9 January 1999
Pigged Out Over Christmas?
Patients who repeatedly seek treatment for digestive tract symptoms but show no evidence of organic disorder should be identified early on so the psychiatric aspects of their conditions can be examined and treated, British researchers recommend.
This would result in better health prospects for the patients concerned and better use of limited health care resources, they suggest.
The recommendation came after a randomized study of 50 "frequent attender" patients at an outpatient gastroenterology clinic at John Radcliffe Hospital in Oxford, England, found exceptionally high rates of psychiatric disorders and psychological distress
"We have shown that the patients' health problems and health care use frequently persist if managed naturalistically," write Christopher Bass, MD, and his colleagues at the hospital in the January issue of General Hospital Psychiatry. "There may therefore be a case for using the hospital computer system to identify such patients proactively at an earlier stage in their hospital careers so that appropriate management can be instituted. This might usefully involve the development of closer working relationships between gastroenterologists and psychiatric or psychological colleagues."
According to the researchers, 90 percent of the "frequent attender" patients had at least one current psychiatric diagnosis, and 48 percent had at least two. The most common diagnoses were somatoform disorders, anxiety, and depression.
A third of the patients had had a previous episode of major depression, they report, 38 percent reported infrequent panic attacks, and a third of the women in the study reported childhood sexual abuse.
Twenty-two percent of the patients were unable to work because of ill health. Their ratings for general health, vitality, physical role, pain, and social functioning were significantly below standards for persons of matched ages.
On average, the patients had been experiencing their symptoms for five years, and they were more likely to attribute the symptoms to "bowel disease" than to stress or psychological problems.
The researchers selected the randomized 50-person sample from 762 persons identified by hospital computers as making four or more visits a year to the out-patient gastroenterology clinic .