensaas
- Uni Research Health, Research Unit for General Practice, Bergen, Norway
| | - Q Aziz
- Wingate Institute of Neurogastroenterology, Barts and The London School of Medicine and Dentistry, London, UK
| | - L A Houghton
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds and Leeds Gastroenterology Institute, Leeds Teaching Hospitals Trust, Leeds, UK.,Centre for Gastrointestinal Sciences, University of Manchester, Manchester, UK.,Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
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7
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Keightley P, Pavli P, Platten J, Looi JC. Gut feelings 1. Mind, mood and gut in irritable bowel syndrome: approaches to psychiatric care. Australas Psychiatry 2015; 23:403-6. [PMID: 26148736 DOI: 10.1177/1039856215590033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Psychiatrists are likely to encounter patients with irritable bowel syndrome (IBS). We aim to provide a clinically-focused summary of psychiatric comorbidities and management. CONCLUSIONS IBS affects up to 15% of the population. Antidepressants and brief psychotherapy can reduce symptom severity and improve coping. These treatments are effective for patients without comorbid mental illness, as well as those with increased somatisation, health-care seeking and sexual abuse histories.
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Affiliation(s)
- Philip Keightley
- Psychiatry Advanced Trainee, Gastroenterology and Hepatology Unit, Canberra Hospital, Garran, ACT, and; Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Garran, ACT, Australia
| | - Paul Pavli
- Senior Specialist, Gastroenterology and Hepatology Unit, Canberra Hospital, Garran, ACT, and; Professor, Australian National University Medical School, Canberra, ACT, Australia
| | - Jan Platten
- Clinical Nurse Consultant Inflammatory Bowel Disease, Gastroenterology and Hepatology Unit, Canberra Hospital, Garran, ACT, Australia
| | - Jeffrey Cl Looi
- Associate Professor and Senior Staff Specialist Neuropsychiatrist, Deputy Head Academic Unit Psychiatry and Addiction Medicine, Australian National University Medical School, Garran, ACT, Australia
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8
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Kennedy PJ, Clarke G, O‘Neill A, Groeger JA, Quigley EMM, Shanahan F, Cryan JF, Dinan TG. Cognitive performance in irritable bowel syndrome: evidence of a stress-related impairment in visuospatial memory. Psychol Med 2014; 44:1553-1566. [PMID: 23985155 PMCID: PMC3967841 DOI: 10.1017/s0033291713002171] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 07/30/2013] [Accepted: 08/04/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Central nervous system (CNS) dysfunction is a prominent feature of the functional gastrointestinal (GI) disorder, irritable bowel syndrome (IBS). However, the neurobiological and cognitive consequences of key pathophysiological features of IBS, such as stress-induced changes in hypothalamic-pituitary-adrenal (HPA)-axis functioning, is unknown. Our aim was to determine whether IBS is associated with cognitive impairment, independently of psychiatric co-morbidity, and whether cognitive performance is related to HPA-axis function. METHOD A cross-sectional sample of 39 patients with IBS, a disease control group of 18 patients with Crohn's disease (CD) in clinical remission and 40 healthy age- and IQ-matched control participants were assessed using the Paired Associates Learning (PAL), Intra-Extra Dimensional Set Shift (IED) and Spatial Working Memory (SWM) tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) and a computerized Stroop test. HPA-axis function was determined by measuring the cortisol awakening response (CAR). RESULTS IBS patients exhibited a subtle visuospatial memory deficit at the PAL six- pattern stage (p = 0.03), which remained after psychiatric co-morbidity was controlled for (p = 0.04). Morning cortisol levels were lower in IBS (p = 0.04) and significantly associated with visuospatial memory performance within IBS only (p = 0.02). CONCLUSIONS For the first time, altered cognitive function on a hippocampal-mediated test of visuospatial memory, which was related to cortisol levels and independent of psychiatric co-morbidity, has been identified in IBS. Visuospatial memory impairment may be a common, but currently neglected, component of IBS. Further elucidation of the nature of this impairment may lead to a greater understanding of the underlying pathophysiology of IBS, and may provide novel therapeutic approaches.
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Affiliation(s)
- P. J. Kennedy
- Alimentary Pharmabiotic Centre, University College Cork, Ireland
- Department of Psychiatry, University College Cork, Ireland
| | - G. Clarke
- Alimentary Pharmabiotic Centre, University College Cork, Ireland
- Department of Psychiatry, University College Cork, Ireland
| | - A. O‘Neill
- Alimentary Pharmabiotic Centre, University College Cork, Ireland
| | | | - E. M. M. Quigley
- Alimentary Pharmabiotic Centre, University College Cork, Ireland
- Department of Medicine, University College Cork, Ireland
| | - F. Shanahan
- Alimentary Pharmabiotic Centre, University College Cork, Ireland
- Department of Medicine, University College Cork, Ireland
| | - J. F. Cryan
- Alimentary Pharmabiotic Centre, University College Cork, Ireland
- Department of Anatomy and Neuroscience, University College Cork, Ireland
| | - T. G. Dinan
- Alimentary Pharmabiotic Centre, University College Cork, Ireland
- Department of Psychiatry, University College Cork, Ireland
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Ljótsson B, Andersson E, Lindfors P, Lackner JM, Grönberg K, Molin K, Norén J, Romberg K, Andersson E, Hursti T, Hesser H, Hedman E. Prediction of symptomatic improvement after exposure-based treatment for irritable bowel syndrome. BMC Gastroenterol 2013; 13:160. [PMID: 24245807 PMCID: PMC3840657 DOI: 10.1186/1471-230x-13-160] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 11/14/2013] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Several studies show that psychological treatments relieve symptoms for patients suffering from irritable bowel syndrome (IBS). However, there are no consistent findings that show what patient characteristics make a psychological treatment more or less likely to result in improvement. We have previously conducted a study of a newly developed internet-delivered cognitive behavioral therapy (ICBT) that emphasized exposure to IBS symptoms and IBS-related situations and reduced symptom-related avoidance. The study showed that the treatment led to improvement in IBS symptoms compared to a waiting list and that treatment gains were maintained over a 15-18 month follow-up period. The aim of the present study was to investigate several possible predictors of short- and long-term treatment outcome in terms of symptom improvement, based on data collected in the previously conducted treatment trial. METHODS Demographics, comorbid psychological distress, IBS-related fear and avoidance behaviors, and IBS-related disability were investigated as predictors of treatment outcome in the sample consisting of 79 participants diagnosed with IBS who had undergone 10 weeks of ICBT. Predictors that were significantly correlated with symptom levels at post-treatment and follow-up were entered into multiple regression analyses that controlled for pre-treatment symptom levels. RESULTS There were measures within each domain, i.e., comorbid psychological distress, IBS-related fear and avoidance behaviors, and IBS-related disability, with the exception of demographic data, that were correlated with the symptom levels at post-treatment and follow-up. However, when these were entered into a multiple regression analyses that controlled for pre-treatment levels, none remained a significant predictor of the post-treatment and follow-up symptomatic status. CONCLUSIONS The study did not find any individual characteristics that made patients more or less likely to respond to the exposure-based ICBT. The finding that comorbid psychological distress did not predict outcome is in accordance with previous studies. Reliable predictors for response to any type of psychological treatment for IBS remain to be established.
