Psychiatric Co-morbidity in Patients With Irritable Bowel Syndrome at a Tertiary Care Center in Northern India

BACKGROUND/AIMS: Irritable bowel syndrome (IBS) is a chronic psycho-physiological disorder. It is considered to be the most common functional gastrointestinal disorder, and about 50–90% of IBS patients have associated psychiatric co-morbidity. We aimed to study psychiatric co-morbidities in patients with IBS visiting a tertiary care center. METHODS: This was a cross-sectional case-control study conducted over a duration of one and a half years from January 2014 to July 2015. Patients were selected from the out-patient department of gastroenterology. About 160 patients with IBS who fulfilled the inclusion criteria and who gave written informed consent were selected as study cases. The healthy attendants of cases were selected as controls. A total of 200 controls were selected. Rome-III criteria were used to diagnose IBS. For diagnosing psychiatric disorders, we used the Mini International Neuropsychiatric Interview Schedule Plus. RESULTS: Mean age of our cases and controls was 39.7 ± 11.4 and 37.7 ± 9.6 years, respectively. Females outnumbered males in our cases as well as their controls by a ratio of 2:1 approximately. Psychiatric disorders were seen in 84.4% of IBS patients as compared to 41.5% in controls. Major psychiatric disorders seen in our patients were generalized anxiety disorders (30.0%) and depression (28.0%). CONCLUSIONS: The majority of patients with IBS who present to a tertiary care center have co-morbid psychiatric disorders. We need to screen these patients for such co-morbidities and develop a holistic approach for better outcome in such cases.

Neurological outcome following delayed fixation of unstable thoracolumbar spinal injuries with short segment posterior fixation

To evaluate the improvement in neurological deficit following late decompression and stabilization of the fractured thoracolumbar spine. Between January 2001 and August 2004 neurological recovery in 120 thoracolumbar fractures was studied after posterior stabilization at the Hospital for Bone and Joint Surgery, Srinagar, India. There were 88 male and 32 female patients. Fall from a height, usually a tree, was the most common [90%] cause of injury. Seventy-six patients [63%] had neurologic deficit at the time of presentation. The unstable spine was fixed, between 4-18 days after trauma, by posterior short segment instrumentation [Steffee]. Neurological recovery for the patients was recorded in the follow-up period. Frankel grade was used to assess the neurological status. The average follow-up period was 25 months [range 8-44 months], and average age was 34 years [18-54]. There were 40 patients [30%] with an incomplete neurological deficit, namely, patients with Frankel grade B, C, and D. Two grades of improvement were found in 8 patients, and one grade improvement in 32 patients with incomplete lesion. Only one third of the patients with complete neuro deficit improved at the final follow-up. The overall result of the surgery for partial lesions was an improvement of at least one Frankel grade in all cases, but no improvement in most of the cases with complete lesion. This study demonstrates a clear relationship between the level of injury and Frankel grades, translational injuries are associated with a more severe neurologic grade, and surgical intervention appears to improve the neurological outcome, even when the intervention is inadvertently delayed [average 7.9 days]