Psychiatry in GI Flashcards
What psychological life events can be linked to disorders of the GI tract?
- Abnormal relationships with parents
- Hx or present abuse
- Anxiety
- Depression
- Inadequate social support
What is a globus?
The sensation of a lump in the throat
What can cause a Globus?
- Foreign body
- Reflux
- Inflammation of pharynx
- Pharyngeal pouch
- Cancers
- Pollen food syndrome / Oral allergy syndrome
- Neurological conditions
OR an intense emotional/psychological experience
Why does an emotional experience cause the sensation of a globus?
Nervousness may lead to:
- a dry mouth
- repeated swallowing
- enhanced awareness of the throat
How can a globus be managed?
- Reassurance
- Anti-reflux treatment
- Stopping smoking
- Referral to SALT
- Neck/shoulder relaxation techniques and exercises
- Vocal hygiene (‘wet’ vs ‘dry’/‘check’ swallow)
- Tx for stress
=> Antidepressants/ CBT
What is meant by “functional dysphagia”?
- sensation of solid (or liquid) food ‘sticking’ on the way down the oesophagus
- usually a diagnosis of exclusion
How is “functional dysphagia” managed?
- Reassurance
- Dietary adjustments (avoid trigger foods)
- Advising careful chewing of food
- Avoiding fizzy drink
Psychotic symptoms can cause patients to experience GI symptoms. Please give an example of this.
- Patient believed she couldn’t swallow because there was a devil in her throat
- Elderly woman with psychotic depression stopped eating and believed her gut was dead
What is the definition of IBS?
- Group of bowel disorders
Characterised by: - abdominal discomfort/ bloating/ pain
- assoc. with defecation/ change in bowel habit
- Symptoms present for at least 6 months (NICE)
The cause of IBS is not really known, but what are some theories for the pathophysiology?
- may follow acute bacterial gastroenteritis => changes gut reactivity
- due to emotional stimuli such as stress or abuse
- may be linked to trauma
Dysregulation of the brain-gut axis
- more stress may cause modulation of afferent signals from the enteric nervous system
Is IBS more common in men or women?
Women (2:1)
- many often find symptoms change with their menstrual cycle
How is IBS managed without medication?
- Diet modifications (fibre, caffeine, regular meals, probiotics?)
- Exercise
- Reduce stress
What medications can be used to manage IBS?
- Antispasmodics => reduce pain/cramp
- Laxatives
- Antimotility medicines => relievediarrhoea
- Low-dose antidepressants => reduce stomach pain/cramp
- Reducing / stopping opioid analgesics
What is the definition of anorexia nervosa?
- BMI <17.5
OR - Children: failure to make expected weight gain during growth
How is weight loss self-induced in anorexia nervosa?
- Avoidance of “fattening foods”
- Progressive dietary restriction
- Calorie counting / excessive weighing
- Self-induced vomiting (Russell’s sign)
- Diuretics / laxatives / appetite suppressants
- Excessive exercise