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Affiliation(s)
- Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, Stockholm 171 65, Sweden.
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Phillips K, Wright BJ, Kent S. Psychosocial predictors of irritable bowel syndrome diagnosis and symptom severity. J Psychosom Res 2013; 75:467-74. [PMID: 24182637 DOI: 10.1016/j.jpsychores.2013.08.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 08/01/2013] [Accepted: 08/02/2013] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This study explored the role of psychosocial factors in predicting both membership to either an irritable bowel syndrome (IBS) or control group, and the severity of IBS symptoms. METHODS A total of 149 participants (82 IBS and 67 controls) completed a battery of self-report inventories assessing disposition and environment, cognitive processes, and psychological distress. Logistic regression analyses were used to assess predictive contribution of psychosocial variables to IBS diagnosis. Hierarchical linear regression was then used to assess the relationship of psychosocial variables with the severity of IBS symptoms. RESULTS Significant predictors of IBS were found to be alexithymia, the defectiveness/shame schema, and four coping dimensions (active coping, instrumental support, self-blame, and positive reframing), χ(2) (6, N=130)=46.99, p<.001, with predictive accuracy of 72%. Significant predictors of IBS symptom severity were two of the alexithymia subscales (difficulty identifying feelings, and difficulty describing feelings), gender, the schemas of defectiveness/shame and entitlement, and global psychological distress. This model predicted IBS severity F (6, 64)=16.94, p<.001 and accounted for 61.3% of the variability in IBS severity scores. CONCLUSION Psychosocial variables account for a large percentage of the differences between an IBS and control group, as well as the variance of symptoms experienced within the IBS group. Alexithymia and the defectiveness schema appear to be related to both IBS and symptom severity.
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Affiliation(s)
- Kristy Phillips
- School of Psychological Science, La Trobe University, Melbourne, Australia
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Williams AE, Czyzewski DI, Self MM, Shulman RJ. Are child anxiety and somatization associated with pain in pain-related functional gastrointestinal disorders? J Health Psychol 2013; 20:369-79. [PMID: 24155191 DOI: 10.1177/1359105313502564] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
This study investigated individual and incremental contributions of somatization and trait anxiety to pain report in children with pain-related functional gastrointestinal disorders. Eighty children (7-10 years) with pain-related functional gastrointestinal disorders completed the State-Trait Anxiety Inventory for Children, the Children's Somatization Inventory, and 2-week pain diaries (assessing pain frequency and maximum pain). Hierarchical regressions indicated that both trait anxiety and somatization were significantly related to maximum pain and pain frequency, with somatization explaining more variance. Trait anxiety did not significantly add to prediction above somatization. Assessment of somatization may assist with treatment planning for children with functional abdominal pain.
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Affiliation(s)
| | | | - Mariella M Self
- Baylor College of Medicine, USA Texas Children's Hospital, USA
| | - Robert J Shulman
- Baylor College of Medicine, USA Texas Children's Hospital, USA Children's Nutrition Research Center, USA
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12
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Naliboff BD, Fresé MP, Rapgay L. Mind/Body psychological treatments for irritable bowel syndrome. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 5:41-50. [PMID: 18317547 PMCID: PMC2249749 DOI: 10.1093/ecam/nem046] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Accepted: 04/04/2007] [Indexed: 12/15/2022]
Abstract
Currently, the goal of treatment for those with irritable bowel syndrome (IBS) is to improve the quality of life through a reduction in symptoms. While the majority of treatment approaches involve the use of traditional medicine, more and more patients seek out a non-drug approach to managing their symptoms. Current forms of non-drug psychologic or mind/body treatment for IBS include hypnotherapy, cognitive behavioral therapy and brief psychodynamic psychotherapy, all of which have been proven efficacious in clinical trials. We propose that incorporating the constructs of mindfulness and acceptance into a mind/body psychologic treatment of IBS may be of added benefit due to the focus on changing awareness and acceptance of one's own state which is a strong component of traditional and Eastern healing philosophies.
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Affiliation(s)
- Bruce D Naliboff
- UCLA Center for Neurovisceral Sciences and Women's Health, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA and Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Kapfhammer HP. [Psychopharmacological treatment in patients with somatoform disorders and functional body syndromes]. DER NERVENARZT 2013; 83:1128-41. [PMID: 22895795 DOI: 10.1007/s00115-011-3446-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Somatoform disorders and functional body syndromes define a major, diagnostically heterogeneous group of patients with medically unexplained physical symptoms. Psychopharmacological approaches can be derived from the conceptualization of somatoform symptoms and syndromes within a biopsychosocial model. The survey presented focuses on randomized, double-blind and placebo-controlled studies. Antidepressants show a statistically and clinically relevant impact on many somatoform symptoms. In special reference to pain symptoms serotonergic and noradrenergic antidepressants seem to mediate a more favorable effect than selective serotonin reuptake inhibitors. For some functional body syndromes, e.g. irritable bowel syndrome and fibromyalgia, a major analgesic effect of antidepressants can be underlined as well. The empirical data for fibromyalgia, however, seem to be more convincing than for irritable bowel syndrome. Pregabalin holds an empirically well established position in the treatment of fibromyalgia. As yet there is no convincing psychopharmacological strategy for chronic fatigue syndrome. Probably due to the inherent relationships to anxiety, obsessive-compulsive and depressive disorders, both hypochondria and body dysmorphic disorder can be positively treated by serotonergic antidepressants as well.
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Affiliation(s)
- H P Kapfhammer
- Klinik für Psychiatrie, Medizinische Universität Graz, Auenbruggerplatz 31, 8036 Graz, Österreich.
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Dekel R, Drossman DA, Sperber AD. The use of psychotropic drugs in irritable bowel syndrome. Expert Opin Investig Drugs 2013; 22:329-39. [PMID: 23316916 DOI: 10.1517/13543784.2013.761205] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Irritable bowel syndrome (IBS), the most common functional gastrointestinal disorder, is manifested by chronic abdominal pain associated with irregular bowel movements. Although not life threatening, IBS is associated with impaired quality of life that ranges from mild to severe. AREAS COVERED The pathogenesis of IBS is not completely understood, but involves dysfunction of the "brain-gut axis" including peripheral visceral hypersensitivity and central maladaptive processing of visceral pain input. Stress and concomitant psychopathologies such as somatization, anxiety and depression are thought to play a major role in the development, clinical course and response to treatment. Psychopharmacological agents such as selective serotonin/serotonin-norepinephrine receptor antagonists, tricyclic antidepressants as well as other agents are commonly used in treating moderate to severe IBS. This review will provide the pathophysiological rationale for the use of psychopharmacological agents in IBS, review the main classes of drugs and evidence for their use in IBS and offer a practical approach to the use of these drugs. EXPERT OPINION Psychotropic drugs can play a pivotal role in the treatment of IBS patients, so doctors should be familiar with their use. Further research with these drugs is needed to solidify our current knowledge and increase our therapeutic options.
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Affiliation(s)
- Roy Dekel
- Tel Aviv Medical Center, Gastroenterology, Tel Aviv, Israel.
