4. Psychosomatics/ the example of Irritable Bowel Syndrome

Question 1

What is IBS?

Answer 1

Irritable bowel syndrome a common digestive condition

Question 2

How is IBS diagnosed?

Answer 2

That in the last 3 months, with symptom onset at least 6 months prior to diagnosis the individual experiences recurrent abdominal pain or discomfort** at least 3 days/month in the last 3 months associated with two or more of the following:
• Improvement with defecation
• Onset associated with a change in frequency of stool
• Onset associated with a change in form (appearance) of stool

Question 3

4 impacts of IBS on patients

Answer 3

• work?
• visits to health professionals
• Health Related Quality of Life (HRQoL)
• psychological health

Question 4

IBS, causes?

Answer 4

• psychological disorders
• hyper-reactivity in the brain-gut interface
• infection
• food intolerance
• abnormal muscle contraction • serotonin receptors

Question 5

Describe the common sense model of IBS

Answer 5

Health messages (such as abdominal pain, disturbed bowel habit) affected by:

• Gastrointestinal infections
• Food intolerances
• Abnormal guy physiology

Affect the cycle of coping procedures to deal with emotional reaction to life events and representation of illness risk.

Perceptions of treatment impact the emotional response to treatment.

Question 6

IBS management, 4 main approaches?

Answer 6

1. Diet/ lifestyle (physical activity) changes approach
   - Food diary: Monitor food intolerances, encourage healthy diet
   - Assess activity levels
2. Drug treatments approach
   - Treat the symptoms
3. Psychological approaches
   - After 12 months
   - Cognitive behavioural therapy
   - Hypotherapy
   - Psycholoical therapy
4. Complementary therapies approach
   - Nutraceuticals
   - Chinese herbal medicine
   - Probiotics

Question 7

What are the first line and second line drugs for treatment of IBS?

Answer 7

First line:
– Antidiarrhoeal (loperamide) – Laxatives (not lactulose)
– Antispasmodics

Second line:
– Laxatives (linaclotide)
– Antidepressants (second line)
• TCAs (if first line ineffective) 
• SSRIs (if TCAs ineffective)

Question 8

Outline the diet/lifestyles approach to treating IBS?

Answer 8

1. Diet/ lifestyle (physical activity) changes approach
   - Food diary: Monitor food intolerances, encourage healthy diet
   - Assess activity levels

Question 9

Outline the drug treatments approach to treating IBS?

Answer 9

2. Drug treatments approach
   - Treat the symptoms

First line:
– Antidiarrhoeal (loperamide) – Laxatives (not lactulose)
– Antispasmodics

Second line:
– Laxatives (linaclotide)
– Antidepressants (second line)
• TCAs (if first line ineffective) 
• SSRIs (if TCAs ineffective)

Question 10

Outline the psychological approach to treating IBS?

Answer 10

3. Psychological approaches
   - After 12 months
   - Cognitive behavioural therapy
   - Hypotherapy
   - Psycholoical therapy

Question 11

Outline the complementary therapies approach to treating IBS?

Answer 11

4. Complementary therapies approach
   - Nutraceuticals
   - Chinese herbal medicine
   - Probiotics