Intervention to increase physical activity in irritable bowel syndrome shows long-term positive effects

AIM: To assess the long-term effects of physical activity on irritable bowel syndrome(IBS) symptoms and on quality of life, fatigue, depression and anxiety.METHODS: Seventy-six patients from a previous randomized controlled interventional study on increased physical activity in IBS were asked to participate in this long-term follow-up study. The included patients attended one visit in which they filled out questionnaires and they underwent a submaximal cycle ergometer test. The primary end point was the change in the IBS Severity Scoring System(IBS-SSS) at baseline, i.e., before the intervention and at follow-up. The secondary endpoints were changes in quality of life, fatigue, depression and anxiety.RESULTS: A total of 39 [32 women, median age 45(28-61) years] patients were included in this followup. Median follow-up time was 5.2(range: 3.8-6.2) years. The IBS symptoms were improved compared with baseline [IBS-SSS: 276(169-360) vs 218(82-328), P = 0.001]. This was also true for the majority of the dimensions of psychological symptoms such as disease specific quality of life, fatigue, depression and anxiety. The reported time of physical activity during the week before the visit had increased from 3.2(0.0-10.0) h at baseline to 5.2(0.0-15.0) h at follow-up, P = 0.019. The most common activities reported were walking, aerobics and cycling. There was no significant difference in the oxygen uptake 31.8(19.7-45.8) m L per min per kg at baseline vs 34.6(19.0-54.6) m L/min per kg at follow-up.CONCLUSION: An intervention to increase physical activity has positive long-term effects on IBS symptoms and psychological symptoms.     

Risk factors for proton pump inhibitor refractoriness in Chinese patients with non-erosive reflux disease

AIM:To analyze risk factors for refractoriness to proton pump inhibitors(PPIs) in patients with non-erosive reflux disease(NERD).METHODS:A total of 256 NERD patients treated with the PPI esomeprazole were enrolled.They were classified into symptom-free and residual symptoms groups according to Quality of Life in Reflux and Dyspepsia(QolRad) scale.All subjects completed questionnaires on psychological status(self-rating anxiety scale;selfrating depression scale) and quality of life scale(Short Form 36).Multivariate analysis was used to determine the predictive factors for PPI responses.RESULTS:According to QolRad,97 patients were confirmed to have residual reflux symptoms,and the remaining 159 patients were considered symptom free.There were no significant differences between the two groups in lifestyle factors(smoking and alcohol consumption),age,Helicobacter pylori infection,and hiatal hernia.There were significant differences between the two groups in relation to sex,psychological distress including anxiety and depression,body mass index(BMI),and irritable bowel syndrome(IBS)(P < 0.05).Logistic regression analysis found that BMI < 23,comorbid IBS,anxiety,and depression were major risk factors for PPI resistance.Symptomatic patients had a lower quality of life compared with symptom-free patients.CONCLUSION:Some NERD patients are refractory to PPIs and have lower quality of life.Residual symptoms are associated with psychological distress,intestinal disorders,and low BMI.     

Heartburn in children and adolescents in the presence of functional dyspepsia and/or irritable bowel syndrome correlates with the presence of sleep disturbances,anxiety, and depression

