Hostname: page-component-848d4c4894-pftt2 Total loading time: 0 Render date: 2024-06-12T10:44:26.625Z Has data issue: false hasContentIssue false

The Role of the Mental Health Professional in the Assessment and Management of Irritable Bowel Syndrome

Published online by Cambridge University Press:  07 November 2014

Abstract

Irritable bowel syndrome (IBS), a condition common in the health-care setting, can be especially challenging to manage for both the referring physician and the psychiatrist. Much of this difficulty arises from the understanding and treatment of the disorder from a disease-based biomedical approach rather than a biopsychosocial model. The latter model offers a more effective method to understand the development and clinical expression of IBS, and as a result, directly informs subsequent management. This article defines and describes the epidemiology of IBS, reviews its pathophysiology, identifies the role of psychosocial factors using a biopsychosocial model of IBS, and clarifies the role of the mental health professional in its management. IBS management involves identifying psychiatric comorbidities, assessing the patient's perspective of the role of psychosocial factors, offering psychotherapy directed toward adaptive coping mechanisms, providing psychotropic medication consultation, and engaging in ongoing collaboration with the referring physician.

Type
Feature Articles
Copyright
Copyright © Cambridge University Press 1999

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Drossman, DA, Whitehead, WE, Camilleri, M. Irritable bowel syndrome: a technical review for practice guideline development. Gastroenterology. 1997;112:21202137.CrossRefGoogle ScholarPubMed
2.Thompson, WGC. Functional bowel disorders and functional abdominal pain. In: Drossman, DA, Richter, JE, Talley, NJ, Thompson, WG, Corazziari, E, eds. Functional Gastrointestinal Disorders: Diagnosis, Pathophysiology and Treatment. McLean, Va: Degnon Associates; 1994:115173.Google Scholar
3.Drossman, DA. Diagnosing and treating patients with refractory functional gastrointestinal disorders. Ann Intern Med. 1995;123:688697.CrossRefGoogle ScholarPubMed
4.Drossman, DA, Thompson, WG. The irritable bowel syndrome: review and a graduated, multicomponent treatment approach. Ann Intern Med. 1992;116:10091016.CrossRefGoogle Scholar
5.Drossman, DA, Li, Z, Andruzzi, E, et al.US householder survey of functional gastrointestinal disorders: prevalence, soeiodemography and health impact. Dig Dis Sci. 1993;38:15691580.CrossRefGoogle ScholarPubMed
6.Talley, NJ, Zinsmeister, AR, Van Dyke, C, Melton, LJ III. Epidemiology of colonic symptoms and the irritable bowel syndrome. Gastroenterology. 1991;101:927934.CrossRefGoogle ScholarPubMed
7.Walker, EA, Roy-Byrne, PP, Katon, WJ. Irritable bowel syndrome and psychiatric illness. Am J Psychiatry. 1990;147:565572.Google ScholarPubMed
8.Gaynes, B, Russo, M, Drossman, DA. How do gastroenterologists address the psychosocial component of irritable bowel syndrome? Proceedings of the 151st American Psychiatric Association Annual Meeting; June 4, 1998. Toronto, Canada.Google Scholar
9.Sandler, RS, Drossman, DA, Nathan, HP, McKee, DC. Symptom complaints and health care seeking behavior in subjects with bowel dysfunction. Gastroenterology. 1984;87:314318.CrossRefGoogle ScholarPubMed
10.Drossman, DA, McKee, DC, Sandler, RS, et al.Psychosocial factors in the irritable bowel syndrome: a multivariate study of patients and nonpatients with irritable bowel syndrome. Gastroenterology. 1988;95: 701708.CrossRefGoogle ScholarPubMed
11.Whitehead, WE, Cheskin, LJ, Heller, BR, et al.Evidence for exacerbation of irritable bowel syndrome during menses. Gastroenterology. 1990;98:14851489.CrossRefGoogle ScholarPubMed
