Psychosomatics: the example of Irritable Bowel Syndrome

Question 1

What are psychosomatic disorders?

Answer 1

Disorders in which a persons emotional or psychological state can impact upon symptoms

Question 2

What are some common psychosomatic disorders?

Answer 2

• Asthma
• Atopic dermatitis
• Tension-type headaches
• Chronic fatigue syndrome
• IBS

Question 3

What percentage of people have a tension-type headache on most days?

Answer 3

3%

Question 4

What is the msot common functional gastrointestinal disorder encountered in primary and secondary care?

Answer 4

Irritable Bowel Syndrome

Question 5

Hat are functional GI disorders?

Answer 5

• Disorders of gut-brain interaction
• A group of GI symptoms related to any combination of the following:
• Motility disturbance
• Visceral hypersensitivity
• Altered mucosal and immune function
• Altered gut microbacteria
• Altered CNS processing

Question 6

Who is affected by IBS?

Answer 6

• 20 - 30 years old
• More common in women
• 11 % of the population

Question 7

How is IBS diagnosed?

Answer 7

The Rome IV criteria

• In last 3 months, symptom onset at least 6 months prior to diagnosis in the individual experiences recurrent abdominal pain at least 1 day/week in the last 3 months associated with 2 or more of the following:
• Related to defecation
• Associated with a change in frequency of stool
• Associated with a change in form (appearence) of stool

Question 8

What additional criteria (aside from the Rome IV) is required to diagnose IBS in the UK?

Answer 8

• 2 of the following
• A change in how you pass stools (urgency, not emptied bowels)
• Bloating, hardness or tension in abdomen
• Symptoms worse after eating
• Passing mucus from rectum

Question 9

How can IBs impact patients?

Answer 9

• Work
• Visits to health proffesionals
• Health related Quality of Life
• Psychological health

Question 10

What are some of the possible biological causes of IBS?

Answer 10

• Abnormal muscle contraction
• Serotonin receptors
• Infection
• Food intolerance

Question 11

What are some of the psychological causes of IBS?

Answer 11

• Psychological disorders e.g depression and anxiety
• Psychiatric disorders (40 - 60% attending FGID clinic patients)
• Hyper-reactivity in the brain-gut interface (hypersensitivity or hypervigilance)`

Question 12

What are some of the possible social causes of IBS?

Answer 12

• Adverse childhood experiences

- Social learning

Question 13

What are some of the ways people can manage IBS?

Answer 13

• Diet / lifestyle (physical activity) changes approach
• Drug treatments approach
• Complementary therapies approach
• Psychological approaches

Question 14

What are some diet / lifestyle changes to deal with IBS?

Answer 14

• Food diary
  Food intolerances
  Healthy diet
• Assess activity levels

Question 15

What are the 1st line drug treatments for IBS?

Answer 15

• Antidiarrhoeal (loperamide)
• Laxatives (not lactulose)
• Antispasmodics

Question 16

What are some of the 2nd line drug treatments to treat IBS?

Answer 16

• Antidepressants
  TCAs
  SSRIs (if TCAs are uneffective)
• Laxatives (linaclotide only if previous laxatives have not worked)

Question 17

What are some complementary therapies?

Answer 17

• Nutraceuticals (plant compounds / peppermint)`
• Chinese herbal medicine
• Probiotics
  Not recommended
  Acupuncture and reflexology

Question 18

What are some psychological approaches?

Answer 18

• Cognitive behavioural therapy
• Hypnotherapy
• Psychological therapy

Question 19

What should the targets be when treating a patient with IBS?

Answer 19

• Optimistic but realistic
• Targets could be:
  Reducing disability
  Improving coping
  Reducing dependance on health care
• Listen to your patient