The aim of this study was to assess the relationship of heartburn in pediatric patients with functional dyspepsia (FD) and irritable bowel syndrome (IBS) with gastrointestinal symptoms, sleep disturbances, and psychologic distress.The overlap in symptoms of FD, IBS, and gastroesophageal reflux disease (GERD) predicts greater symptom severity and decreased quality of life and presents opportunities for improved diagnostic classification and personalized therapeutics.A cross-sectional observational study of 260 pediatric patients with abdominal pain was conducted. Patients completed standardized questionnaires assessing clinical symptoms, sleep quality, and psychologic symptoms during routine clinical care. Questionnaire data were compared for patients reporting heartburn and not reporting heartburn using χ² and t tests where appropriate.Gastrointestinal symptoms were significantly more prevalent among patients with a positive report of heartburn (vs a negative report of heartburn): pain with eating (83% vs 67%, P = .007), bloating (63% vs 44%, P = .005), acid regurgitation (47% vs 24%, P ≤ .001), and chest pain (45% vs 20%, P ≤ .001). Likewise, initiating and maintaining sleep (P = .007), arousal/nightmares (P = .046), sleep-wake transition (P = .001), hyperhidrosis during sleep (P = .016), and anxiety (P = .001) and depression (P = .0018) were also significantly increased in patients who reported heartburn versus patients who did not report heartburn.Patients with a positive report of heartburn, whether classified as having FD and/or IBS, had increased gastrointestinal symptoms, sleep disturbances, anxiety, and depression than patients with a negative report of heartburn. A better understanding of these associations may allow for personalized treatment for youth with abdominal pain and heartburn as a primary symptom.     

Prevalencia de síntomas de intestino irritable en población asistente a centros comerciales de Santiago de Chile

BackgroundIrritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by abdominal pain or discomfort that is associated with altered bowel habit. Both its prevalence and clinical characteristics vary throughout Latin America. A percentage of patients does not seek medical attention, therefore a reliable prevalence figure can only be established by interviewing non-selected populations.AimsTo study the prevalence and clinical characteristics of IBS symptoms in non-selected subjects in Santiago, Chile.MethodsA total of 437 shopping mall visitors above the age of 15 years (246 women) participated in the study by answering the Rome II validated questionnaire for IBS. The demographic and socioeconomic backgrounds, comorbidities, and a family history of IBS were registered.ResultsA total of 64.1% subjects reported having gastrointestinal symptoms and 28.6% had symptoms suggestive of IBS. When the subjects with IBS symptoms were compared with the asymptomatic individuals, a predominance of women (65.6 vs. 42.9, P<.001) and a greater cholecystectomy frequency (33.6 vs. 12.9% P<.05) were observed in the former. The age of symptom onset was 30.4 years. An equal percentage of subjects (42.4%) presented with diarrhea and constipation and 15.2% presented with alternating IBS. Participants with a higher educational level reported a lower percentage of IBS (P<.05). A family history of the disease was present in 40% of the subjects with IBS, compared with 14.9% in the asymptomatic individuals (P<.05). Only 39.2% of the subjects had seen a physician for their symptoms and the treatment and tests ordered were inappropriate.ConclusionThe prevalence of IBS symptoms in the population studied is one of the highest described. Therefore, health teams should have the necessary knowledge and skill required for its management.     

Prevalence of irritable bowel syndrome in young adult Malaysians: a survey among medical students

BACKGROUND AND AIMS: Irritable bowel syndrome (IBS) is a common functional bowel disease in the West. Information on the prevalence of IBS in the Asian population is relatively scanty. The aims of the present study were to determine the prevalence of IBS and to assess the symptom subgroups based on the predominant bowel habit in a young adult population of Asian origin. METHODS: Basic demographic data and symptoms of IBS using the Rome I criteria were sought using a questionnaire administered to all apparently healthy students in a medical school. Other questions asked related to alcohol intake, smoking, chili consumption, dietary fiber intake, and to psychological and psychosomatic symptoms of anxiety, depression, insomnia, headache, and backache. The health-care seeking behavior of the subjects was also analyzed. RESULTS: Of the 610 questionnaires administered, 533 complete responses were received (response rate of 87.4%). The responders comprised 229 men (43.0%) and 304 (57.0%) women with a mean age of 22 +/- 1.8 years. The ethnic distribution was Malays 278 (52.2%), Chinese 179 (33.6%), Indians 46 (8.6%), and others 30 (5.6%). Eighty-four (15.8%) reported symptoms consistent with the diagnosis of IBS, predominantly women. Sixty-five (77.4%) and six (7.1%) were of the constipation-predominant and diarrhea-predominant IBS subgroups, respectively. Thirteen (15.5%) subjects fell into the non-specific IBS subgroup. The self-reported psychological and psychosomatic symptoms of anxiety (P = 0.02), depression (P = 0.002), insomnia (P = 0.006), headache (P = 0.04), and backache (P = 0.006) were encountered more frequently in the subjects with IBS. Only 13.1% of the IBS group had consulted their health-care practitioner, and 20.2% reported self-medication. CONCLUSIONS: Symptoms supportive of the diagnosis of IBS were common among young Malaysians, with a prevalence rate of 15.8%. There were significantly more women with IBS than men. Within the IBS population, the majority (77.4%) was of the constipation-predominant IBS subgroup. A significantly higher prevalence of psychological and psychosomatic symptoms was found in individuals with IBS. Only a minority sought medical advice for their symptoms.     