12.Burns, DG. The risk of abdominal surgery in irritable bowel syndrome. South African Medical Journal. 1986;70:91.Google ScholarPubMed
13.Talley, NJ, Gabriel, SE, Harmsen, WS, Zinsmeister, AR, Evans, RW. Medical costs in community subjects with irritable bowel syndrome. Gastroenterology. 1995;109:17361741.CrossRefGoogle ScholarPubMed
14.Everhart, JE, Renault, PF. Irritable bowel syndrome in office-based practice in the United States. Gastroenterology. 1991;100:9981005.CrossRefGoogle ScholarPubMed
15.Sandler, R. Epidemiology of irritable bowel syndrome in the United States. Gastroenterology. 1990;99:409415.CrossRefGoogle ScholarPubMed
16.Lydiard, RB. Anxiety and the irritable bowel syndrome: psychiatric, medical, or both? J Clin Psychiatry. 1997;58(suppl 3):5158; discussion 59-61.Google ScholarPubMed
17.Whitehead, WE, Schuster, MM. Behavioral approaches to the treatment of gastrointestinal motility disorders. Med Clin North Am. 1981;65:13971411.CrossRefGoogle Scholar
18.Gwee, KA, Graham, JC, McKendrick, MW, et al.Psychometric scores and persistence of irritable bowel after infectious diarrhea (comments). Lancet. 1996;347:150153.CrossRefGoogle Scholar
19.Gwee, KA, Leong, YL, Graham, C, et al.The role of psychological and biological factors in post-infective gut dysfunction. Gut. In press.Google Scholar
20.Drossman, DA. Psychological factors in post-infectious gut dysfunction: a model for IBS?Gut. In press.Google Scholar
21.Elam, M, Thoren, P, Svensson, TH. Locus coeruleus neurons and sympathetic nerves: activation by visceral afferents. Brain Res. 1986;375:117125.CrossRefGoogle ScholarPubMed
22.Silverman, DHS, Munakata, JA, Ennes, H, Mandelkern, MA, Hoh, CK, Mayer, EA. Regional cerebral activity in normal and pathologic perception of visceral pain. Gastroenterology. 1997;112:6472.CrossRefGoogle ScholarPubMed
23.Walker, E, Unutzer, J, Katon, W. Understanding and caring for the distressed patient with multiple medically unexplained physical symptoms. Am Board Fam Prac. 1997;11:347356.CrossRefGoogle Scholar
24.Walker, EA, Katon, W, Roy-Byrne, PP, Li, L, Amos, D. Psychiatric illness and irritable bowel syndrome: a comparison with inflammatory bowel disease. Am J Psychiatry. 1990;147:16561661.Google ScholarPubMed
25.Stone, RT, Barbero, GJ. Recurrent abdominal pain in childhood. Pediatrics. 1970;45:732738.CrossRefGoogle ScholarPubMed
26.Oster, J. Recurrent abdominal pain, headache and limb pains in children and adolescents. Pediatrics. 1972;50:429436.CrossRefGoogle ScholarPubMed
27.Levy, RL, Whitehead, WE, Von Korff, MR, Saunders, KW, Feld, AD. Intergenerational transmission of GI illness behavior. Gastroenterology. 1997;112:A775.Google Scholar
28.Lowman, BC, Drossman, DA, Cramer, EM, McKee, DC. Recollection of childhood events in adults with irritable bowel syndrome. J Clin Gastroenterol. 1987;9:324330.CrossRefGoogle ScholarPubMed
29.Apley, J, Hale, B. Children with recurrent abdominal pain: how do they grow up? Br Med J. 1973;3:79.CrossRefGoogle ScholarPubMed
30.Waller, SI, Misciewicz, JJ. Prognosis in the irritable bowel syndrome. Lancet. 1969;2:753756.CrossRefGoogle ScholarPubMed
31.Drossman, DA, Leserman, J, Nachman, G, et al.Sexual and physical abuse in women with functional or organic gastrointestinal disorders. Ann Intern Med. 1990;113:828833.CrossRefGoogle ScholarPubMed
32.Drossman, DA, Li, Z, Leserman, J, Toomey, TC, Hu, Y. Health status by gastrointestinal diagnosis and abuse history. Gastroenterology. 1996;110:9991007.CrossRefGoogle ScholarPubMed
33.Creed, FH, Craig, T, Farmer, RG. Functional abdominal pain, psychiatric illness and life events. Gut. 1988;29:235242.CrossRefGoogle ScholarPubMed
34.Whitehead, WE, Crowell, MD, Robinson, JC, Heller, BR, Schuster, MM. Effects of stressful life events on bowel symptoms: subjects with irritable bowel syndrome compared to subjects without bowel dysfunction. Gut. 1992;33:825830.CrossRefGoogle ScholarPubMed
