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Query: UMLS:C0022104 (irritable bowel syndrome)
 8,033 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The purpose of this investigation is to determine if the high prevalence rates of major depression, panic disorder, and agoraphobia found in tertiary-care studies of irritable bowel syndrome and medically unexplained gastrointestinal symptoms are also found in the general population. Structured psychiatric interviews on 18,571 subjects from the NIMH Epidemiologic Catchment Area (ECA) Study were reviewed for prevalence of gastrointestinal distress symptoms and selected psychiatric disorders. Medically unexplained gastrointestinal symptoms had a high prevalence in the general population (6-25%). When compared with those reporting no gastrointestinal symptoms, subjects who report at least one of these symptoms were significantly more likely to have also experienced lifetime episodes of major depression (7.5% vs 2.9%), panic disorder (2.5% vs 0.7%), or agoraphobia (10.0% vs 3.6%). Subjects with two gastrointestinal symptoms had even higher lifetime rates of depression (13.4%), panic (5.2%), or agoraphobia (17.8%). Lifetime rates of affective and anxiety disorders in the general population are higher in subjects with gastrointestinal symptoms compared with subjects without gastrointestinal symptoms. An even higher prevalence of affective and anxiety disorders is found in patients with medically unexplained gastrointestinal symptoms in tertiary-care clinics. Future studies are needed in primary-care populations where prevalence rates of psychiatric illness are probably intermediate between those of the general population and tertiary care.
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PMID:Comorbidity of gastrointestinal complaints, depression, and anxiety in the Epidemiologic Catchment Area (ECA) Study. 153 Nov 68

The purpose of this review is to describe the relationship between panic disorder, somatization, functional disability, and high medical utilization. Data from community, primary-care, and specialty studies were reviewed to determine the prevalence of anxiety and panic disorder in these populations. Data from the Epidemiologic Catchment Area Study were reviewed to emphasize the effect of panic disorder on health-care utilization and health perception in a community population. Data on the prevalence of panic disorder in primary care and mode of presentation of primary-care patients with panic disorder were also reviewed. Finally, the epidemiologic psychiatric findings from our recent study of distressed high utilizers of primary care were presented. Panic disorder was found to occur in 1-3% of people in the study community and 1.4-8% of primary-care patients. Of people with or without psychiatric disorder, people with panic disorder in the community had the highest risk of having multiple medically unexplained symptoms and of being high utilizers of medical ambulatory services. People with panic disorder in the community compared to both community psychiatric and nonpsychiatric controls tend to perceive themselves as having poor physical health and to be high users of emergency and hospital inpatient services, as well as ambulatory services. Most patients with panic disorder present to their primary-care physician with somatic complaints, especially cardiac (tachycardia, chest pain), gastrointestinal (epigastric pain or irritable bowel syndrome), or neurologic complaints (headaches, dizziness, or presyncope). Patients who were distressed high utilizers of primary care had an extremely high prevalence of current panic disorder (12%) and lifetime panic disorder (30%), which supported the association between panic disorder and high medical utilization found in the Epidemiologic Catchment Area (ECA) Study.
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PMID:Panic disorder: relationship to high medical utilization. 173 34

Structured psychiatric interviews and psychological self-report measures were administered to 28 patients with irritable bowel syndrome and 19 patients with inflammatory bowel disease. Significantly more of the patients with irritable bowel syndrome had lifetime diagnoses of major depression, somatization disorder, generalized anxiety disorder, panic disorder, and phobic disorder. They had significantly more medically unexplained somatic symptoms, and most had suffered from psychiatric disorders, particularly anxiety disorders, before the onset of their irritable bowel symptoms.
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PMID:Psychiatric illness and irritable bowel syndrome: a comparison with inflammatory bowel disease. 205 50

Response to pharmacologic treatments may identify groups of disorders with a common pathophysiology. The authors applied a treatment-response model, based on four classes of antidepressants (tricyclic types, monoamine oxidase inhibitors, serotonin uptake inhibitors, and atypical agents), to the medical literature. The model identified eight disorders that may share a pathophysiologic abnormality: major depression, bulimia, panic disorder, obsessive-compulsive disorder, attention deficit disorder with hyperactivity, cataplexy, migraine, and irritable bowel syndrome. Phenomenologic and family studies support this grouping. If the model is validated, this family of disorders, which the authors term "affective spectrum disorder," would represent one of the most prevalent diseases in the population.
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PMID:Affective spectrum disorder: does antidepressant response identify a family of disorders with a common pathophysiology? 200 8