Comorbid elevated symptoms of anxiety and depression in adults with type 1 or type 2 diabetes: Results from the International Diabetes MILES Study

AimsWe examined: (a) the prevalence of comorbid elevated symptoms of anxiety/depression; (b) its demographic/clinical correlates; (c) associations with self-care behaviors, by diabetes type.MethodsCross-sectional self-report data of 6590 adults with diabetes (42% type 1; 58% type 2) from the Australian and Dutch Diabetes MILES studies were used. Elevated symptoms of anxiety/depression were defined as GAD-7 ≥ 10/PHQ-9 ≥ 10.ResultsIn both diabetes types, comorbid elevated symptoms of anxiety/depression were present in 9% and symptoms of anxiety alone in 2%; symptoms of depression alone were present in 8% of adults with type 1 diabetes and 11% with type 2 diabetes. Shorter diabetes duration (type 1 only) was the only characteristic that distinguished those with comorbid elevated symptoms of anxiety/depression but not those with symptoms of anxiety/depression alone from the reference group (no/minimal symptoms of anxiety/depression). Those with comorbid elevated symptoms of anxiety/depression had increased odds of sub-optimal diabetes self-care behaviors compared with the reference group, with higher odds than those with symptoms of anxiety or depression alone.ConclusionsComorbid elevated symptoms of anxiety/depression affected one in ten respondents, who also had increased odds of suboptimal diabetes self-care. Those with shorter type 1 diabetes duration may be at increased risk.     

Association between gastrointestinal symptoms and affectivity in patients with bipolar disorder

AIMTo study if anxiety, depression and experience of stress are associated with gastrointestinal (GI) symptoms in patients with bipolar disorder.METHODSA total of 136 patients with bipolar disorder (mean age 49.9 years; 61% women) and 136 controls from the general population (mean age 51.0 years; 60% women) were included in the study. GI symptoms were assessed with The Gastrointestinal Symptom Rating Scale-irritable bowel syndrome (GSRS-IBS), level of anxiety and depression with The Hospital Anxiety and Depression Scale (HADS) and stress-proneness with Perceived Stress Questionnaire. Over a ten year period, all visits in primary care were retrospectively recorded in order to identify functional GI disorders.RESULTSIn subjects with low total HADS-score, there were no significant differences in GI-symptoms between patients and controls (GSRS-IBS 7.0 vs 6.5, P = 0.513). In the patients with bipolar disorder there were significant correlations between all GSRS and HADS subscores for all symptom clusters except for “constipation” and “reflux”. Factors associated to GI symptoms in the patient group were female sex (adjusted OR = 2.37, 95%CI: 1.07-5.24) and high HADS-Depression score (adjusted OR = 3.64, 95%CI: 1.07-12.4). These patients had also significantly more visits for IBS than patients with low HADS-Depression scores (29% vs 8%, P = 0.008). However, there was no significant differences in consulting behaviour for functional GI disorders between patients and controls (25% vs 17%, P = 0.108).CONCLUSIONFemale patients and patients with high HADS depression score reported significantly more GI symptoms, whereas patients with low HADS scores did not differ from control subjects.     

