UNDERSTANDING AND TREATING MEDICALLY UNEXPLAINED SYMPTOMS ñ THE EXAMPLE OF IRRITABLE BOWEL SYNDROME

Professor Francis Creed, University of Manchester, U.K.

Medically unexplained symptoms account for a large proportion of medical consultations. In gastroenterology irritable bowel syndrome and functional dyspepsia account for half of all consultations. This presentation will briefly review the evidence that psychological factors interact with physical aetiological factors. The extent to which psychological factors may play a part in symptom causation or exacerbation, will be illustrated using evidence from treatment trials. The most recent of these included 250 subjects which severe irritable bowel syndrome who were randomised to brief interpersonal psychodynamic therapy, an SSRI antidepressant or treatment as usual. The results indicate that psychological treatments lead to improvement in health related quality of life in the long term at no additional cost. This improvement will be examined in relation to changes in pain, depression and number of other bodily symptoms and also in relation to a reported history of sexual abuse. The last was associated with greater improvement in the psychological treatment groups. Further evidence indicating the role of prior adversity in relation to outcome comes from clinical studies of patients with medically unexplained symptoms in several clinics. A provisional model which indicates the relationship between prior trauma, depression and worry about illness in functional disorders will be proposed. The implications for psychological treatment in patients with irritable bowel syndrome and functional dyspepsia will be stressed.