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Relationship of functional gastrointestinal disorders and psychiatric disorders: Implications for treatment
Open accessAbstract
This article revisits the links between psychopathology and functional gastrointestinal disorders such as irritable bowel syndrome (IBS), discusses the rational use of antidepressants as well as non-pharmacological approaches to the management of IBS, and suggests guidelines for the treatment of IBS based on an interdisciplinary perspective from the present state of knowledge. Relevant published literature on psychiatric disorders, especially somatization disorder, in the context of IBS, and literature providing direction for management is reviewed, and new directions are provided from findings in the literature. IBS is a heterogeneous syndrome with various potential mechanisms responsible for its clinical presentations. IBS is typically complicated with psychiatric issues, unexplained symptoms, and functional syndromes in other organ systems. Most IBS patients have multiple complaints without demonstrated cause, and that these symptoms can involve systems other than the intestine, e.g. bones and joints (fibromyalgia, temporomandibular joint syndrome), heart (non-cardiac chest pain), vascular (post-menopausal syndrome), and brain (anxiety, depression). Most IBS patients do not have psychiatric illness per se, but a range of psychoform (psychological complaints in the absence of psychiatric disorder) symptoms that accompany their somatoform (physical symptoms in the absence of medical disorder) complaints. It is not correct to label IBS patients as psychiatric patients (except those more difficult patients with true somatization disorder). One mode of treatment is unlikely to be universally effective or to resolve most symptoms. The techniques of psychotherapy or cognitive-behavioral therapy can allow IBS patients to cope more readily with their illness. Specific episodes of depressive or anxiety disorders can be managed as appropriate for those conditions. Medications designed to improve anxiety or depression are not uniformly useful for psychiatric complaints in IBS, because the psychoform symptoms that sound similar to those seen in psychiatric disorders may not have the same significance in patients with IBS.
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“The various functional disorders have important characteristics in common, including epidemiology (female predominance), pathophysiology (inflammation, hypersensitivity, impaired central processing of afferent sensory information, role of serotonin, psychological distress and somatization, and the role of stress and life events), diagnosis (symptom-based), the central role of the patient-physician”
From Irritable Bowel Syndrome and Co-morbid Gastrointestinal and Extra-gastrointestinal Functional Syndromes (2010) · cites this paper as [10]
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“However, as discussed by North et al.10 most IBS patients do not have psychiatric illness per se but do manifest psychoform symptoms and somatoform complaints.”
From Irritable Bowel Syndrome and Co-morbid Gastrointestinal and Extra-gastrointestinal Functional Syndromes (2010) · cites this paper as [10]
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Metadata
- Authors
- North, C. S.
- Affiliations
- VA North Texas Health Care System (US)
- Corresponding author
- North, Carol S
- ORCID
- North, Carol S
- Venue
- World Journal of Gastroenterology
- Publisher
- Baishideng Publishing Group Inc.
- Published
- 2007
- Volume
- 13
- Issue
- 14
- Pages
- 2020
- ISSN
- 1007-9327 (ISSN-L)
- PMC
- PMC4319119
- OpenAlex
- W39026146
- Cited by
- 122
- References
- 56
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 4 · 2022: 6 · 2021: 11 · 2020: 4 · 2019: 5 · 2018: 5 · 2017: 6 · 2016: 7 · 2015: 8 · 2014: 12 · 2013: 7 · 2012: 6
- FWCI
- 1.42
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- World Journal of Gastroenterology (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Digital Commons@Becker (Washington University School of Medicine) (submittedVersion)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Health and Development
- Keywords
- irritable bowel syndrome, functional gastrointestinal disorders, psychiatric comorbidity, somatization disorder, antidepressants, cognitive behavioral therapy, psychotherapy, depression, anxiety, treatment guidelines, fibromyalgia, temporomandibular disorders, non-cardiac chest pain
- MeSH terms
- Antidepressive Agents, Mental Disorders, Gastrointestinal Diseases, Humans, Psychotherapy, Psychotropic Drugs, Somatoform Disorders, Inflammatory Bowel Diseases, Cognitive Behavioral Therapy
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