Gastrointestinal symptoms are associated with hypothalamic-pituitary-adrenal axis suppression in healthy individuals

OBJECTIVE: The brain-gut axis has been proposed to influence symptoms in irritable bowel syndrome (IBS). In animal studies corticotropin-releasing hormone (CRH) challenge has been associated with decreased upper gastrointestinal motility and increased colonic motility. The purpose of this study was to investigate the association between gastrointestinal symptoms and the effect of CRH on the hypothalamic-pituitary-adrenal (HPA) axis using a weight-adjusted low-dose dexamethasone test in a group of healthy individuals (n = 157). MATERIAL AND METHODS: Pre- and post-dexamethasone morning serum cortisol was analysed. All participants completed questionnaires regarding symptoms of IBS (GSRS-IBS (Gastrointestinal Symptom Rating Scale-IBS) and symptoms of anxiety and depression (HADS (Hospital Anxiety and Depression Scale)). After exclusions, 124 subjects were available for analysis (F/M: 60/64, mean age 55.8 years, SD 15.4, range 21-80 years). RESULTS: A positive correlation was found between the GSRS-IBS score and HADS score (rs =0.36; p <0.001). There was no linear correlation between either pre- (rs = 0.145; p = 0.11) or post-dexamethasone cortisol levels (rs =0.087; p =0.337) and GSRS-IBS scores. By subgrouping the subjects at the lower and higher 25th percentiles of their post-dexamethasone morning cortisol levels, we found a trend towards a higher GSRS-IBS score (median 7.0 versus 5.0; p =0.069) (multivariate adjusted OR 2.6; CI 0.80-8.3) and a significantly higher diarrhoea score (median 2 versus 0; p = 0.021) (multivariate adjusted OR 5.7; CI 1.5-22), and a higher early satiety score (p=0.008) (multivariate adjusted OR 6.7; CI: 1.9-23) in the subjects with high post-dexamethasone cortisol levels (low HPA suppression) compared with the subjects with intermediate post-dexamethasone cortisol levels. Furthermore, individuals with low post-dexamethasone cortisol levels (high HPA suppression) showed a significant, higher score for diarrhoea (median 2.0 versus 0; p =0.010) (multivariate adjusted OR 6.1; CI 1.8-20) and early satiety (p=0.076) (multivariate adjusted OR 3.2; CI 1.0-10) compared with those with intermediate cortisol levels. CONCLUSIONS: A trend toward a non-linear relationship between IBS-like symptoms and post-dexamethasone cortisol levels was observed in healthy individuals, with significantly more symptoms of diarrhoea and early satiety in individuals with high or low post-dexamethasone cortisol levels in comparison with those with intermediate post-dexamethasone cortisol levels.     

精神心理因素在肠易激综合征和功能性消化不良重叠症中的作用

目的探讨精神心理因素在肠易激综合征和功能性消化不良重叠症中的作用。方法对38例肠易激综合征（iBS）与功能性消化不良（FD）重叠症患者采用汉密尔顿焦虑量表（HAMA）14项和汉密尔顿抑郁量表（HAMD）17项版本进行心理测评,并将调查对象分为体力劳动组和非体力劳动组,比较分析各组评分的特点。结果女性FD与IBS重叠症患者焦虑抑郁障碍发病率较男性无显著性差异（68．2％vs75．0％,X2=0．21,P〉0．05）,非体力劳动者FD与IBS重叠症患者焦虑抑郁障碍发病率较体力劳动者显著升高（85．2％vs36．4％,X2=9．09,P〈0．005）。结论非体力劳动者FD与IBS重叠症患者合并精神心理压力可能通过增加内脏敏感性使FD与IBS重叠症发病率更高,提示心理治疗可能有助于治疗FD与IBS重瞢症。     