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15
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Clauwaert N, Jones MP, Holvoet L, Vandenberghe J, Vos R, Tack J, Van Oudenhove L. Associations between gastric sensorimotor function, depression, somatization, and symptom-based subgroups in functional gastroduodenal disorders: are all symptoms equal? Neurogastroenterol Motil 2012; 24:1088-e565. [PMID: 22816492 DOI: 10.1111/j.1365-2982.2012.01985.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Previous work indicated that psychosocial factors (depression and somatization) are more strongly associated with symptom severity and weight loss in functional dyspepsia (FD) than gastric sensorimotor function. However, there is conflicting evidence regarding the association of these etiopathogenetic factors with Rome III symptom-based subgroups in FD [epigastric pain syndrome (EPS), postprandial distress syndrome (PDS)]. We aimed to test whether gastric sensitivity and emptying, depression, and somatization are differentially associated with empirically derived functional gastroduodenal disorders (FGD) symptom factors in one comprehensive model. METHODS In 259 tertiary care FD patients, we studied gastric sensorimotor function with barostat and gastric emptying breath test. Depression, somatization, and FGD symptoms were measured using self-report questionnaires. Confirmatory factor analysis (CFA) on 7 FGD symptoms was used to determine the fit of a latent variable structure based on Rome III symptom-based subgroups. Structural equation modeling (SEM) was used to test the putative relationships of the symptom factors with gastric sensorimotor function, depression, and somatization. KEY RESULTS The results of the CFA show a good fit [C(min) /DF = 1.54, CFI(comparative fit index) = 0.97] for the three-factor solution based on Rome III subgroups. The SEM also fitted the data well (C(min) /DF = 1.24, CFI = 0.98) and demonstrated that gastric sensitivity and depression are associated with PDS and nausea and vomiting. Gastric emptying is uniquely associated with EPS and somatization is strongly associated with all three symptom factors. CONCLUSIONS & INFERENCES Confirmatory factor analysis confirms the existence of three FGD symptom factors, corresponding to Rome III symptom-based subgroups. The SEM results suggest that different psychobiological mechanisms may play a role in these subgroups.
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Affiliation(s)
- N Clauwaert
- Child and Adolescent Psychiatry, University Psychiatric Centre, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
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Surdea-Blaga T, Băban A, Dumitrascu DL. Psychosocial determinants of irritable bowel syndrome. World J Gastroenterol 2012; 18:616-26. [PMID: 22363132 PMCID: PMC3281218 DOI: 10.3748/wjg.v18.i7.616] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 09/22/2011] [Accepted: 01/18/2012] [Indexed: 02/06/2023] Open
Abstract
From a pure motor disorder of the bowel, in the past few years, irritable bowel syndrome (IBS) has become a multifactorial disease that implies visceral hypersensitivity, alterations at the level of nervous and humoral communications between the enteric nervous system and the central nervous system, alteration of the gut microflora, an increased intestinal permeability and minimum intestinal inflammation. Psychological and social factors can interfere with the communication between the central and enteric nervous systems, and there is proof that they are involved in the onset of IBS and influence the response to treatment and outcome. There is evidence that abuse history and stressful life events are involved in the onset of functional gastrointestinal disorders. In order to explain clustering of IBS in families, genetic factors and social learning mechanisms have been proposed. The psychological features, such as anxiety, depression as well as the comorbid psychiatric disorders, health beliefs and coping of patients with IBS are discussed in relation to the symptoms and outcome.
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Schröder A, Oernboel E, Licht RW, Sharpe M, Fink P. Outcome measurement in functional somatic syndromes: SF-36 summary scores and some scales were not valid. J Clin Epidemiol 2012; 65:30-41. [DOI: 10.1016/j.jclinepi.2011.03.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 03/14/2011] [Accepted: 03/22/2011] [Indexed: 01/01/2023]
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Reme SE, Stahl D, Kennedy T, Jones R, Darnley S, Chalder T. Mediators of change in cognitive behaviour therapy and mebeverine for irritable bowel syndrome. Psychol Med 2011; 41:2669-2679. [PMID: 21477419 DOI: 10.1017/s0033291711000328] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cognitive behaviour therapies (CBTs) have through several trials been demonstrated to reduce symptoms and disability in irritable bowel syndrome (IBS) patients, but the mechanisms responsible for the changes are still unknown. The aim of this study was to test a theoretical model of CBT and investigate if cognitions and/or behaviour mediated the changes seen in CBT for IBS. METHOD To assess for possible mediating effects, we applied path analysis to the dataset of 149 diagnosed participants randomized to mebeverine hydrochloride plus CBT or mebeverine hydrochloride alone. Primary outcome was symptom severity, while secondary outcomes were work and social adjustment and anxiety. RESULTS The path analyses supported mediational paths for all outcomes. Changes in behaviour and cognitions mediated all three outcomes, with models placing behaviour change 'upstream' of cognition change having best fit. The analyses of model fits revealed best fit for the anxiety model and hence provide increased confidence in the causal model of anxiety. CONCLUSIONS Changes in behaviour and cognitions mediate the change in CBT given to IBS patients. The results strengthen the validity of a theoretical model of CBT by confirming the interaction of cognitive, emotional and behavioural factors in IBS.
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Affiliation(s)
- S E Reme
- Department of Psychological Medicine, and Department of Primary Care, King's College Hospital, London.
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19
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Functional somatic syndromes and somatoform disorders in special psychosomatic units: organizational aspects and evidence-based treatment. Psychiatr Clin North Am 2011; 34:673-87. [PMID: 21889686 DOI: 10.1016/j.psc.2011.05.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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20
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Van Oudenhove L, Holvoet L, Vandenberghe J, Vos R, Tack J. Do we have an alternative for the Rome III gastroduodenal symptom-based subgroups in functional gastroduodenal disorders? A cluster analysis approach. Neurogastroenterol Motil 2011; 23:730-8. [PMID: 21447145 DOI: 10.1111/j.1365-2982.2011.01703.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Functional dyspepsia (FD) is a heterogeneous biopsychosocial disorder. The Rome III consensus proposed a subdivision into epigastric pain syndrome and postprandial distress syndrome, based on gastroduodenal symptom pattern only; nausea/vomiting- and belching disorders were classified as separate functional gastroduodenal disorders (FGD). We aimed to investigate an alternative subdivision of FGD, taking into account gastric sensorimotor function, anxiety & depression and 'somatization', besides gastroduodenal symptoms. METHODS Gastroduodenal symptom data were available for 857 consecutive FGD patients (Rome II criteria). In a subsample (n=259), additional data were obtained on gastric sensitivity, anxiety, depression and 'somatization'. Two separate cluster analyses were performed. In analysis 1, clustering was based on individual gastroduodenal symptom scores. In analysis 2, gastric sensitivity, anxiety & depression and 'somatization', besides total gastroduodenal symptoms score, were used for clustering. KEY RESULTS Analysis 1 identified four clusters, largely supporting the Rome III classification, with early satiation, pain and nausea/vomiting clusters, besides a limited severity cluster (R(2) = 0.32). Analysis 2 suggested a five-cluster solution (R(2) = 0.48). Anxiety, depression and 'somatization' were the most important variables separating the clusters. 'Primary somatization' (with low psychiatric symptom levels) as well as 'secondary somatization' (with high anxiety & depression scores) subgroups were identified, besides three other subgroups characterized by psychiatric/gastroduodenal symptoms, mild anxiety symptoms and limited overall severity, respectively. CONCLUSIONS & INFERENCES We propose an alternative to the current subgrouping in FGD that is exclusively based on gastroduodenal symptoms. This may have consequences for future classification of FGD, as well as broader relevance towards the debate on subgrouping 'functional somatic syndromes'.
