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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.)

Background: The irritable bowel syndrome (IBS) may lead to considerable impairment of health-related quality of life and high health care costs. It is not clear whether these poor outcomes directly result from severe bowel symptoms or reflect a coexisting psychiatric disorder. Objective: To determine whether bowel symptom severity and psychological symptoms directly influence health-related quality of life and health care costs. Design: Cross-sectional survey. Setting: Secondary and tertiary gastroenterology clinics. Patients: 257 patients with severe IBS who did not respond to usual treatments and were recruited for a trial of psychological treatment. Measurements: Predictors were abdominal pain, entries in a diary of 10 IBS symptoms, and measures of psychological symptoms. Outcomes were inability to work, health-related quality of life (measured by Medical Outcomes Survey 36-item short-form questionnaire [SF-36] physical component summary scores), and health care and productivity costs. Predictor and outcome measures were compared by using multiple regression and logistic regression analyses. Results: Abdominal pain occurred on average 24 days per month and activities were restricted on 145 days of the previous 12 months. The mean ([+ or -] SD) Hamilton depression score was 11.3 [+ or -] 6.1. The SF-36 physical component summary score was low (37.7 [+ or -] 10.6), and the patients had incurred high health care costs ($1743 [+ or -] $2263) over the previous year. Global severity and somatization scores on the Symptom Checklist 90 Revised, abdominal pain, and Hamilton depression scores independently contributed to the physical component score of the SF-36 (adjusted [R.sup.2] = 35.2%), but only psychological scores were associated with disability due to ill health. These variables did not accurately predict health care or other costs (adjusted [R.sup.2] = 9.3%). History of sexual abuse was not an independent predictor of outcome. Conclusions: Both abdominal and psychological symptoms are independently associated with impaired health-related quality of life in patients with severe IBS. Optimal treatment is likely to require a holistic approach. Since health care and loss of productivity costs are not clearly associated with these symptoms, alleviation of them will not necessarily lead to reduced costs.

Scientists have long known the gut and brain develop from the same part of the human embryo. They share many nerve endings and chemical transmitters and, throughout life, the gut [...]

Symptoms consistent with irritable bowel syndrome occur in an estimated 7%-14% of the general population, yet few seek medical care. Most people with irritable bowel syndrome (IBS) deal with their [...]

This report highlights various considerations regarding the potential effects of concurrent psychiatric conditions and a history of abuse in patient volunteers for clinical trials in irritable bowel syndrome (IBS). Even though many studies have used psychological rating scales to assess personality and psychological traits of patients with IBS, the prevalence of the different psychiatric diagnoses (i.e., categorical assessment) in patients with IBS has only recently been assessed systematically. Recent studies of treatment-seeking patients have indicated that the majority of individuals (50% to 90%) who seek treatment for IBS have a lifetime history or currently have one or more common psychiatric conditions: major depressive disorder, generalized anxiety disorder, panic disorder, social phobia, somatization disorder, and posttraumatic stress disorder. Traditional clinical wisdom is that the presence of a psychiatric disorder increases the likelihood that an IBS patient will seek treatment. However, recent data suggest that IBS and psychiatric disorders are associated regardless of treatment-seeking status. Patients with psychiatric disorders should be included in clinical IBS studies, because this reflects the actual patient population. Extrapolating from the psychiatric literature, inclusion of patients with IBS with mild to moderate anxiety or depression is warranted. Am J Med. 1999;107(5A):65S-73S. [C] 1999 by Excerpta Medica, Inc.

This article reviews the evidence that psychiatric disorders have an adverse influence on the outcome of irritable bowel syndrome (IBS) and relates this to the close relationship between psychological symptoms and severity of abdominal pain, bloating, and diarrhea. Therefore, accurate measurement of psychological symptoms may be an important aspect of trial design for IBS therapy. The importance of psychological distress and health anxiety in differentiating 'consulters' and 'nonconsulters' for IBS is reviewed. The consequences of excluding from a trial people with certain types of psychiatric disorder or with a known past history of sexual abuse are considered. Am J Med. 1999;107(5A):74S-80S. [C] 1999 by Excerpta Medica, Inc.

Psychological difficulties in patients with irritable bowel syndrome (IBS) are strongly related to symptom severity and patient status. This has important implications for clinical practice, and the design and conduct of clinical trials. Psychosocial factors (personality, psychiatric diagnosis illness behavior, life stress, psychological distress) distinguish patients with IBS from patients with no IBS. Psychosocial difficulties (e.g., history of physical or sexual abuse, maladaptive coping, or 'catastrophizing') predict poorer health outcome (greater pain scores, psychologic distress and poorer daily function, more days spent in bed, and more frequent physician visits and surgeries). When using the standardized Functional Bowel Disorder Severity Index, patients classified as severe are distinguished from moderates by several psychosocial difficulties and health-care use variables. In addition, whereas patients with severe illness report more pain, there is no difference from patients with moderate illness in terms of visceral sensation threshold. Given these data, it is important to consider psychosocial factors as predictive of symptom severity and clinical outcome, and this should be considered in clinical care and the design of clinical trials. Am J Med. 1999;107(5A):41S-50S. [C] 1999 by Excerpta Medica, Inc.

ARLINGTON, TEX. Symptoms consistent with irritable bowel syndrome occur in an estimated 7%-14% of the general population, yet few seek medical care. So what's the difference between people with irritable [...]

Strong evidence exists that the irritable bowel syndrome has an important psychological component. Firstly, about half of patients with the irritable bowel syndrome in a hospital clinic have psychiatric disorder [...]

PAIN INTENSITY USUALLY depends on context: When you pull your hand away from a hot stove, your brain circuits amplify the pain signals to send you a stern warning. But [...]

Patients with irritable bowel syndrome have altered brain responses to the anticipation of pain and to pain itself, which may make them more sensitive to painful stimuli. "During expectation of [...]

VIENNA -- Irritable bowel syndrome can be seen as an anxiety disorder--and, as such, responsive to cognitive-behavioral therapy. "Core symptomatology of IBS is clearly physiological, but the cause of suffering [...]

MONTREAL -- Comorbid psychosocial disorders are an important consideration in patients presenting with severe symptoms of irritable bowel syndrome, Douglas A. Drossman, M.D., said at the 13th World Congress of [...]

MONTREAL -- Comorbid psychosocial disorders are an important consideration in patients presenting with severe symptoms of irritable bowel syndrome, Douglas A. Drossman, M.D., said at the 13th World Congress of [...]

Significant differences were found in the cortical pain responses of patients with irritable bowel syndrome, compared with healthy controls, in a small study by Canadian researchers. C.L. Kwan of the [...]

Rationale for Use Irritable bowel syndrome (IBS) is estimated to afflict about 10%-20% of the U.S. population. In its most severe form, IBS has an impact on quality of life [...]

The first NHS gut-directed hypnotherapy unit has reported long term follow up of 273 patients treated for irritable bowel syndrome. Of the 71% who had responded to initial treatment and […]

Orlando, Fla. -- Identification of irritable bowel syndrome patients with certain interpersonal problems could help clinicians target those at higher risk of more severe disease, according to a presentation at [...]

The improvement of irritable bowel symptoms with paroxetine treatment does not differ for patients with or without comorbid anxiety disorders, reported Dr. Prakash S. Masand of Duke University, Durham, N.C., [...]