Prevalence of irritable bowel syndrome and its relationship with psychological stress status in Chinese university students

Background and Aims: Although irritable bowel syndrome (IBS) is a common disorder in the West, information on the prevalence of IBS in university students is relatively scant, especially in Asia. The aims of the present study were to investigate the prevalence and pattern of symptoms of IBS and its relationship with psychological stress status in Chinese university students. Methods: Basic demographic data and IBS symptoms were sought using the Rome II criteria and a validated bowel symptom questionnaire. Another questionnaire used related to psychosomatic symptoms of depression and anxiety. Results: In total, 491 of the 530 students in the trial met the selected criteria, which included 241 men. The participants were medical college students (313/491) and non‐medical college students (178/491). The apparent prevalence of IBS was 15.7%, with a prevalence of 14.5% in men and 16.8% in women. The most common symptom was abdominal pain associated with change in the consistency of stool (36.9%), followed by altered stool frequency (16.3%), and abdominal pain relieved by defecation (12.4%), predominantly in women. The self‐reported psychological and psychosomatic symptoms of anxiety (P < 0.001) and depression (P < 0.001) were encountered more frequently in participants with IBS. The depression (P = 0.03) and anxiety measures (P = 0.02) significantly predicted IBS status. Conclusion: The prevalence of IBS in Chinese university students is often compared with university students in developed countries and the general Chinese population. Depression and anxiety could potentially induce IBS. Medical education should be considered when aiming to reduce stress of university students who are susceptible to IBS.     

Anxiety and depression in various functional gastrointestinal disorders: Do differences exist?

OBJECTIVE: To examine the differences in the prevalence and severity of anxiety and depression in patients with functional dyspepsia (FD), nonerosive reflux disease (NERD), irritable bowel syndrome (IBS) and healthy controls. METHODS: Consecutive patients undergoing an index endoscopic examination for various symptoms were interviewed. All the three functional gastrointestinal disorders (FGIDs) were diagnosed according to the Rome III criteria. Anxiety and depression were diagnosed using a locally validated version of the hospital anxiety and depression scale. RESULTS: A total of 248 patients were recruited (62 in FD, NERD, IBS and control groups each) with no differences in the basic characteristics. There was a higher prevalence of anxiety and depression in FD, NERD and IBS groups than that in the control group (43.5%, 45.2% and 67.7% vs 14.5%, P < 0.001; and 22.6%, 33.9% and 38.7% vs 6.5%, P < 0.0001). Using the cut‐off score (> 8) for anxiety or depression, IBS patients had a higher rate of anxiety than FD (P = 0.01) and NERD (P = 0.02), while no significant differences in depression rates were observed among all three groups. CONLUSION: Anxiety is more common in patients with IBS than in those with FD and NERD, indicating a possible causal link in the former.     

Comorbidity and use of health-care services among irritable bowel syndrome sufferers

OBJECTIVE: Patients suffering from irritable bowel syndrome (IBS) have more somatic and psychiatric comorbidity and use more health-care services for comorbid conditions than do other patients. Little is known about the frequency of comorbid symptoms among IBS sufferers in the general population and their influence on use of health-care facilities. The objective of this study was to compare the frequency of somatic and psychiatric symptoms between IBS sufferers and controls in the general population, and to study how comorbidity rates are distributed among consulters and non-consulters and how they predict the use of health care-services. MATERIAL AND METHODS: By means of a questionnaire sent to 5000 randomly selected adults IBS was identified according to the Rome II criteria. The questionnaire also covered upper GI symptoms, non-GI somatic symptoms, depression and anxiety. A logistic regression analysis with 26 variables was carried out to determine the independent predictors of health-care seeking for GI and non-GI complaints. RESULTS: The response rate was 73% and prevalence of IBS 5.1% (95% CI 4.4-5.8%). Dyspeptic symptoms, somatic extra-GI symptoms and psychiatric symptoms were reported by 45%, 69% and 51% of IBS sufferers, respectively, and 6%, 35% and 27%, of controls, respectively. Visiting a physician because of GI complaints was associated with disturbing abdominal symptoms, but not with depression or anxiety. Of the present GI conditions, only dyspeptic symptoms were associated with an increased consultation rate also for non-GI complaints. CONCLUSIONS: In the general population, both IBS consulters and non-consulters demonstrate high rates of comorbidity. Seeking health care for abdominal complaints is associated with abdominal symptoms rather than psychiatric comorbidity.     