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Affiliation(s)
- L Van Oudenhove
- Department of Pathophysiology, Gastroenterology Section, University of Leuven, Herestraat 49, Leuven, Belgium.
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Austin PD, Henderson SE. Biopsychosocial assessment criteria for functional chronic visceral pain: a pilot review of concept and practice. PAIN MEDICINE 2010; 12:552-64. [PMID: 21143765 DOI: 10.1111/j.1526-4637.2010.01025.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
UNLABELLED Functional chronic visceral pain (FCVP) is one of the most common causes of morbidity in the general population. Pain perceived within the abdomen may occur due to a range of different mechanisms according to the organ and their afferent pathways. Advances in our understanding of the complexities of FCVP could lead to the exploitation of contemporary research in order to develop and utilize our understanding of neurobiological and psychobiological visceral mechanisms in a clinical setting. This progression, together with increasing amounts of epidemiological and gender based information concerning specific abdominal pain syndromes can allow us to develop assessment tools that go beyond disease only analysis and move toward a more comprehensive assessment model so that patients may have access to expert or multidisciplinary management sooner, rather than later. Based on current evidence, one must consider the main contributors to pain, whether it is nociceptive, neuropathic or psychosocial or as is common with FCVP, a combination of all three. AIM This comprehensive assessment model should encompass not only systematic evaluation for reliable communication, but should also progress toward idiographic diagnosis relating to the uniqueness of the patient. This model should be practical in a multidisciplinary setting, taking into account the multi-faceted nature of this presentation.
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Affiliation(s)
- Philip D Austin
- College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK.
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22
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Gwee KA, Bak YT, Ghoshal UC, Gonlachanvit S, Lee OY, Fock KM, Chua ASB, Lu CL, Goh KL, Kositchaiwat C, Makharia G, Park HJ, Chang FY, Fukudo S, Choi MG, Bhatia S, Ke M, Hou X, Hongo M. Asian consensus on irritable bowel syndrome. J Gastroenterol Hepatol 2010; 25:1189-205. [PMID: 20594245 DOI: 10.1111/j.1440-1746.2010.06353.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIMS Many of the ideas on irritable bowel syndrome (IBS) are derived from studies conducted in Western societies. Their relevance to Asian societies has not been critically examined. Our objectives were to bring to attention important data from Asian studies, articulate the experience and views of our Asian experts, and provide a relevant guide on this poorly understood condition for doctors and scientists working in Asia. METHODS A multinational group of physicians from Asia with special interest in IBS raised statements on IBS pertaining to symptoms, diagnosis, epidemiology, infection, pathophysiology, motility, management, and diet. A modified Delphi approach was employed to present and grade the quality of evidence, and determine the level of agreement. RESULTS We observed that bloating and symptoms associated with meals were prominent complaints among our IBS patients. In the majority of our countries, we did not observe a female predominance. In some Asian populations, the intestinal transit times in healthy and IBS patients appear to be faster than those reported in the West. High consultation rates were observed, particularly in the more affluent countries. There was only weak evidence to support the perception that psychological distress determines health-care seeking. Dietary factors, in particular, chili consumption and the high prevalence of lactose malabsorption, were perceived to be aggravating factors, but the evidence was weak. CONCLUSIONS This detailed compilation of studies from different parts of Asia, draws attention to Asian patients' experiences of IBS.
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Affiliation(s)
- Kok-Ann Gwee
- Stomach Liver and Bowel Clinic, Gleneagles Hospital, Singapore.
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Martens U, Enck P, Matheis A, Herzog W, Klosterhalfen S, Rühl A, Zipfel S, Sammet I. Motivation for Psychotherapy in Patients With Functional Gastrointestinal Disorders. PSYCHOSOMATICS 2010. [DOI: 10.1016/s0033-3182(10)70689-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fink P, Schröder A. One single diagnosis, bodily distress syndrome, succeeded to capture 10 diagnostic categories of functional somatic syndromes and somatoform disorders. J Psychosom Res 2010; 68:415-26. [PMID: 20403500 DOI: 10.1016/j.jpsychores.2010.02.004] [Citation(s) in RCA: 209] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Revised: 02/04/2010] [Accepted: 02/04/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND In order to clarify the classification of physical complaints not attributable to verifiable, conventionally defined diseases, a new diagnosis of bodily distress syndrome was introduced. The aim of this study was to test if patients diagnosed with one of six different functional somatic syndromes or a DSM-IV somatoform disorder characterized by physical symptoms were captured by the new diagnosis. METHOD A stratified sample of 978 consecutive patients from neurological (n=120) and medical (n=157) departments and from primary care (n=701) was examined applying post-hoc diagnoses based on the Schedules for Clinical Assessment in Neuropsychiatry diagnostic instrument. Diagnoses were assigned only to clinically relevant cases, i.e., patients with impairing illness. RESULTS Bodily distress syndrome included all patients with fibromyalgia (n=58); chronic fatigue syndrome (n=54) and hyperventilation syndrome (n=49); 98% of those with irritable bowel syndrome (n=43); and at least 90% of patients with noncardiac chest pain (n=129), pain syndrome (n=130), or any somatoform disorder (n=178). The overall agreement of bodily distress syndrome with any of these diagnostic categories was 95% (95% CI 93.1-96.0; kappa 0.86, P<.0001). Symptom profiles of bodily distress syndrome organ subtypes were similar to those of the corresponding functional somatic syndromes with diagnostic agreement ranging from 90% to 95%. CONCLUSION Bodily distress syndrome seem to cover most of the relevant "somatoform" or "functional" syndromes presenting with physical symptoms, not explained by well-recognized medical illness, thereby offering a common ground for the understanding of functional somatic symptoms. This may help unifying research efforts across medical disciplines and facilitate delivery of evidence-based care.
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Affiliation(s)
- Per Fink
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, 8000 Aarhus, Denmark.
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25
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Reme SE, Kennedy T, Jones R, Darnley S, Chalder T. Predictors of treatment outcome after cognitive behavior therapy and antispasmodic treatment for patients with irritable bowel syndrome in primary care. J Psychosom Res 2010; 68:385-8. [PMID: 20307706 DOI: 10.1016/j.jpsychores.2010.01.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Revised: 12/17/2009] [Accepted: 01/05/2010] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To examine predictors of treatment outcome in IBS-patients who participated in a randomized controlled trial in primary care, where 149 irritable bowel syndrome (IBS) patients were randomized to mebeverine hydrochloride (n=77) or mebeverine+cognitive behavior therapy (CBT) (n=72). CBT offered additional benefit over mebeverine alone. METHODS Regression analyses were used to identify predictors of work and social adjustment 12 months after treatment ended. The intervention groups were analyzed separately in order to look at the separate effects in each group. RESULTS Lower levels of psychological distress (anxiety and depression) at baseline predicted a good outcome in the mebeverine group [beta=0.388 (95% CI: 0.065-0.936), P=.025] but not in the mebeverine+CBT group. In the adjusted model for the mebeverine+CBT group less adaptive IBS related behavioral coping predicted a good outcome [beta=0.285 (95% CI: 0.002-0.210), P=.045]. CONCLUSION Different factors are associated with outcome depending on the treatment received. At assessment clinicians should assess patients coping styles and may want to consider recommending CBT to those patients with IBS in primary care who are engaging in unhelpful coping behavior.
