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It is estimated that between 13 and 52 percent of all new patients attending gastroenterology clinics have irritable bowel syndrome. Previous studies have associated irritable bowel syndrome with a high incidence of coexisting mental disorders. However, the methodologies used in these studies have been flawed by the lack of structured psychiatric interviewing, control groups, or the use of inappropriate controls, which make the results inconclusive. This study was performed to investigate the association between irritable bowel syndrome and psychiatric illness using an improved methodology. The experimental group consisted of 28 patients diagnosed with irritable bowel syndrome; a control group of 19 individuals diagnosed with inflammatory bowel disease was also assessed. All patients were evaluated using the NIMH Diagnostic Interview Schedule (DIS) Version III-A in the abridged form, along with other diagnostic measurements. Criteria from the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised, were also used to investigate symptoms for a wide variety of psychiatric disorders such as anxiety, depression, and phobia. Patient interviews were also conducted and the interviewers were unaware of the gastrointestinal complaints of the patient. The results revealed that when compared with the patients with inflammatory bowel disease, the patients with irritable bowel syndrome had significantly more diagnoses of major depression, along with a number of disorders, including somatization, panic, generalized anxiety, and phobic disorders. Patients with irritable bowel syndrome had a 93 percent lifetime prevalence of a mental disorder and a 61 percent prevalence of depression. These patients had more physical symptoms that could not be medically explained and were generally more sensitive to psychological stress than the individuals with inflammatory bowel disease. It is concluded, based on these results, that evaluation of patients with irritable bowel syndrome should probably include a formal psychiatric evaluation, and administration of psychiatric treatment, if necessary. (Consumer Summary produced by Reliance Medical Information, Inc.)

Irritable bowel syndrome (IBS) has been defined as a condition involving three complaints, comprising abdominal pain that is relieved by defecating, disturbed defecation, and bloating. Although the disorder represents between 15 and 52 percent of new referrals to gastroenterologists, its diagnostic validity remains questionable. The syndrome is very often accompanied by such psychiatric symptoms as mood, anxiety, and somatization disorders. A review of studies concerning the coexistence of gastrointestinal and psychiatric symptoms was performed. Analysis of the results supports the hypothesis that IBS is a somatic (bodily) expression of psychiatric illness, rather than the competing hypothesis, namely that the accompanying psychiatric illnesses are a consequence of prolonged physical discomfort. In a study of 13 patients with IBS and 10 patients with inflammatory bowel disease, 85 percent of the IBS patients had a history of anxiety, compared with only 20 percent of the controls. The authors speculate that the bowel motility disorders associated with IBS may be the consequence of abnormalities of interaction between the so-called 'third-division' of the autonomic nervous system, the enteric nervous system. The link between the psychiatric disorder and IBS may be the locus ceruleus (in the brain), because of its nervous connections to the gut. Psychiatrists involved in the treatment of IBS are advised to pay close attention to family history, and should focus their efforts on alleviation of symptoms rather than cure. (Consumer Summary produced by Reliance Medical Information, Inc.)