3- psychiatry & GI tract

Question 1

what are functional symptoms?

Answer 1

= umbrella term for symptoms that seemingly exist without expected organic pathology

• disorder of “function” rather than “structure” →still a real symptom (still matter obviously)

Question 2

what is the most common functional GI problem?

Answer 2

irritable bowel syndrome = the pathophysiology is not well understood

Question 3

what are symptoms of IBS?

Answer 3

• abdominal pain usually cramping, mid/lower abdominal can be mild or severe
• altered bowel habit →diarrhoea, constipation or both, faecal urgency, mucous with stool
• bloating/distension
• bloating/pain relieved by passing stool or flatus →most specific symptom for IBS
• nausea/vomiting (unusual)

= usually worse when stressed

Question 4

what are risk factors for IBS?

Answer 4

• under 50
• more female
• history of physical and/or sexual abuse as a child
• PTSD
• family history
• previous bacterial gastroenteritis

Question 5

what investigation is done for IBS?

Answer 5

more to rule out
- full blood count →if abnormal then would need more investigations like for cancer, coeliac, IBD

Question 6

what is management of IBS?

Answer 6

• dietary modification e.g. sensitive to caffeine, lactose
• probiotics
• laxatives/anti diarrhoeal
• antispasmodics
• tricyclic antidepressants e.g. amitriptyline
• psychological therapies

*not mental illness just that mental illness may be exacerbating

Question 6

what is cyclical vomiting syndrome?

Answer 6

• vomiting episodes, can be severe
• triggered by stress + anxiety
• big chunk of patients respond to migraine treatments

Question 7

what is chronic abdominal pain?

Answer 7

• chronic pain that often doesn’t get diagnosis
• often strongly associated with psychiatric conditions

treat →MDT approach ideally (psychology, anaesthetics, physical rehab)

Question 8

what is important aspect of treating functional disorders?

Answer 8

→treating psychological symptoms in functional disorder is alternative pathway to improve quality of life, not a substitute for medical treatment

Question 9

what is somatic symptom disorder?

Answer 9

• patients come in with lots of random symptoms seemingly unrelated →usually very anxious and worried and impair personal/social/occupational function
• anxiety causes excessive attention to normal bodily sensations
• Somatisation: psychological disturbance causes physical symptoms
• These are unconscious processes
• Treating anxiety improves symptoms

Question 10

what are people with somatic symptom disorder at risk of?

Answer 10

risk of over-investigation and iatrogenic harm

Question 11

what is malingering?

Answer 11

= when person faking it →should never approach patient thinking they’re making it up

• Intentional fabrication of physical or psychological symptoms for presumed materia gain (benefit, compensation, avoid prosecution or other responsibilities)
• Rare, but generally easier to diagnose than factitious disorder as Patients tend to disengage when challenged

Question 12

what is factitious disorder?

Answer 12

disorder of malingering = intentional fabrication of physical or psychological symptoms for presumed psychological gain

• very rare and hard to prove -very poor prognosis
• can also get factitious disorder imposed on another

Question 13

what psychotropic medications effect GI system?

Answer 13

antidepressants = nausea
antipsychotics = increased appetite, constipation, weight gain, metabolic syndrome
stimulants (ADHD) = reduced appetite