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Kruse J, Joksimovic L, Cavka M, Wöller W, Schmitz N. Effects of trauma-focused psychotherapy upon war refugees. J Trauma Stress 2009; 22:585-92. [PMID: 19960519 DOI: 10.1002/jts.20477] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The aim of this study is to evaluate the effects of a trauma-focused psychotherapy upon war refugees from Bosnia. Seventy refugees who met the criteria for posttraumatic stress disorder (PTSD) and somatoform disorders were included. The first 35 refugees were offered psychotherapy and the following 35 refugees received usual care. Outcome variables were changes in self-reported PTSD symptoms, psychological symptoms, and health status. At 12-month follow-up, participants in the intervention group reported significantly lower scores on the PTSD scale and the measure of psychological symptoms than the comparison group participants. Our results suggest that psychotherapy reduces symptoms of PTSD and somatoform disorders among war refugees even in the presence of insecure residence status.
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Affiliation(s)
- Johannes Kruse
- Department of Psychosomatic Medicine, University Giessen, Friedrichstrasse 33, 35392 Giessen, Germany.
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Hyphantis T, Tomenson B, Paika V, Almyroudi A, Pappa C, Tsifetaki N, Voulgari PV, Drosos AA, Pavlidis N, Creed F. Somatization is associated with physical health-related quality of life independent of anxiety and depression in cancer, glaucoma and rheumatological disorders. Qual Life Res 2009; 18:1029-42. [DOI: 10.1007/s11136-009-9527-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Accepted: 08/06/2009] [Indexed: 02/07/2023]
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Atypical antipsychotic quetiapine in the management of severe refractory functional gastrointestinal disorders. Dig Dis Sci 2009; 54:1284-91. [PMID: 19242800 DOI: 10.1007/s10620-009-0723-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 01/12/2009] [Indexed: 01/01/2023]
Abstract
Management of severe refractory functional gastrointestinal disorders (FGIDs) is difficult. Quetiapine, an atypical antipsychotic, may benefit patients by mitigating associated anxiety and sleep disturbances, augmenting the effect of antidepressants, and providing an independent analgesic effect. Outpatient records from a university-based FGID clinic were reviewed, and 21 patients with refractory symptoms who received quetiapine were identified and interviewed. Outcomes included global relief of symptoms, treatment efficacy questionnaire, and change in gastrointestinal (GI) and psychological symptoms. Eleven of 21 patients continued therapy at the time of interview. Six of 11 demonstrated global relief of symptoms, and 9 were satisfied with treatment. The remaining 10 of 21 discontinued therapy because of somnolence and lack of GI benefits. Quetiapine in low doses appeared beneficial in more than half of the adults with severe FGIDs who stayed on treatment. This response in otherwise refractory patients suggests quetiapine might augment the effectiveness of antidepressants in severe FGIDs.
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Han C, Masand PS, Krulewicz S, Peindl K, Mannelli P, Varia IM, Pae CU, Patkar AA. Childhood abuse and treatment response in patients with irritable bowel syndrome: a post-hoc analysis of a 12-week, randomized, double-blind, placebo-controlled trial of paroxetine controlled release. J Clin Pharm Ther 2009; 34:79-88. [PMID: 19125906 DOI: 10.1111/j.1365-2710.2008.00975.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Although irritable bowel syndrome (IBS) is frequently comorbid with childhood trauma, information on the clinical implications of this comorbidity is limited. We investigated whether a history of abuse was associated with response to treatment in a double blind, randomized, placebo controlled trial of paroxetine controlled release (CR) in IBS. METHODS Seventy-two IBS subjects were randomized to receive paroxetine CR (dose 12.5-50 mg/day) or placebo for 12 weeks. Subject selection was independent of abuse history. Sixty-one subjects completed the Sexual and Physical Abuse Questionnaire about their childhood abuse history. IBS symptoms were recorded using the Interactive Voice Response System (IVRS). Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Perceived Stress Scale (PSS) and Clinical Global Impression (CGI) were also measured. The primary outcome was treatment response defined as > or =25% reduction in composite pain scores (CPS) on the IVRS from randomization to end of treatment. RESULTS The rate of abuse history was 50.8% (n = 31/61). Baseline demographic clinical characteristics (CPS, BDI, BAI, PSS, CGI scores) were not associated with abuse history. After 12 weeks of treatment, subjects with abuse history showed significantly higher CPS (t = 2.422, P = 0.018) than subjects without a history and less mean change of CPS (t = 3.506, P = 0.001). In a logistic regression analysis, history of abuse did not predict treatment response as measured by > or =25% reduction in CPS (OR = 0.481, CI = 0.164-1.406, P = 0.181), while the drug status (paroxetine CR) was significantly associated with treatment response as defined by a CGI improvement score of 1-2 (OR = 12.121, CI = 2.923-50.271, P = 0.001). Abuse history did not predict CGI-I (Fisher's exact, P = 0.500) improvements during the trial. CONCLUSIONS History of abuse did not appear to have any significant clinical correlates at baseline and did not predict treatment response. Further studies are needed to confirm whether SSRIs are effective in IBS patients irrespective of their abuse history.
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Affiliation(s)
- C Han
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
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Grover M, Drossman DA. Psychopharmacologic and behavioral treatments for functional gastrointestinal disorders. Gastrointest Endosc Clin N Am 2009; 19:151-70, vii-viii. [PMID: 19232286 DOI: 10.1016/j.giec.2008.12.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Functional gastrointestinal disorders (FGIDs) are commonly seen gastrointestinal (GI) conditions that are diagnosed using established symptom-based criteria. These disorders that typically defy traditional diagnostic methods based on structural abnormalities have intrigued researchers for several decades. This has led to the emergence of the current discipline of neurogastroenterology or the study of the "brain-gut axis," which is based on dysregulation of neuroenteric pathways as a key pathophysiologic feature of the FGIDs. Psychopharmacologic and behavioral treatments can influence the dysregulation of these pathways, especially at the severe end of the spectrum, and improve the clinical manifestations of these conditions, visceral discomfort or pain and bowel dysfunction. Their actions are mostly at spinal and supraspinal levels with some direct benefits at the level of the gut. Improvements in coping, global distress, and overall quality of life (QOL) have been shown more consistently with these treatments compared with improvement in GI symptoms. A successful approach to patients with these treatments requires a good physician-patient relationship. Strategizing treatments with these modalities is based on recognition of their dual effects on brain and gut, understanding the nature and severity of the GI symptoms and their psychosocial concomitants, and applying them within the context of the patient's understanding of their value.
