Khleber C Attwell, M.D.

The Patient With GI Symptoms and Psychiatric Distress
Wyszynski, Antoinette Ambrosino; Bronson, Brian D; Attwell, Khleber Chapman
Manual of psychiatric care for the medically ill Washington, DC, US: American Psychiatric Publishing, Inc., 2005,
(from the chapter) Patients with gastrointestinal (GI) complaints and psychiatric symptoms are encountered often in clinical practice. Irritable bowel syndrome (IBS), the main focus of this chapter, is the most frequently occurring functional GI disorder (the others include globus hystericus, pseudodysphagia, and nonulcer dyspepsia). Up to 50% of outpatients referred to gastroenterologists ultimately receive a diagnosis of IBS. Terms that have been used synonymously with IBS include spastic colon/colitis, colonic neurosis, dyskinesia of the colon, functional diarrhea/enterocolonopathy, nervous diarrhea, and unhappy colon. This chapter will focus on conditions with GI complaints that often masquerade as primary psychiatric illness. Knowing the differential diagnosis of psychological and GI complaints helps to distinguish in triage between patients requiring additional workup and those who would benefit from a primarily psychiatric intervention. Medical conditions of this type include acute intermittent porphyria (which may present in the emergency room as psychiatric symptomatology occurring with an 'acute abdomen' but no surgical findings), B12 (cobalamin) deficiency (overlooked because of its psychiatric presentation), and pancreatic cancer (whose initial presentation may be atypical, treatment-resistant depressive or anxiety states). Table 6-1 summarizes the conditions discussed in this chapter.
— id: 3590, year: 2005, vol: , page: 99, stat: Chapter,