35.Drossman, DA, Creed, FH, Olden, KW, Svedlund, J, Toner, BB, Whitehead, WE. Psychosocial aspects of the functional gastrointestinal disorders. In: Drossman, DA, Talley, NJ, Thompson, WG, Corazziari, E, Whitehead, WE, eds. The Functional Gastrointestinal Disorders: Diagnosis, Pathophysiology and Treatment: A Multinational Consensus. McLean, Va: Degnon and Associates; In press.Google Scholar
36.Toner, BB, Garfinkel, PE, Jeejeebhoy, KN. Psychological factors in irritable bowel syndrome. Can J Psychiatry. 1990;35:158161.CrossRefGoogle ScholarPubMed
37.Lydiard, RB, Fossey, MD, Marsh, W, Ballenger, JC. Prevalence of psychiatric disorders in patients with irritable bowel syndrome. Psychosomatics. 1993;34:229234.CrossRefGoogle ScholarPubMed
38.Scarinci, IC, McDonald-Haile, JM, Bradley, LA, Richter, JE. Altered pain perception and psychosocial features among women with gastrointestinal disorders and history of abuse: a preliminary model. Am J Med. 1994;97:108118.CrossRefGoogle ScholarPubMed
39.Drossman, DA, Li, Z, Leserman, J, Toomey, T, Hu, Y. Association of coping pattern and health status among female GI patients after controlling for GI disease type and abuse history. Psychosom Med. 1997;59:105.Google Scholar
40.Cohen, S, Syme, SL. Issues in the study and application of social support. In: Cohen, S, Syme, SL, eds. Social Support and Health. Orlando, Fla: Academic Press; 1985:322.Google Scholar
41.Berkman, L. The role of social relations in health promotion. Psychosom Med. 1995;57:245254.CrossRefGoogle ScholarPubMed
42.Whitehead, WE, Bosmajian, L, Zonderman, AB, Costa, PTJ, Schuster, MM. Symptoms of psychologic distress associated with irritable bowel syndrome: comparison of community and medical clinic samples. Gastroenterology. 1988;95:709714.CrossRefGoogle ScholarPubMed
43.Kettell, J, Jones, R, Lydeard, S. Reasons for consultation in irritable bowel syndrome: symptoms and patient characteristics. Br J Gen Pract. 1992;42:459461.Google ScholarPubMed
44.Drossman, DA. Gastrointestinal illness and biopsychosocial model (Presidential address). Psychosom Med. 1998;60:258267.CrossRefGoogle ScholarPubMed
45.Irwin, C, Falsetti, SA, Lydiard, RB, Ballenger, JC, Brock, CD, Brener, W. Comorbidity of posttraumatic stress disorder and irritable bowel syndrome. J Clin Psychiatry. 1996;57:576578.CrossRefGoogle ScholarPubMed
46.Drossman, DA. Do psychosocial factors define symptom severity and patient status?Am J Med. 1999. In press.Google Scholar
47.Olden, KW, Hom, SS. The refractory functional GI patient: definition and implications for cost effective care. Gastroenterology. 1998;114:G3343.Google Scholar
48.Walker, E, Katon, W, Roy-Byrne, P. Histories of sexual victimization in patients with irritable bowel syndrome or inflammatory bowel disease. Am J Psychiatry. 1993:15021506.Google Scholar
49.Drossman, DA, Li, Z, Leserman, J, Toomey, T, Hu, Y. Relationship of GI diagnosis, abuse and demographic factors with coping styles. Gastroenterology. 1996;110:658.Google Scholar
50.Drossman, DA, Li, Z, Leserman, J, Toomey, T, Hu, Y. Association of coping pattern and health status among female GI patients after controlling for GI disease type and abuse history: a prospective study. Gastroenterology. 1997;112:724.Google Scholar
51.Olden, KW. Approach to the patient with irritable bowel syndrome. In: Stern, TA, Herman, JB, Slavin, PL, eds. The MGH Guide to Psychiatry in Primary Care. New York, NY: McGraw-Hill; 1998:113120.Google Scholar
52.Clouse, RE. Antidepressants for functional gastrointestinal syndromes. Dig Dis Sci. 1994;39:23522363.CrossRefGoogle ScholarPubMed
53.Finley, PR. Selective serotonin reuptake inhibitors: pharmacologic profiles and potential therapeutic distinctions. Ann Pharmacother. 1994;28:13591369.CrossRefGoogle ScholarPubMed