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Affiliation(s)
- Madhusudan Grover
- Division of Internal Medicine, Michigan State University, B-301 Clinical Center, East Lansing, MI 48824, USA
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Masand PS, Pae CU, Krulewicz S, Peindl K, Mannelli P, Varia IM, Patkar AA. A double-blind, randomized, placebo-controlled trial of paroxetine controlled-release in irritable bowel syndrome. PSYCHOSOMATICS 2009; 50:78-86. [PMID: 19213976 DOI: 10.1176/appi.psy.50.1.78] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) disease that causes significant impairment in quality of life and accounts for $8 billion per year to the healthcare system and loss of productivity in the workplace. OBJECTIVE The authors examined the efficacy and safety of paroxetine controlled-release (paroxetine-CR) in patients with IBS. METHOD Seventy-two patients with IBS participated in a 12-week, double-blind, randomized, placebo-controlled study of paroxetine-CR (12.5 mg-50 mg/day). Efficacy was measured by Composite Pain Scores (primary outcome) and the Clinical Global Impression-Improvement (CGI-I) and Severity (CGI-S) ratings. RESULTS In intent-to-treat analyses, there were no significant differences between paroxetine-CR (N=36) and placebo (N=36) on reduction in Composite Pain Scores, although the proportion of responders on CGI-I was significantly higher in the paroxetine-CR group. The treatment was well tolerated. CONCLUSION The study did not demonstrate a statistically significant benefit for paroxetine-CR over placebo on the primary outcome measure, although there was improvement in secondary outcome measures. Overall, paroxetine-CR seems to have potential benefit in IBS. Studies with adequate samples may clarify the role of paroxetine-CR in IBS.
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Affiliation(s)
- Prakash S Masand
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 1001 Winstead Dr., Suite 200, Cary, NC 27513, USA.
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Heitkemper MM, Jarrett ME. Update on irritable bowel syndrome and gender differences. Nutr Clin Pract 2008; 23:275-83. [PMID: 18595860 DOI: 10.1177/0884533608318672] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Irritable bowel syndrome (IBS) is a chronic functional GI disorder characterized by abdominal pain associated with alterations in defecation or stool frequency and consistency. In Western industrialized countries, women seek health care services for their symptoms more frequently than men. The cause of IBS is likely multifactorial involving altered motility, visceral hypersensitivity, and dysregulation of the autonomic nervous system. Many patients note that their symptoms are exacerbated by diet and stress, and women frequently report menstrual cycle fluctuations in symptoms. Current approaches to IBS management include behavioral management therapies such as dietary intake changes and stress reduction cognitive restructuring. Drug therapies are targeted at altering pain sensitivity, motility, and secretion. This review provides an overview of the pathogenesis of IBS, factors that contribute to gender differences, and current therapeutic approaches for symptom management.
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Affiliation(s)
- Margaret M Heitkemper
- Department of Biobehavioral Nursing, University of Washington, Seattle, WA 98195, USA.
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Creed F, Tomenson B, Guthrie E, Ratcliffe J, Fernandes L, Read N, Palmer S, Thompson DG. The relationship between somatisation and outcome in patients with severe irritable bowel syndrome. J Psychosom Res 2008; 64:613-20. [PMID: 18501262 DOI: 10.1016/j.jpsychores.2008.02.016] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Revised: 02/18/2008] [Accepted: 02/18/2008] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This study aimed to assess the relationship between somatisation and outcome in patients with severe irritable bowel syndrome (IBS). METHOD Two hundred fifty-seven patients with severe IBS included in a randomised controlled trial were assessed at baseline and divided into four quartiles on the basis of their somatisation score. The patients were randomised to receive the following over 3 months: brief interpersonal psychotherapy, 20 mg daily of the SSRI antidepressant paroxetine, or treatment as usual. Outcome 1 year after treatment was assessed using the Short Form-36 physical component summary (PCS) score and total costs for posttreatment year. RESULTS The patients in the quartile with the highest baseline somatisation score had the most severe IBS, the most concurrent psychiatric disorders, and the highest total costs for the year prior to baseline. At 1 year after the end of treatment, however, the patients with marked somatisation, who received psychotherapy or antidepressant, had improved health status compared to those who received usual care: mean (S.E.) PCS scores at 15 months were 36.6 (2.2), 35.5 (1.9), and 26.4 (2.7) for psychotherapy, antidepressant, and treatment-as-usual groups, respectively (adjusted P=.014). Corresponding data for total costs over the year following the trial, adjusted for baseline costs, were pound 1092 (487), pound 1394 (443), and pound 2949 (593) (adjusted P=.050). CONCLUSIONS Patients with severe IBS who have marked somatisation improve with treatment like other IBS patients and show a greater reduction of costs. Antidepressants and psychotherapy are cost-effective treatments in severe IBS accompanied by marked somatisation.
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Affiliation(s)
- Francis Creed
- Division of Psychiatry, University of Manchester, Manchester, UK.
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Mikocka-Walus AA, Turnbull DA, Andrews JM, Moulding NT, Wilson IG, Harley HAJ, Hetzel DJ, Holtmann GJ. Psychological problems in gastroenterology outpatients: A South Australian experience. Psychological co-morbidity in IBD, IBS and hepatitis C. Clin Pract Epidemiol Ment Health 2008; 4:15. [PMID: 18500977 PMCID: PMC2430958 DOI: 10.1186/1745-0179-4-15] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Accepted: 05/23/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND In independent studies, IBD, IBS and HCV have each been associated with a substantially increased risk of psychological problems such as depression and anxiety and impairment of quality of life compared to the general healthy population. However, the relative psychological burden for each of these diagnoses is unknown as it has never been compared contemporaneously at one institution. Current local data are therefore needed to enable an evidence-based allocation of limited clinical psychological resources. METHODS Overall, 139 outpatients (64 IBD, 41 HCV, and 34 IBS) were enrolled in this cross-sectional study. The HADS, SCL90, SF-12 and appropriate disease-specific activity measures were administered. Differences between groups were assesed with ANOVA, the Chi-Square test and the independent samples t-test (two-tailed). RESULTS Each of the three groups had significantly lower quality of life than the general population (p < 0.05). Overall, a total of 58 (42%) participants met HADS screening criteria for anxiety and 26 (19%) participants for depression. The HCV group had a significantly higher prevalence of depression than either of the other groups (HCV = 34%, IBS = 15% and IBD = 11%, p = 0.009). In the SCL90, the three disease groups differed on 7 out of 12 subscales. On each of these subscales, the HCV group were most severely affected and differed most from the general population. CONCLUSION Patients with these common chronic gastrointestinal diseases have significant impairment of quality of life. Anxiety is a greater problem than depression, although patients with HCV in particular, should be regularly monitored and treated for co-morbid depression. Evaluation of specific psychological interventions targeting anxiety is warranted.