Depression and Health-Related Quality of Life in Chronic Obstructive Pulmonary Disease

Background

Prior research on the risk of depression in chronic obstructive pulmonary disease (COPD) has yielded conflicting results. Furthermore, we have an incomplete understanding of how much depression versus respiratory factors contributes to poor health-related quality of life.

Methods

Among 1202 adults with COPD and 302 demographically matched referents without COPD, depressive symptoms were assessed using the 15-item Geriatric Depression Score. We measured COPD severity using a multifaceted approach, including spirometry, dyspnea, and exercise capacity. We used the Airway Questionnaire 20 and the Physical Component Summary Score to assess respiratory-specific and overall physical quality of life, respectively.

Results

In multivariate analysis adjusting for potential confounders including sociodemographics and all examined comorbidities, COPD subjects were at higher risk for depressive symptoms (Geriatric Depression Score ≥6) than referents (odds ratio [OR] 3.6; 95% confidence interval [CI], 2.1-6.1; P <.001). Stratifying COPD subjects by degree of obstruction on spirometry, all subgroups were at increased risk of depressive symptoms relative to referents (P <.001 for all). In multivariate analysis controlling for COPD severity as well as sociodemographics and comorbidities, depressive symptoms were strongly associated with worse respiratory-specific quality of life (OR 3.6; 95% CI, 2.7-4.8; P <.001) and worse overall physical quality of life (OR 2.4; 95% CI, 1.8-3.2; P <.001).

Conclusions

Patients with COPD are at significantly higher risk of having depressive symptoms than referents. Such symptoms are strongly associated with worse respiratory-specific and overall physical health-related quality of life, even after taking COPD severity into account.     

Relationship of functional gastrointestinal disorders and psychiatric disorders： Implications for treatment

This article revisits the links between psychopathology and functional gastrointestinal disorders such as irritable bowel syndrome （IBS）, discusses the rational use of antidepressants as well as non-pharmacological approaches to the management of IBS, and suggests guidelines for the treatment of IBS based on an interdisciplinary perspective from the present state of knowledge. Relevant published literature on psychiatric disorders, especially somatization disorder, in the context of [BS, and literature providing direction for management is reviewed, and new directions are provided from findings in the literature. IBS is a heterogeneous syndrome with various potential mechanisms responsible for its clinical presentations. IBS is typically complicated with psychiatric issues, unexplained symptoms, and functional syndromes in other organ systems. Most IBS patients have multiple complaints without demonstrated cause, and that these symptoms can involve systems other than the intestine, e.g. bones and joints （fibromyalgia, temporomandibular joint syndrome）, heart （non-cardiac chest pain）, vascular （post-menopausal syndrome）, and brain （anxiety, depression）. Host IBS patients do not have psychiatric illness per se, but a range of psychoform （psychological complaints in the absence of psychiatric disorder） symptoms that accompany their somatoform （physical symptoms in the absence of medical disorder） complaints. It is not correct to label IBS patients as psychiatric patients （except those more difficult patients with true somatization disorder）. One mode of treatment is unlikely to be universally effective or to resolve most symptoms. The techniques of psychotherapy or cognitive-behavioral therapy can allow IBS patients to cope more readily with their illness. Specific episodes of depressive or anxiety disorders can be managed as appropriate for those conditions. Medications designed to improve anxiety or depression are not uniformly useful for psychiatric complaints in IBS, because the p     

