Psychosomatics: Irritable Bowel Syndrome Flashcards
Define psychosomatic disorders.
Psychosomatic disorders are ones where emotional or psychological factors can impact on the severity, frequency, or nature of the symptoms.
What model of illness was challenged by the idea that a persons psychological state could impact on their physical state ? What model of illness thereby replaced this ?
Biomedical model of illness
Biopsychosocial model of illness
What’s another word for psychosomatic ?
Psychophysiological
Identify examples of psychosomatic disorders.
- Asthma
- Irritable bowel syndrome
- Atopic dermatitis
- Chronic fatigue syndrome
What is the most common functional gastrointestinal disorder encountered in primary and secondary care ?
Irritable bowel syndrome
Irritable Bowel Syndrome:
- Time frame
- Treatment
- Cause
- Time frame: symptoms come and go over time, and can last for days, weeks or months at a time, but the condition is usually a lifelong one
- Treatment: no cure, but diet changes and medications can help control symptoms
- Cause: exactly cause unknown, associated with food passing through your gut too quickly or too slowly, oversensitive nerves in your gut, stress, and a family history of IBS..
What are the main symptoms of irritable bowel syndrome ?
MAIN
- Stomach pain/cramps
- Bloating (tummy uncomfortably full and swollen)
- Diarrhea (watery poo)
- Constipation (strain when pooing)
ALSO
- Flatulence
- Passing mucus from bottom
- Tiredness/lack of energy
- Nausea
- Backage
- Problems peeing (needing to pee often, feeling like can’t empty bladder)
- Incontinence (can’t control when you poo)
What are the exacerbators/relievers of stomach pain/cramps as part of IBS ?
Exacerbated after eating food
Relieved after taking a poo
What epidemiological groups are most affected by IBS occurrence ?
20-30
More common in women
What proportion of the population is affected by IBS ?
10-20%
How are constipation and diarrhea both some of the main symptoms of IBS ?
IBS is characterized by abdominal pain accompanied by either diarrhea or constipating or diarrhea alternating with constipation
How is IBS diagnosed ?
• Clinical diagnosis, based on Rome III criteria:
- 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/months in the last 3 months associated with two or more of the following:
1) Improvement with defecation
2) Onset associated with a change in frequency of stool
3) Onset associated with a change in appearance of stool - In the UK, that + 2 other symptoms out of the following:
- A change in how pass stool (urgency, not emptied bowels)
- Bloating, hardness, or tension in abdomen
- Symptoms worse after eating
- Passing mucus from rectum
• Blood tests (Coeliac) and stool tests (Calprotectin- IBD) can be used to rule out other conditions
What are some of the impacts of IBS on patients ?
♠ Work (higher probability of being unemployed + more likely to take days off due to IBS)
♠ Visits to health professionals (frequent, due to lack of clarity over diagnosis)
♠ HRQoL (affects activities, foods they avoid, level of concern about their health)
♠ Psychological health (anxiety and depression more common amongst IBS patients BUT unclear whether they pre-date the symptoms or they are a result )
What are some putative causes of IBS ? Explain how these tie to the patient’s experience of IBS
PSYCHOLOGICAL
1) Emotional stress
2) Psychological disorder (anxiety and depression more common amongst IBS then IBD patients, unclear whether pre-date or consequence)
3) Hyper-reactivity in the brain-gut interface
(over sensitivity, i.e. more sensitive reaction to gut pain than someone without IBS +
hyper vigilance, i.e. more likely to pay attention to stimuli from their gut )
PHYSIOLOGICAL
4) Infection (higher probability of IBS if had GI infection previously)
5) Food intolerance (to gluten and lactose especially)
6) Abnormal muscle contractions in GI
7) Serotonin receptors
Probably a combination of these (psychosomatic disorder)
These lead to bowel symptoms, and both directly and indirectly (through the bowel symptoms) are cognitively appraised by the individual, leading to patient’s experience of IBS (refer to slide 22 of lecture for diagram representation)
Explain why serotonin receptors have been linked with potentially causing IBS.
- Differences in number of cells in gut that contain serotonin receptors in people who have diarrhea predominant IBS vs constipation predominant IBS
- Some people in IBS have exaggerated serotonin release after eating (which is when it gets worse for IBS patients in terms of symptoms)