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Affiliation(s)
- Antonina A Mikocka-Walus
- Department of Epidemiology & Preventive Medicine, Monash University, The Alfred, Level 3, Burnet Tower, 89 Commercial Rd, Melbourne 3004, VIC, Australia
| | - Deborah A Turnbull
- School of Psychology, University of Adelaide, Level 4, Hughes Building, Adelaide 5005, SA, Australia
| | - Jane M Andrews
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Wing Q7, Adelaide 5005, SA, Australia
| | - Nicole T Moulding
- School of Social Work and Social Policy, University of South Australia, Magill Campus, H1-32, Magill 5068, SA, Australia
| | - Ian G Wilson
- School of Medicine, University of Western Sydney, Locked Bag 1797, Penrith South DC NSW 1797, Australia
| | - Hugh AJ Harley
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Wing Q7, Adelaide 5005, SA, Australia
| | - David J Hetzel
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Wing Q7, Adelaide 5005, SA, Australia
| | - Gerald J Holtmann
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Wing Q7, Adelaide 5005, SA, Australia
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Farnam A, Somi MH, Sarami F, Farhang S, Yasrebinia S. Personality factors and profiles in variants of irritable bowel syndrome. World J Gastroenterol 2008. [PMID: 18081232 DOI: 10.3748/wjg.13.6414] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To study the association between irritable bowel syndrome (IBS) variants (constipation, diarrhea, or both) and personality traits in non-psychiatric patients. METHODS IBS was diagnosed using the Rome II diagnostic criteria after exclusion of organic bowel pathology. The entry of each patient was confirmed following a psychiatric interview. Personality traits and the score of each factor were evaluated using the NEO Five Factor Inventory. RESULTS One hundred and fifty patients were studied. The mean age (+/- SD) was 33.4 (+/- 11.0) year (62% female). Subjects scored higher in neuroticism (26.25 +/- 7.80 vs 22.92 +/- 9.54, P < 0.0005), openness (26.25 +/- 5.22 vs 27.94 +/- 4.87, P < 0.0005) and conscientiousness (32.90 +/- 7.80 vs 31.62 +/- 5.64, P < 0.01) compared to our general population derived from universities of Iran. Our studied population consisted of 71 patients with Diarrhea dominant-IBS, 33 with Constipation dominant-IBS and 46 with Altering type-IBS. Scores of conscientiousness and neuroticism were significantly higher in C-IBS compared to D-IBS and A-IBS (35.79 +/- 5.65 vs 31.95 +/- 6.80, P = 0.035 and 31.97 +/- 9.87, P = 0.043, respectively). Conscientiousness was the highest dimension of personality in each of the variants. Patients with C-IBS had almost similar personality profiles, composed of higher scores for neuroticism and conscientiousness, with low levels of agreeableness, openness and extraversion that were close to those of the general population. CONCLUSION Differences were observed between IBS patients and the general population, as well as between IBS subtypes, in terms of personality factors. Patients with constipation-predominant IBS showed similar personality profiles. Patients with each subtype of IBS may benefit from psychological interventions, which can be focused considering the characteristics of each subtype.
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Affiliation(s)
- Alireza Farnam
- Liver and Gastrointestinal Diseases Research Center, Imam Hospital, University Ave; Tabriz, East Azerbaijan, Iran
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Marks DM, Han C, Krulewicz S, Pae CU, Peindl K, Patkar AA, Masand PS. History of depressive and anxiety disorders and paroxetine response in patients with irritable bowel syndrome: post hoc analysis from a placebo-controlled study. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2008; 10:368-75. [PMID: 19158975 PMCID: PMC2629067 DOI: 10.4088/pcc.v10n0504] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Accepted: 04/03/2008] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Although irritable bowel syndrome (IBS) is highly comorbid with depressive and anxiety disorders, information on the clinical implications of this comorbidity is limited. We investigated whether a history of depressive and/or anxiety disorders was associated with response to treatment in a double-blind, randomized, placebo-controlled trial of paroxetine controlled release (CR) in IBS. METHOD Seventy-two IBS subjects (diagnosed using Rome II criteria) were recruited from August 2003 to November 2005 and randomly assigned to receive flexibly dosed paroxetine CR (dose, 12.5-50 mg/day) or placebo for 12 weeks. The Mini-International Neuropsychiatric Interview (MINI-Plus version) was used to ascertain current (exclusionary) or past diagnoses of depressive and anxiety disorders. Subjective depression, anxiety, and stress were assessed at entry and throughout the trial using the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Perceived Stress Scale (PSS). Severity of IBS symptoms was determined by the Composite Pain Score (CPS), administered via Interactive Voice Response System, and the Clinical Global Impressions scale (CGI). The primary outcome was treatment response defined as ≥ 25% reduction in CPS from randomization to end of treatment. A post hoc analysis (multivariate logistic regression) was done to evaluate whether a history of depressive and/or anxiety disorder was associated with response to medication. RESULTS Baseline demographic and clinical characteristics (CPS, BDI, BAI, PSS, CGI scores) were similar between groups (history of depressive/anxiety disorder vs. no history). In multivariate logistic regression analysis, treatment response was not predicted by history of depressive and/or anxiety disorder (OR = 0.58, CI = 0.29 to 1.68, p = .32) or drug status (paroxetine CR vs. placebo) (OR = 1.26, CI = 0.68 to 3.21, p = .19). Drug status was significantly associated with the secondary outcome variable of treatment response as defined by a CGI improvement score of 1 to 2 (OR = 12.14, CI = 2.9 to 48.4, p < .001). Paroxetine CR was safe and well tolerated during the study. CONCLUSIONS History of depressive and/or anxiety disorder was not associated with response of IBS symptoms to paroxetine CR. Conclusions are limited due to insufficient statistical power. Further research is needed to clarify the role of selective serotonin reuptake inhibitors in the treatment of IBS and to elucidate the treatment ramifications of comorbid psychiatric disorders. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00610909.
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Affiliation(s)
- David M Marks
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
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Farnam A, Somi MH, Sarami F, Farhang S, Yasrebinia S. Personality factors and profiles in variants of irritable bowel syndrome. World J Gastroenterol 2007; 13:6414-8. [PMID: 18081232 PMCID: PMC4205462 DOI: 10.3748/wjg.v13.i47.6414] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Revised: 09/12/2007] [Accepted: 11/19/2007] [Indexed: 02/06/2023] Open
Abstract
AIM To study the association between irritable bowel syndrome (IBS) variants (constipation, diarrhea, or both) and personality traits in non-psychiatric patients. METHODS IBS was diagnosed using the Rome II diagnostic criteria after exclusion of organic bowel pathology. The entry of each patient was confirmed following a psychiatric interview. Personality traits and the score of each factor were evaluated using the NEO Five Factor Inventory. RESULTS One hundred and fifty patients were studied. The mean age (+/- SD) was 33.4 (+/- 11.0) year (62% female). Subjects scored higher in neuroticism (26.25 +/- 7.80 vs 22.92 +/- 9.54, P < 0.0005), openness (26.25 +/- 5.22 vs 27.94 +/- 4.87, P < 0.0005) and conscientiousness (32.90 +/- 7.80 vs 31.62 +/- 5.64, P < 0.01) compared to our general population derived from universities of Iran. Our studied population consisted of 71 patients with Diarrhea dominant-IBS, 33 with Constipation dominant-IBS and 46 with Altering type-IBS. Scores of conscientiousness and neuroticism were significantly higher in C-IBS compared to D-IBS and A-IBS (35.79 +/- 5.65 vs 31.95 +/- 6.80, P = 0.035 and 31.97 +/- 9.87, P = 0.043, respectively). Conscientiousness was the highest dimension of personality in each of the variants. Patients with C-IBS had almost similar personality profiles, composed of higher scores for neuroticism and conscientiousness, with low levels of agreeableness, openness and extraversion that were close to those of the general population. CONCLUSION Differences were observed between IBS patients and the general population, as well as between IBS subtypes, in terms of personality factors. Patients with constipation-predominant IBS showed similar personality profiles. Patients with each subtype of IBS may benefit from psychological interventions, which can be focused considering the characteristics of each subtype.
