Síndrome de intestino irritable / Irritable bowel syndrome

Irritable bowel syndrome is a functional disease with highly variable symptoms and difficult to diagnose. The clinical picture is fundamental to reach a correct diagnosis and discard other gastrointestinal diseases. Its etiology is not well known; psychological problems and stress probably play an important role in the development of the disease. Irritable bowel syndrome impairs the quality of life of patients and is a frequent cause of consultation in primary care. Its therapy is basically symptomatic and requires psychological support. The physician must warn his/her patients that immediate results are rarely obtained and that a prolonged clinical follow up may be necessary

Terapia cognitivo-comportamental e sindrome de colon irritavel / Cognitive-behavioral therapy and irritable bowel syndrome

O tratamento para a sindrome de colon irritavel atraves da terapia cognitivo-comportamental tem sido considerado eficaz por estudos metodologicos controlados , implicando a reducao dos sintomas intestinais e pscologicos, promovendo a aquisicao de...

Stressful life-events, anxiety, depression and coping in patients of irritable bowel syndrome.

A lot of research has pointed to a complex interaction between stressful life events, psychiatric morbidity and the irritable bowel syndrome (IBS). AIM: The present study aimed to determine the: stressful life-events in patients with irritable bowel syndrome patients in comparison to normal controls; effect of these events in causing clinically significant anxiety and depression; and the effect of psychopathology i.e. anxiety and depression on coping skills in these patients. METHODOLOGY: Thirty patients with irritable bowel syndrome were compared with thirty matched normal controls, on the presumptive stressful life events scale and the mechanisms of coping scale. Further, among the irritable bowel syndrome patient group, the anxious and depressed subgroups were separated from the non-anxious and non-depressed subgroups using the hospital anxiety and depression scale. Positive and negative coping mechanisms between these subgroups were compared. RESULTS: Significantly higher stress scores were found in the irritable bowel syndrome patient group than normal controls. Not all, but slightly more than fifty percent of irritable bowel syndrome had definite and clinically significant anxiety and/or depression. Those IBS patients with either definite depression tended to use predominantly negative coping styles as compared to those IBS patients without anxiety or depression. CONCLUSION: Stressful life-event scores are significantly higher in IBS patients than in normal controls. Although not all of these patients have anxiety and/or depression, a significant number of patients show evidence of the same. Presence or absence of anxiety and/or depression influences how the patient with IBS copes with illness. Therefore, though further studies on the issue are required, we suggested that, as a supplement to medical management, recognition and treatment of anxiety and depression in this subgroup of IBS patients with psychotropic drugs and cognitive therapy for gaining more positive coping skills, may require special attention in the management of irritable bowel syndrome.

Objective evaluation of psychological abnormality in irritable bowel syndrome.

BACKGROUND: Irritable bowel syndrome (IBS) is frequently regarded as a psychological disorder. Data on objective evaluation of psychological abnormalities among IBS patients and control subjects are scanty in our country. We therefore objectively studied patients with IBS. METHODS: 42 patients satisfying the Manning's criteria and Munich workers' for diagnosis of IBS underwent psychological evaluation using the following tests: a) Eyesenck personality questionnaire. b) State and trait anxiety inventory according to Speilberger's method. c) Hamilton depression rating scale for detection of depression. d) Whitely index of hypochondriasis and discriminant function by Pilowsky's illness behavior questionnaire. RESULTS: Neuroticism was detected in 76% of IBS patients compared to 9% in control population (p < 0.01). State and trait anxiety scores were 44.5 +/- 17.1 and 49.0 +/- 15.3 respectively in IBS patients; these were higher than those in controls (35.5 +/- 7.5 and 41.2 +/- 6.1 respectively; p < 0.01). Severe depression was observed in 26% of IBS patients and 6% of control subjects (p < 0.05). Significantly higher hypochondriasis score was observed in IBS patients as compared to controls (p < 0.001). CONCLUSION: Neuroticism, hypochondriasis and depression were significantly more prevalent in IBS patients attending a clinic, compared to control population.

Neuroticism and stressful life events in patients with non-ulcer dyspepsia.

Hindi adaptation of the Middlesex Hospital Questionnaire (MHQ), Brief Psychiatric Rating Scale and Presumptive Stressful Life Events Scale were used to measure neuroticism, psychiatric morbidity and stressful life events in 35 patients with non-ulcer dyspepsia (NUD), 22 cass of peptic ulcer disease (PUD), 65 irritable bowel syndrome (IBS) and 45 age and sex matched healthy controls. NUD subjects had significantly higher total MHQ scores (28.8 +/- 11.3; p < 0.001) and scores in subscales of somatization (7.8 +/- 3.4; p < 0.001) and hysterical personality traits (5.5 +/- 2.8; p < 0.01) compared to healthy controls. MHQ scores in IBS subjects was significantly higher than in NUD, but in PUD subjects it was in-between NUD and healthy controls. Psychiatric morbidity, as assessed by Brief Psychiatric Rating Scale, was significantly higher in patients with NUD and IBS than in normal controls. Stressful Life event score was statistically similar in all the groups.

Registro de observaçöes de pesquisa clínica do IGESP-IBEPEGE / Records of clinical research of the Instituto de Gastroenterologia de Säo Paulo - IGESP and the Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE

Exercícios clínico-patológicos do Centro Médico e Cirúrgico - CMC - do Instituto de Gastroenterologia de Säo Paulo - IGESP e do Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE, discutidos segundo a Psicologia médica, visäo sócio-psicossomática. Organizaçäo de José Fernandes Pontes

Neuroticism in patients with irritable bowel syndrome.

Employing a Hindi adaptation of the Middlesex Hospital Questionnaire (MHQ), neuroticism level was assessed in 133 subjects with irritable bowel syndrome and compared with that in patients with organic bowel disease (33), healthy population (140) and known neurotics (110). Compared with healthy controls and patients with organic bowel disease, significantly higher scores were found among irritable bowel syndrome patients in all the subscales except obsession. The total of scores was midway between those of the normal population and known neurotics. Neurotic disorder was detected in 51% of irritable bowel syndrome patients compared to 24% of organic bowel disease subjects (P less than 0.05) and 7.8% of the healthy population. Cut-off points, calculated as mean + 2 SD of scores in the healthy population, were found to be reliable as shown by clinical interview.

Trastorno funcional y enfermedad psicosomática: diferenciación psicométrica / Functional disorders and psychosomatic disease: psychometric assessment

El análisis del contenido de la expresión verbal de un grupo de pacientes ulcerosos (n=9) y de un grupo de pacientes diagnosticados como colon irritable (n=11) de edad, sexo y estrato social comparable, no revela diferencias significativas en la comunicación afectiva durante una entrevista semiestandarizada. El análisis factorial de distintas variables psicométricas no identifica factores idénticos en lambas muestras, si bien los pacientes ulcerosos exhiben mayor intensidad en la variable alexitimia. Estos datos se interpretan en el contexto de diferencias esperables entre pacientes "funcionales" y "psicosomáticos". Se discute la ventaja de un análisis multivariado en la delimitación nosológica de entidades clínicas