The role of incongruence between the perceived functioning by patients and clinicians in the detection of psychological distress among functional and motor digestive disorders

Objectives Previous research on gastrointestinal and other medical conditions has shown the presence of incongruence between self- and clinician-reported functioning and its relation with psychopathology. The main objective of this study was to test whether inconsistencies between clinician- and self-assessed functionality can be used to detect psychopathology among patients diagnosed of motor or functional gastrointestinal disorders. Methods One hundred and three patients from a gastroenterology inpatient unit were included in this study. All patients underwent clinical assessment, including intestinal manometry, Rome III criteria for functional gastrointestinal disorders, and psychological and psychiatric evaluation. Patients with suspected gastroparesis underwent a scintigraphic gastric emptying test. Definitive diagnoses were made at discharge. Results Patients with higher levels of incongruence differed in various sociodemographic (age, educational level, work activity and having children) and psychopathological (all SCL-90-R subscales except anxiety and hostility) characteristics. Using general lineal models, incongruence was found to be the variable with stronger relations with psychopathology even when controlling for diagnosis. Interactions were found between incongruence and diagnosis reflecting a pattern in which patients with functional disorders whose subjective evaluation of functioning is not congruent with that of the clinician, have higher levels of psychopathology than patients with motor disorders. Conclusions Incongruence between clinician and self-reported functionality seems to be related to higher levels of psychopathology in patients with functional disorders. These findings underscore the need for routine psychosocial assessment among these patients. Gastroenterologists could use the concept of incongruence and its clinical implications, as a screening tool for psychopathology, facilitating consultation-liaison processes

Irritábilisbél-szindróma: komorbid pszichiátriai zavarok és pszichológiai kezelési lehetőségek = Irritable bowel syndrome: comorbid psychiatric disorders and psychological treatment options

Absztrakt: Az irritábilisbél-szindróma a lakosság 7–21%-át érintő krónikus funkcionális gastrointestinalis megbetegedés. A betegcsoportot csökkent életminőség, munkahelyi teljesítményromlás és nagymértékű pszichológiai distressz jellemzi. Az érintettek a komorbid pszichiátriai zavarok, hangsúlyosan a depresszív és generalizált szorongásos zavarok megemelkedett prevalenciáját mutatják. Az irritábilisbél-szindróma biopszichoszociális megközelítése, illetve az agy-bél tengelynek a betegség patogenezisében betöltött központi szerepe a pszichológiai beavatkozási lehetőségek szükségességére hívja fel a figyelmet. Ezen intervenciók elsősorban központi idegrendszeri mechanizmusokra, a betegekre jellemző megemelkedett zsigeri érzékenységre, csökkent fájdalomtoleranciára, illetve a gastrointestinalis panaszokhoz kapcsolódó fokozott szorongásra fókuszálnak. Sikeresen csökkentik a betegséggel kapcsolatos negatív hiedelmeket, a maladaptív megküzdési stratégiák alkalmazását, a tünetek katasztrofizációját és a krónikus izomfeszültséget. Ennek következtében szignifikáns tünetjavulást eredményeznek, illetve pozitív hatást gyakorolnak a mentális egészségre és a mindennapi funkcionálásra. A pszichológiai kezelési lehetőségeknek az irritábilisbél-szindróma terápiájában történő alkalmazása, illetve a különböző szakmák dinamikus együttműködése jelentős támogatást jelenthet a családorvosi gyakorlatban, és összességében csökkentheti az egészségügyi ellátórendszer igénybevételét. A jelen áttekintő tanulmány az irritábilisbél-szindrómában megjelenő komorbid pszichiátriai zavarok, illetve a betegség terápiájában alkalmazható, tudományos eredményekkel alátámasztott pszichológiai kezelési eljárások kurrens szakirodalmán alapszik. A ScienceDirect, illetve a PubMed adatbázisok felhasználásával közel 60 tanulmány elemzésére került sor. A legtöbb kutatási eredmény a kognitív viselkedésterápia, illetve a hipnoterápia vonatkozásában jelent meg, mely területeken metaanalíziseket is publikáltak. A különböző stresszkezelési módszerek és relaxációs technikák kérdésköre ezzel szemben rendkívül alulreprezentált. A tudatos jelenlét elméletén alapuló, irritábilisbél-szindrómával élők számára tervezett intervenciók elterjedése pedig további metaelemzéseket sürget. Ennek következtében a testi folyamatok tudatosításán alapuló terápiák szisztematikus vizsgálata a jövőbeli kutatások kiemelt feladata. Orv Hetil. 2018; 159(50): 2115–2121. | Abstract: Irritable bowel syndrome is a chronic functional gastrointestinal disorder with a prevalence of 7–21%. It has a negative impact on health-related quality of life and work productivity and it is associated with increased psychological distress and mental comorbidity, like major depression disorder and generalised anxiety disorder. Due to biopsychosocial factors and the brain-gut axis playing a key role in the aetiology of the disease, the use of psychological treatments has great importance in the therapy of irritable bowel syndrome. These interventions focus on central mechanisms, like visceral sensitivity, pain amplification, hypervigilance and gastrointestinal symptom-specific anxiety. They significantly reduce damaging illness-related cognitions, the use of maladaptive coping strategies, catastrophic appraisals of bodily sensations and chronic muscle tension. The utilization of these treatments is associated with clinically significant symptom improvement and positive mental health outcomes. This review study focuses on the psychiatric comorbidity of irritable bowel syndrome and the use of evidence-based psychological therapies in the treatment of the disease. Using ScienceDirect and PubMed databases, almost 60 studies have been selected. A high number of studies investigate the efficacy of cognitive behaviour therapy and hypnotherapy with meta-analyses included. There is also growing evidence on the beneficial impacts of mindfulness-based stress reduction. Future research will need to concentrate on studying the utility of mind-body therapies such as relaxation techniques in the treatment of irritable bowel syndrome with meta-analyses on the effects of mindfulness-based interventions. Orv Hetil. 2018; 159(50): 2115–21121

A whole new world of healing:exploring medical hypnotherapy for pediatric patients: A review

This narrative review aims to unravel the potential of medical hypnotherapy for the treatment of children with a variety of diseases and symptoms. Going beyond its history and assumed neurophysiology, the chances of success for hypnotherapy will be outlined per pediatric speciality, accentuated by clinical research and experiences. Future implications and recommendations are given on extracting the positive effects of medical hypnotherapy for all pediatricians. Conclusion: Medical hypnotherapy is an effective treatment for children with specified conditions such as abdominal pain or headache. Studies suggest effectiveness for other pediatric disciplines, from the first line up to third line of care. In a time in which health is defined as 'a state of complete physical, mental and social well-being’, hypnotherapy stays an underrated treatment option for children. It is a unique mind–body treatment, which true potential still needs to be unraveled. What is Known: • Mind–body health techniques become a more relevant and accepted part of treatment in pediatric patients. • Medical hypnotherapy is an effective treatment for children with specified conditions such as functional abdominal pain. What is New: • Studies suggest the effectiveness of hypnotherapy in a high variety of pediatric symptoms and disease. • Hypnotherapy is a unique mind–body treatment which potential goes far beyond its current utilization.</p

Gut-directed hypnotherapy significantly augments clinical remission in quiescent ulcerative colitis

Psychotherapy is not routinely recommended for in ulcerative colitis (UC). Gut-directed hypnotherapy (HYP) has been linked to improved function in the gastrointestinal tract and may operate through immune-mediated pathways in chronic diseases