Psychiatry-Psychosomatic GI Disorders Flashcards
What is responsible for psychologically-induced peptic ulcer disease?
When people are stressed they don’t treat their body well (smoke, drink, NSAIDs, poor diet) and behaviors can cause ulcers. Cortisol slows healing, mucosal defenses are impaired, pepsinogen and acid secretions go up and blood flow changes.
Psychological treatment of peptic ulcer disease, IBD and IBS?
Change behaviors, screen for anxiety/depression, anxiolytics, antidepressants and CBT.
What condition is strongly predictive of IBD relapse?
Depression. Psychiatric disorders are more common in patients with IBD than the general population
What psychological drugs should you think twice about giving to people with IBD?
SSRIs or TCAs, they can make diarrhea worse
A patient presents with slow onset “inappropriate napping”, irritability, stupor and eventually goes into a coma. What is likely causing these symptoms?
Liver failure allows ammonium to go straight to the brain and cause ammonium toxicity.
What do you need to prophylax for when treating hepatitis C with interferon alpha?
Depression.
Symptoms of personality change, depression, psychosis and catatonia often precede what hepatic disorder?
Wilson’s disease.
Autosomal dominant disorder characterized by recurrent abdominal pain with an overactive sympathetic response that imitates bipolar illness and schizophrenia. What usually leads to the diagnosis?
Porphyria. Triggers like surgery, fasting, infection and drug use usually manifest porphyria.
GI disorders that have significant improvement when you treat the psychiatric disorder
Functional GI disorders
How to diagnose functional GI disorders
Rome III criteria
Tiers of treatment for functional GI disorders
Education, reassurance, monitor symptoms, manage stress (pharmacotherapy or psychotherapy)
2 unexplained GI symptoms
Somatoform disorder
A child presents with severe 10/10 abdominal pain for the 5th time. What could this be?
Recurrent abdominal pain, usually from an anxiety disorder
Most common psychosomatic GI disorder
IBS. Often associated with traumatic loss and failure to engage in grief process. Stress is also highly associated with symptoms, but they get very defensive and deny it.
