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    DR AJAY DR AJAY Presentation Transcript

    • PSYCHIATRIC CORRELATES OF GASTROINTESTINAL DISORDERS DR.AYAY KUMAR MD-PSYCHIATRY,FINAL YEAR BAGALORE9/21/201319/21/20139/21/2013 1DR AYAY KUMAR
    • INDEX • INTRODUCTION • PSYCHIATRIC COMORBIDITY IN FUNCTIONAL GASTROINTESTINAL DISORDER • GASTROINTESTINAL SYMPTOMS IN PSYCHIATRIC DISORDERS • PSYCHOTROPIC DRUG SIDE EFFECTS ON GASTROINTESTINAL FUNCTION • PSYCHIATRIC ADVERSE EFFECTS OF DRUGS PRESCRIBED COMMONLY FOR GASTROINTESTINAL CONDITIONS • REFERENCES 9/21/2013 2DR AYAY KUMAR
    • INTRODUCTION The role of psychiatry is important in various gastrointestinal disorder In view of numbers of functional disorders and the evolving concept of biopsychosoicial model of the disease The war of mind and body going since the inception of psychiatry as a specialty of medicine 9/21/2013 3DR AYAY KUMAR
    • • The term psychosomatic used by “Johann christian Heinroth” • And used in DSM I(1952), later DSM II(1968) use the term psychophysiological autonomic and viceral disorder • In DSMIII” psychological factors affecting physical conditions and then in DSM IV finally used as psychological factors affecting medical conditions • In contrast ICD described them in various different chapters , sometoform F45, eatin disorder F 52, sexual dysfunction F 54 and disease classified elsewhere 9/21/2013 4DR AYAY KUMAR
    • PSYCHIATRIC COMORBIDITY IN FUNCTIONAL GI DISORDER • GASTROESOPHAGEAL REFLUX DISEASE • IRRITABLE BOWEL SYNDROME • PEPTIC ULCER DISEASE • HEPATITIS AND LIVER FAILURE 9/21/2013 5DR AYAY KUMAR
    • GASTROESOPHAGEAL REFFLUX DISEASE • Symptoms-Heart burn ,regurgitation and pain with swallowing. • Psychological distress-excessive stress,depression; increases symptom severity in those prone to GERD. • Increased rates of GERD symptoms did not appear to be related to psychotropic drug use factors. • Psychiatric co morbidity may influence the outcome of surgical treatment, resulting in decreased satisfaction post procedure. 9/21/2013 6DR AYAY KUMAR
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    • IRRITABLE BOWEL DISEASE •SYMPTOMS-Abdominal pain, diarrhea, bloating, constipation, nausea and vomiting. •Study by NIMH ECA, on 18000 subjects in United States gives the following data: •One GI symptom-depression(7.5 vs 2.9);agoraphobia(10.0 vs 3.6);panic disorder(2.5 vs 7.0) •Two GI symptoms-depression(13.4);agoraphobia(17.8);panic disorder(5.2) • Proposed models: 1. SOMATIZATION DISORDER HYPOTHESIS: People display their mental troubles like anxiety, depression, mood disorders with multiple non specific somatic symptoms. 2. SOMATOPSYCHIC HYPOTHESIS: Psychological symptoms are due to chronic GI stress and unsatisfactory interaction with health care providers. 9/21/2013 8DR AYAY KUMAR
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    • 3. PSYCHOGENIC HYPOTHESIS: Specific psychiatric disorders cause IBS in significant proportion of patients. 4. SELF SELECTION MODEL: Psychiatric co morbidity increases the rate of treatment seeking behavior in patients who have IBS. PHYSIOGICAL EXPLANATION OF IBS IN RELATION TO ACUTE STRESS: Acute stress can result in reduced migratory motor function in small intestine, where as in large intestine there can be increased myoelectrical activity and motility. 9/21/2013 13DR AYAY KUMAR
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    • TREATMENT OF IRRITABLE BOWEL SYNDROME IBS DIARRHEA CONSTIPATION PAIN & PRED. PRED. BLOATING 9/21/2013 16DR AYAY KUMAR