54.Egbunike, IG, Chaffee, BJ. Antidepressants in the management of chronic pain syndromes. Pharmacotherapy. 1990;10:262270.CrossRefGoogle ScholarPubMed
55.Clouse, RE, Lustman, P, Geisman, RA. Antidepressant therapy in 138 patients with irritable bowel syndrome: a five-year clinical experience. Aliment Pharmacol Ther. 1994;8:409416.CrossRefGoogle ScholarPubMed
56.Greenbaum, DS, Mayle, JE, Vanegeren, LE, et al.The effects of desipramine on IBS compared with atropine and placebo. Dig Dis Sci. 1987;32:257266.CrossRefGoogle ScholarPubMed
57.Myren, J, Lovland, B, Larssen, S-E, Larsen, S. A double-blind study of the effect of trimipramine in patients with the irritable bowel syndrome. Scand J Gastroenterol. 1984;19:835843.CrossRefGoogle ScholarPubMed
58.Myren, J, Groth, H, Larssen, SE, Larsen, S. The effect of trimipramine in patients with the irritable bowel syndrome. Scand J Gastroenterol. 1982;17:871875.CrossRefGoogle ScholarPubMed
59.Ritchie, JA, Truelove, SC. Comparison of various treatments for irritable bowel syndrome. Br Med J. 1980;281:13171319.CrossRefGoogle ScholarPubMed
60.Lancaster-Smith, MJ, Prout, BJ, Pinto, T, Anderson, JA, Schiff, AA. Influence of drug treatment on the irritable bowel syndrome and its interaction with psychoneurotic morbidity. Acta Psychiatr Scand. 1982;66:3341.CrossRefGoogle ScholarPubMed
61.Eisendrath, SJ, Kodama, KT. Fluoxetine management of chronic abdominal pain. Psychosomatics. 1992;33:227229.CrossRefGoogle ScholarPubMed
62.Emmanuel, N, Lydiard, R, Crawford, M. Treatment of irritable bowel syndrome [letter]. Am J Psychiatry. 1997;154:711712.Google ScholarPubMed
63.Baume, P, Cuthbert, J. The effect of medazepam in relieving symptoms of functional gastrointestinal distress. Aust NZJ Med. 1973;3:457460.CrossRefGoogle ScholarPubMed
64.Noyes, RJ, Cook, B, Garvey, M, Summers, R. Reduction of gastrointestinal symptoms following treatment for panic disorder. Psychosomatics. 1990;31:7579.CrossRefGoogle ScholarPubMed
65.Owens, M, Risch, S. Atypical antipsychotics. In: Schatzberg, AF, Nemeroff, CB, eds. The American Psychiatric Press Textbook of Psychopharmacology. Washington, DC: American Psychiatric Press, Inc; 1995:263280.Google Scholar
66.Greenshaw, AJ, Silverstone, PH. The non-antiemetic uses of serotonin 5-HT3 receptor antagonists: clinical pharmacology and therapeutic applications. Drugs. 1997;53:2039.CrossRefGoogle ScholarPubMed
67.Maxton, DG, Morris, J, Whorwell, PJ. Selective 5-hydroxytryptamine antagonism: a role in irritable bowel syndrome and functional dyspepsia? Aliment Pharmacol Ther. 1996;10:595599.CrossRefGoogle ScholarPubMed
68.Wilde, MI, Markham, A. Ondansetron: a review of its pharmacology and preliminary clinical findings in novel applications. Drugs. 1996;52:773794.CrossRefGoogle ScholarPubMed
69.Ong, LM, de Haes, JC, Hoos, AM, Lammes, FB. Doctorpatient communication: a review of the literature. Soc Sci Med. 1995;40:903918.CrossRefGoogle ScholarPubMed
70.Gaynes, B, Drossman, D. The Role of psychosocial factors in irritable bowel syndrome. In: Whorwell, P, Houghton, L, eds. Irritable Bowel Syndrome. Bailliere's Clinical Gastroenterology International Practice and Research. London, UK: Bailliere Tindall; In press.Google Scholar
71.Smith, G, Monson, R, Ray, DC. Psychiatric consultation in somatization disorder. N Engl J Med. 1986;314:14071413.CrossRefGoogle ScholarPubMed
72.Van Dulmen, AM, Fennis, JFM, Mokkink, HGA, Van Der Velden, HGM, Bleijenberg, G. Doctor-dependent changes in complaint-related cognitions and anxiety during medical consultations in functional abdominal complaints. Psychol Med. 1995;25:10111018.CrossRefGoogle ScholarPubMed
73.Owens, DM, Nelson, DK, Talley, NJ. The irritable bowel syndrome: long term prognosis and the physicianpatient interaction. Ann Intern Med. 1995;122:107112.CrossRefGoogle ScholarPubMed