WASHINGTON – Psychiatric comorbidities and a history of abuse are often associated with functional gastrointestinal problems, said Dr. Kevin W. Olden at the annual meeting of the American Academy of Clinical Psychiatrists.
“There is no doubt that psychiatry has a lot to offer patients with irritable bowel syndrome and the entire spectrum of gastrointestinal disorders,” said Dr. Olden, director of the division of gastroenterology and hepatology, University of Arkansas, Little Rock.
Four psychiatric diagnoses that are often present in patients with functional gastrointestinal disorders are panic disorder, generalized anxiety disorder, mood disorders (mainly depression), and somatoform disorders. As many as 44% of patients with IBS meet the diagnostic criteria for panic disorder, Dr. Olden noted (Gastroenterol. Clin. N. Am. 2003;32:477-506). In addition, Dr. Olden cited a study in which major depression was identified in 30%-90% of patients with irritable bowel syndrome. The presence of depression can influence patients' ability to seek care for IBS and their ability to cope with it, he said.
The impact of abuse on subsequent psychological problems and comorbid functional gastrointestinal disorders is an area worthy of further research, Dr. Olden said. In a survey of 206 patients who presented to a GI clinic, more than half of the patients with functional GI problems reported a history of abuse, and significantly more of these patients reported abuse, compared with those who had organic GI problems (53% vs. 37%) (Ann. Intern. Med. 1990;113:828-33).
When treatment with antidepressants relieves the gastrointestinal symptoms in some patients, they report fewer physician visits and improved ability to perform daily activities, Dr. Olden said.