    • STEPS OF RX: • DIETARY MODIFICATION • NON PSYCHOPHARMACOLOGICAL DRUG • PSYCHOPHARMACOLOGICAL DRUG • PSYCOTHERAPY • DRUGS & PSYCHOTHERAPY 9/21/2013 17DR AYAY KUMAR
    • RX OF DIARRHEA PRED. IBS: • DIETARY MODIFICATION: Avoid legumes and high dietary fibre • If symptoms persist-ANTIDIARRHEAL DRUGS given-loperamide 2-8mg daily or codeine phosphate 30-90mg daily or colestyramine 1 sachet daily. • If symptoms persist- Amitriptyline 10-25 mg at night. • If symptoms persist-Relaxation therapy, biofeedback, hypnotherapy etc. have to be tried. 9/21/2013 18DR AYAY KUMAR
    • RX OF CONSTIPATION PREDOMINANT IBS: • DIETARY MODIFICATION: High fiber diet. • If symptoms persist Ispaghula, lactulose given. • If symptoms persist relaxation therapy, hypnotherapy are to be thought about. 9/21/2013 19DR AYAY KUMAR
    • RX OF PAIN AND BLOATING IN DIARRHEA • Dietary changes: Exclude wheat, exclude dairy. • If symptoms persist: Spasmolytic preparations are given: Mebeverine, peppermint oil, aiverine. • If symptoms persist :Amitriptyline 10-25 mg at night,probiotics. • If symptoms persist: Relaxation, biofeedback and hypnotherapy advisable.9/21/2013 20DR AYAY KUMAR
    • • PEPTIC ULCER DISEASE: Association with stress has been explained. It is said to be due to the release of gastric acid in response to stress. • HEPATITIS:IV drug abuse increases risk of hepatitis b and hepatits c. Interferon therapy carries neuropsychiatric risks. • LIVER FAILURE: Alcohol abuse and dependence are important etiological factors for liver failure. 9/21/2013 21DR AYAY KUMAR
    • GASTROINTESTINAL SYMPTOMS IN PSYCHIATRIC DISORDERS • Diagnostic criteria and disorder description of many psychiatric illnesses include GI syptoms • Somatization disorder: nausea, vomiting, abdominal pain, diarrhea, food intolerance. • Major depressive disorder: Food intolerance • Panic disorder: nausea, abdominal pain • Eating disorders: Vomting, appetite disturbance, diarrhea 9/21/2013 22DR AYAY KUMAR
    • PSYCHOTROPIC DRUG SIDE EFFECTS ON GI FUNCTION • SSRI’S: Nausea is a major side effect. Other side effects are diarrhea, anorexia, dyspepsia. Fluvoxamine has higher rate of nausea than other SSRI’S. • TCA’S: Dry mouth and constipation- due to anti cholinergic effect. Nortriptyline and desipramine have lower GI adverse effects as these are compounds with lower anti cholinergic potencies. 9/21/2013 23DR AYAY KUMAR
    • PSYCHIATRIC ADVERSE EFFECTS OF DRUGS PRESCRIBED COMMONLY FOR GASTROINTESTINAL CONDITIONS • HISTAMINE RECEPTOR ANTAGONISTS for peptic ulcer disease: Cimetidine causes delirium , increases blood levels of TCA’S and SSRI’S. • PROTON PUMP INHIBITORS for peptic ulcer disease: Omeprazole can increase carbamazepine concentrations. • ANTIEMETICS for nausea: Prochlorperazine can increase drug levels of TCA’S. Ondansetron has interactions with SSRI’S. • ANTIINFECTIVE AGENTS: 1.Hepatitis C: Interferon A –Depression in 15%, insomnia, anxiety and confusion. 2.Metronidazole:Interacts with disulfuram. 9/21/2013 24DR AYAY KUMAR
    • CONCLUSION Thus it is important to understand the correlation between psychiatric and GI Disorders to improve the quality of treatment provided by the attending doctor. 9/21/2013 25DR AYAY KUMAR
    • REFERENCES • COMPREHENSIVE TEXTBOOK OF PSYCHIATRY • DAVIDSON TEXTBOOK OF MEDICINE • HARRISON TEXTBOOK OF MEDICINE • JOURNAL OF ANXIETY DISORDERS • PRIMARY PSYCHIATRY VOL 14, NO 4, 2007 9/21/2013 26DR AYAY KUMAR
    • THANK YOU 9/21/2013 27DR AYAY KUMAR