Comorbidity and use of health-care services among irritable bowel syndrome sufferers

Objective. Patients suffering from irritable bowel syndrome (IBS) have more somatic and psychiatric comorbidity and use more health-care services for comorbid conditions than do other patients. Little is known about the frequency of comorbid symptoms among IBS sufferers in the general population and their influence on use of health-care facilities. The objective of this study was to compare the frequency of somatic and psychiatric symptoms between IBS sufferers and controls in the general population, and to study how comorbidity rates are distributed among consulters and non-consulters and how they predict the use of health care-services. Material and methods. By means of a questionnaire sent to 5000 randomly selected adults IBS was identified according to the Rome II criteria. The questionnaire also covered upper GI symptoms, non-GI somatic symptoms, depression and anxiety. A logistic regression analysis with 26 variables was carried out to determine the independent predictors of health-care seeking for GI and non-GI complaints. Results. The response rate was 73% and prevalence of IBS 5.1% (95% CI 4.4–5.8%). Dyspeptic symptoms, somatic extra-GI symptoms and psychiatric symptoms were reported by 45%, 69% and 51% of IBS sufferers, respectively, and 6%, 35% and 27%, of controls, respectively. Visiting a physician because of GI complaints was associated with disturbing abdominal symptoms, but not with depression or anxiety. Of the present GI conditions, only dyspeptic symptoms were associated with an increased consultation rate also for non-GI complaints. Conclusions. In the general population, both IBS consulters and non-consulters demonstrate high rates of comorbidity. Seeking health care for abdominal complaints is associated with abdominal symptoms rather than psychiatric comorbidity.     

Helicobacter pylori infection and short-term intake of low-dose aspirin have different effects on alpha-1 antitrypsin/alpha-1 peptidase inhibitor (α1-PI) levels in antral mucosa and peripheral blood

Objective. Irritable bowel syndrome (IBS) is common in the population, but not all subjects seek professional health care for their symptoms. The aim of this study was to compare consulters in secondary/tertiary care with those in primary care and non-consulters by using questionnaires to investigate factors of importance for health-care seeking in IBS. Material and methods. The study included 218 subjects with IBS: 70 non-consulters, 53 patients from primary care and 95 from secondary/tertiary care. The subjects completed questionnaires on gastrointestinal (GI) and psychological symptoms, coping resources, health-related quality of life (HRQOL) and reasons for not seeking health care. Results. Consulters (primary and secondary/tertiary care combined) had poorer HRQOL, more severe psychological symptoms, higher levels of GI-specific anxiety and poor coping resources compared with non-consulters, but the GI symptom severity was similar. Mental health and poor social, emotional and physical functioning were independently predictive of being a health-care seeker (r²=0.41). Independent predictors for being a consulter in secondary/tertiary care were a high degree of anxiety, low scores on physical functioning, physical role and food (IBSQOL) (r²=0.65). Several non-consulters reported mild symptoms and ability to control symptoms as reasons for not seeking health care. Having a close relative with similar symptoms reduced the need to seek health care. Thirty-six non-consulters had sought alternative care or advice from friends and/or relatives about their GI symptoms. Conclusions. GI symptom severity alone cannot explain the illness behavior in IBS. HRQOL and psychological symptoms are important for experience of GI symptoms and the health-care seeking pattern in IBS.     

Why do subjects with irritable bowel syndrome seek health care for their symptoms?