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Labus JS. In search of mechanisms of change in treatment outcome research: mediators and moderators of psychological and pharmacological treatments for irritable bowel syndrome. Gastroenterology 2007; 133:702-5. [PMID: 17681186 DOI: 10.1053/j.gastro.2007.06.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Lackner JM, Jaccard J, Krasner SS, Katz LA, Gudleski GD, Blanchard EB. How does cognitive behavior therapy for irritable bowel syndrome work? A mediational analysis of a randomized clinical trial. Gastroenterology 2007; 133:433-44. [PMID: 17681164 PMCID: PMC2645996 DOI: 10.1053/j.gastro.2007.05.014] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2006] [Accepted: 05/10/2007] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS Although multiple clinical trials support the efficacy of psychological treatments for reducing irritable bowel syndrome (IBS) symptoms, the mechanisms responsible for symptomatic improvement are unknown. One hypothesis is that psychological treatments work by alleviating comorbid psychological distress implicated in the worsening of bowel symptoms and quality of life. An alternative hypothesis assumes that changes in distress are not strictly a cause but a consequence of IBS that will decrease with symptomatic improvement. METHODS We evaluated these 2 hypotheses by applying structural equation modeling (SEM) to the data set of a large number (n = 147) of Rome II diagnosed participants randomized to CBT, psychoeducation, or wait list. Per Rome guidelines, the primary end point was global improvement of gastrointestinal (GI) symptoms measured 2 weeks after a 10-week regimen. Secondary end points were distress and quality of life (QOL). RESULTS SEM analyses lend support to a model in which CBT is associated with improvements in IBS symptoms, but that therapeutic gains do not depend on changes in patients' overall level of psychological distress. Symptom severity, but not clinical status (pain catastrophizing, predominant bowel habits, symptom duration, abuse, diagnosable psychiatric disorder) or relevant sociodemographic variables (eg, gender, age), moderated treatment outcome. CONCLUSION CBT has a direct effect on global IBS symptom improvement independent of its effects on distress. Improvement in IBS symptoms is associated with improvements in the QOL, which may lower distress. Symptom improvements are not moderated by variables reflecting the mental well-being of IBS patients.
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Affiliation(s)
- Jeffrey M Lackner
- Division of Gastroenterology, Department of Medicine, University at Buffalo, State University of New York, Buffalo, New York 14215, USA.
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Matheis A, Martens U, Kruse J, Enck P. Irritable bowel syndrome and chronic pelvic pain: a singular or two different clinical syndrome? World J Gastroenterol 2007; 13:3446-55. [PMID: 17659691 PMCID: PMC4146780 DOI: 10.3748/wjg.v13.i25.3446] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Revised: 02/12/2007] [Accepted: 03/12/2007] [Indexed: 02/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) and chronic pelvic pain (CPP) are both somatoform disorders with a high prevalence within the population in general. The objective was to compare both entities, to find the differences and the similarities related to epidemiology and psychosocial aspects like stressful life events, physical and sexual abuse, illness behaviour and comorbidity. The technical literature was reviewed systematically from 1971 to 2006 and compared. According to literature, IBS and CPP seem to be one rather than two different entities with the same localisation of pain. Both syndromes also are similar concerning prevalence, the coexistence of mental and somatoform disorders, the common history of sexual and physical abuse in the past and their health care utilization. It could be shown that there were many similarities between IBS and CPP. Nevertheless both are traded as different clinical pictures as far. Therefore it seems to be reasonable and necessary to generate a common diagnosis algorithm and to bring gynaecologists and gastroenterologists into dialogue.
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Affiliation(s)
- Anna Matheis
- Department of Sychosomatic Medicine and Psychotherapy University Hospitals Tubingen, Frondsbergstrasse 23, Tubingen 72076, Germany
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Abstract
PURPOSE OF REVIEW Pain is a common reason for seeking healthcare. Chronic pain is commonly comorbid with psychiatric disorders. New evidence provides fresh insights into the nature of the link between pain and mental disorders and offers opportunity to refine treatment approaches. RECENT FINDINGS Even though depression is the most commonly studied comorbid psychiatric disorder, new studies show that other mental disorder, especially anxiety disorders, are also common. Comorbid conditions, including other chronic physical conditions, account for a substantial proportion of the disability associated with chronic pain conditions. The causal link between chronic pain and mental disorders may vary depending on the specific mental disorder, but the link may be mediated by biological, psychological, and social factors. Recent findings also suggest that the evolution of the comorbidity may differ between the sexes. Promising interventions for chronic pain that also target contextual psychosocial problems have been recently described. SUMMARY The frequent occurrence of mental disorders among patients with pain, especially those whose pain is chronic, has implications for the management of such patients. Current understanding of the complexity of this link not only provides opportunities for designing appropriate interventions but also raises new questions for further research.
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Affiliation(s)
- Oye Gureje
- Department of Psychiatry, University of Ibadan, University College Hospital, Ibadan, Nigeria.
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Thombs BD, Bernstein DP, Ziegelstein RC, Bennett W, Walker EA. A brief two-item screener for detecting a history of physical or sexual abuse in childhood. Gen Hosp Psychiatry 2007; 29:8-13. [PMID: 17189738 DOI: 10.1016/j.genhosppsych.2006.10.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2006] [Revised: 10/31/2006] [Accepted: 10/31/2006] [Indexed: 11/16/2022]
Abstract
BACKGROUND A number of medical practice guidelines and recommendations call for screening adult patients for a history of physical or sexual abuse in childhood, but no brief screening tools exist. The objective of this study was to assess the accuracy of a two-item screener for physical or sexual abuse in childhood. METHODS This is a cross-sectional study of randomly selected women (aged 18-65 years) from a large health maintenance organization. One thousand two hundred twenty-five patients were administered a questionnaire, which included two items in a brief screener: (a) "When I was growing up, people in my family hit me so hard that it left me with bruises or marks" and (b) "When I was growing up, someone tried to touch me in a sexual way or tried to make me touch them." A subset of 216 patients completed a semistructured interview for a history of physical or sexual abuse in childhood. RESULTS The two-item screener was sensitive (84.8%) and specific (88.1%) for detecting a history of physical or sexual abuse in childhood, as determined by the semistructured interview. CONCLUSIONS The two-item screener provides an accurate tool, which is easily integrated into a comprehensive health questionnaire or administered verbally by a clinician, to assess for history of abuse.
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Affiliation(s)
- Brett D Thombs
- Department of Psychiatry, Sir Mortimer B. Davis Jewish General Hospital and McGill University, Montreal, Quebec, Canada H3T 1E4.
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