Symptoms of gastrointestinal distress, including those of irritable bowel syndrome, were reported more frequently by patients with panic disorder than by nonanxious controls. Five of 30 subjects with panic disorder met criteria for irritable bowel syndrome, the onset of which coincided with the onset of panic disorder. Effective treatment for the anxiety disorder was accompanied by a reduction in gastrointestinal symptoms in all subjects.
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PMID:Reduction of gastrointestinal symptoms following treatment for panic disorder. 230 Jun 59

Five patients who had been diagnosed with panic disorder and irritable bowel syndrome are described. Both panic and gastrointestinal symptoms responded dramatically and rapidly to pharmacologic treatment of panic symptoms in all five patients. The frequent overlap of gastrointestinal symptoms and psychiatric (particularly anxiety) disorders suggests that some patients with functional gastrointestinal complaints may have a primary anxiety disorder.
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PMID:Can panic disorder present as irritable bowel syndrome? 374 30

Patients with panic disorder perceive physical symptoms which they interpret as dangerous phenomena; therefore, they normally seek help from physicians in somatic medicine and do not consult with a psychotherapist or psychiatrist. The combination of physical symptoms and catastrophic thinking induces such an intense feeling of anxiety that patients often visit an emergency unit. Thus, the prevalence of panic disorder is high among patients who seek help for heart symptoms within the setting of an emergency department (18%); in other clinical populations it may even be higher (patients with negative coronary angiography 33 to 59%, with irritable bowel syndrome 29 to 38%, with migraine headache 5 to 15%). Already in the emergency department it is possible to establish with the patient an understanding of the impact such catastrophic interpretations of basically benign physical changes have on the development of panic. This helps to avoid long-standing and expensive patient careers that have often been described in the literature. The present review includes a description of the cognitive model of the origin and the treatment of panic disorder as well as an overview of drug treatments with benzodiazepines and antidepressive drugs.
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PMID:[Panic disorders in the emergency room]. 772 77

Variable blood pressure responses, manifesting either as a "white-coat" phenomenon or lability between office visits, confound hypertension management decisions. An attempt was made to determine whether these phenomena are associated with concurrent diagnoses of psychosocial dysfunction, therefore mitigating against antihypertensive medical therapy. Forty-seven patients with such variable blood pressure responses were identified in a rural family practice over a three-year period and compared to randomly selected age- and sex-matched controls for the following concurrent diagnoses: generalized anxiety, psychogenic spastic bladder, panic disorder, depression, alcohol use, chronic headache, fibromyalgia, temporomandibular joint syndrome, irritable bowel syndrome, and premenstrual syndrome. No statistical associations between white-coat hypertension and these diagnoses were demonstrated although a small sample size tempers conclusions. However, chi-square analysis (P < 0.01) of the phenomenon characterized by lability of blood pressure between different office visits demonstrated a statistical association with alcoholic hepatitis in men. White-coat hypertension is a diagnosis that may warrant disassociation from other psychosocial disorders, although further study is indicated. Physicians should remain attuned to the presence of lability of blood pressure in males and consider possible associations with alcoholism.
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PMID:A pilot study of white-coat and labile hypertension: associations with diagnoses of psychosocial dysfunction. 848 44

We compared 71 patients with irritable bowel syndrome (IBS) and 40 patients with inflammatory bowel disease (IBD) using structured interviews for psychiatric, gastrointestinal and sexual/physical victimization histories, as well as self-reported measures of personality, functional disability and dissociation. IBS patients had significantly higher lifetime prevalence rates of major depression, current panic disorder, and childhood sexual abuse. Despite the absence of organic pathology, IBS patients had significantly higher numbers of medically unexplained physical symptoms and disability ratings equal to, or greater than, those of patients with severe organic gastrointestinal disease.
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PMID:Psychiatric diagnoses, sexual and physical victimization, and disability in patients with irritable bowel syndrome or inflammatory bowel disease. 863 55

Irritable bowel syndrome (IBS) has been reported in 10 to 22% of adults. Using a semi-structured clinical interview to study the prevalence of irritable bowel syndrome, we compared 41 patients seeking treatment for panic disorder in an outpatient setting to an age- and sex-matched control group of 40 patients who were seeking treatment in a general physician's office for other medical illnesses. The control group did not have any Axis I disorders. IBS was diagnosed according to the criteria of Drossman et al. Nineteen (46.3%) patients with panic disorder met the criteria for IBS, in contrast to one (2.5%) patient in the control group (p < 0.000005). Patients with panic disorder and IBS were more likely to report symptoms of back pain as well as a personal history of bowel disease compared to patients with panic disorder but without IBS. IBS is fairly common in patients seeking treatment for panic disorder. Prospective studies should address the question whether treatment of panic disorder leads to an improvement or resolution of the symptoms of IBS.
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PMID:The relationship of irritable bowel syndrome (IBS) and panic disorder. 880 32


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