OBJECTIVE: Irritable bowel syndrome (IBS) is common in the population, but not all subjects seek professional health care for their symptoms. The aim of this study was to compare consulters in secondary/tertiary care with those in primary care and non-consulters by using questionnaires to investigate factors of importance for health-care seeking in IBS. MATERIAL AND METHODS: The study included 218 subjects with IBS: 70 non-consulters, 53 patients from primary care and 95 from secondary/tertiary care. The subjects completed questionnaires on gastrointestinal (GI) and psychological symptoms, coping resources, health-related quality of life (HRQOL) and reasons for not seeking health care. RESULTS: Consulters (primary and secondary/tertiary care combined) had poorer HRQOL, more severe psychological symptoms, higher levels of GI-specific anxiety and poor coping resources compared with non-consulters, but the GI symptom severity was similar. Mental health and poor social, emotional and physical functioning were independently predictive of being a health-care seeker (r (2)=0.41). Independent predictors for being a consulter in secondary/tertiary care were a high degree of anxiety, low scores on physical functioning, physical role and food (IBSQOL) (r (2)=0.65). Several non-consulters reported mild symptoms and ability to control symptoms as reasons for not seeking health care. Having a close relative with similar symptoms reduced the need to seek health care. Thirty-six non-consulters had sought alternative care or advice from friends and/or relatives about their GI symptoms. CONCLUSIONS: GI symptom severity alone cannot explain the illness behavior in IBS. HRQOL and psychological symptoms are important for experience of GI symptoms and the health-care seeking pattern in IBS.     

Depression and anxiety were low amongst virally suppressed,long-term treated HIV-infected individuals enrolled in a public sector antiretroviral program in Thailand*

HIV/AIDS and anxiety/depression are interlinked. HIV-infected patients suffering from depression may be at risk for poor adherence which may contribute to HIV disease progression. Additionally, an HIV diagnosis and/or using certain antiretroviral agents may trigger symptoms of anxiety/depression. The objective of the study was to assess the prevalence and factors associated with anxiety and depression in HIV-infected patients from the Thai National HIV Treatment Program. This cross-sectional study was performed from January 2012 to December 2012 in HIV-infected out-patients, aged ≥18 years, from three HIV referral centers. Symptoms of anxiety and depression were measured using the Thai-validated Hospital Anxiety and Depression Scale (HADS). A score of ≥11 was defined as having anxiety and depression. Associated factors were assessed by multivariate logistic regression. Totally 2023 (56% males) patients were enrolled. All patients received antiretroviral therapy (ART) for a mean duration of 7.7 years. Median CD4 was 495?cells/mm³. Ninety-five percent had HIV-RNA?p?=?.01], having adherence <90% [OR?=?2.2(95%CI 1.5–3.4), p?p?p?=?.01], were independently associated with having anxiety or depression. Our findings demonstrated that prevalence of depression and anxiety was low amongst virally suppressed, long-term antiretroviral-treated HIV-infected individuals. Some key characteristics such as the female sex, poor adherence, poor/fair QOL and EFV exposure are associated with anxiety and depression. These factors can be used to distinguish who would need a more in-depth evaluation for these psychiatric disorders.     

Nefazodone treatment of comorbid alcohol dependence and major depression

BACKGROUND: Major depression is a common comorbid condition among individuals with alcohol dependence. This study examined the effects of nefazodone, a norepinephrine and serotonin reuptake blocker and 5-hydroxytryptamine-2 receptor antagonist, on mood and anxiety symptoms and drinking behavior in a sample of depressed alcoholics. METHODS: This study was a double-blind, placebo-controlled comparison of nefazodone (200-600 mg/day) or placebo in a sample of alcohol-dependent subjects (n = 41; 52% women) with current major depression. After a 1-week placebo lead-in period, subjects were randomly assigned to receive study medication and supportive psychotherapy for 10 weeks. RESULTS: Depressive and anxiety symptoms declined significantly over time. Although the nefazodone group showed greater reductions in these symptoms, the effects did not reach statistical significance. Nonetheless, nefazodone-treated subjects showed a significantly greater reduction in heavy drinking days and in total drinks compared with placebo-treated subjects. CONCLUSIONS: The lack of significant effects on depression and anxiety symptoms may reflect limited statistical power. Despite the small sample size, nefazodone significantly reduced some measures of alcohol consumption in this sample of depressed alcoholics.