Irritable Bowel Syndrome

IBS and schizophrenia

Patients with continuous hypochondriacal schizophrenia can reveal IBS symptoms, like those with neurosises and hypochondriacal development. However in these cases clinical displays of irritable bowel syndrome and accompanying psychopathological semiology gain a number of features that determine diagnostics of endogenous disease.

In the clinical picture abnormal corporal sensations dominate in abdominal area whereas changes of frequency and consistence of stool are distinctly expressed, as a rule, only in the period of disease manifestation, and later only incidentally. Abdominal sensations lose the painful character; they are characterized by patients with uncertainty (they use words such as twisting, flipping, drilling, rolling).

Persistent aspiration to medical inspection in connection with fears of malignant neoplasms is combined with vigilance and mistrust to the opinion of doctors stating doubt about the possibility of oncological disease. The negative results of inspection don’t bring relief (what’s typical of patients with neurotic disorders), and, on the contrary, may lead to more mistrust, and in some cases to the conviction that doctors purposefully hide the fact of heavy somatic disease. Vigilance concerning possible oncological pathology is accompanied with unilateral interpretation of the changes of the health state: constipation are treated as signs of intestinal impassability, insignificant weight loss – as display of cancer cachexia.

One more feature of the clinical picture of schizophrenia patients with irritable bowel syndrome is the absurd of dietary schemes and other means to which patients resort in order to alleviate unpleasant sensations in the large intestine area: strong pressing or knocking on the area of pain projection, long stay in the bath with cool water, etc.

Alongside with hypochondriac fixing on painful sensations and changes of stool pattern the typical schizophrenia symptoms are revealed: autism and asthenic defect. Autisation connected with endogenic process is lead to gradual narrowing of circle of communication, loss of warm feelings towards relatives, refusal from any kinds of activity and interpersonal contacts, etc.

Signs of asthenic defect increasing in course of time determine lasting sensation of weakness in all body, flabbiness of muscles, intolerance of intellectual, emotional and physical loadings: aggravation of painful sensations and change of stool pattern is occur in reply to any strain.

IBS connected with schizophrenia has the least favorable outcome with the expressed decrease of the professional level and social disadaptation even to the extent of complete loss of working capacity and invalidization.

Irritable bowel syndrome and somatized depression

Irritable bowel syndrome is manifested together with depressive disorders approximately 2 times more often than with neurotic disorders. Long-lasting (more than 2 years) endogenous depressions prevail: the periodic depressive states occurring autochtonously (with no direct connection with psychotraumatic events), are, as a rule, of light and mild severity.

Among clinical signs of depression the greatest role is played by the so-called somatic symptoms of depression with the prevalence of disorders of the digestive system. At the same time symptoms of gastrointestinal disorders typical of irritable bowel syndrome – constipations, abdominal pains, etc. – come out as the common symptoms of depression and pathology of the digestive system along with reduction of appetite (depressive anorexia), sensation of unpleasant taste, bitterness or dryness in the mouth. Also a significant decrease of body weight and sleeping disorders are marked.

In contrast to patients with neurotic disorders patients with depression abdominal pains are characterized as monotonous and only in single instances are accompanied by pathological corporal sensations of extra-abdominal localization. Pains are usually nagging and aching and only incidentally there are sharp spastic algic sensations. Patients characterize pains as burdensome, “torturing” and “exhausting”. Abdominal pains have constant localization and keep during the whole period of wakefulness. Intensity of pains varies seldom, mainly depending on the daily rhythm of intensity of depressive symptoms (usually in the morning and less often in the evening time).

Diagnostics of such depressions, generally referred to as somatized depressions, demand careful clinical inspection, as the main symptoms of endogen depressions – depressive mood, ideas of inferiority, feeling of fault, pessimistic estimation of one’s position in the world around – remain as though on the background. Qualification of depression in this case should be based on separate, but the most significant symptoms: actually depressive mood (persistent depression, despirit, feeling of melancholy), a pathological daily rhythm, self-accusation, suicidal ideas, periodicity of semiology, remittent clinical course.

Irritable bowel syndrome and hypochondriac development

In some cases IBS symptoms are connected with pathological dynamics of personal features which are known as hypochondriac development. It is characterized by premorbid personal features such as rigidity, scrupulousness, excessive inclination for order, anxiety in case of changes in traditional way of life, sticking on troubles.

In such a way, manifestation of irritable bowel syndrome is connected with psychotraumatic situation. However when the situation is settled IBS symptoms don’t disappear or abate. On the contrary, manifestation of irritable bowel syndrome remains steadily over several years. It all tells on patient’s consciousness and his look on the disease. As a result, the patient becomes hypochondriac.

Abdominal pains that are strong, long lasting and have strict localization are exacerbated periodically in connection with psychotraumatic influences. Consequently, patients focus themselves on their pains and quite often become phobic about their health problems.

Such hypochondriac patients often study corresponding popular scientific literature carefully and practice non-medical ways of treatment. They try to diet and gradually exclude more and more products from their daily ration. And if at the initial stages of the disease the diet is composed in accordance with recommendations of the doctor, in the course of time the chose of foods becomes more independent but less and less rational. This choice is based mainly on scanty information from some medical encyclopedias and the nature of pains and physical discomfort after consuming various products. Such patients refuse to follow doctor’s advice and change their diet saying that even a slight deviation from current nutritional behaviour will definitely lead to exacerbation of abdominal pains, swelling, meteorism, negative change in stool pattern. Similar selectivity is observed in case of medications. Thus, hypochondriac behaviour causes additional problems in treatment of irritable bowel syndrome.