Psychologically mediated abdominal pain in surgical and medical outpatients clinics.

Abstract

SummaryNinety-six patients complaining of recurrent or persistent abdominal pain were referred consecutively to a surgical clinic and a medical clinic, respectively. They were examined psychiatrically after their initial physical investigation. The psychiatric examination included rating scales for depression and anxiety, a personality inventory, life-events schedule, scale of verbal expressivity, and family and personal patterns of pain and invalidism.Only 15 patients (15 6%) had organic disorders that could be responsible for their symptoms. In the remainder, psychiatric factors were considered primarily responsible for their abdominal pain: 31 were depressed; 21 had chronic tension; in 17 hysterical mechanisms were prominent; and 12 were found to be unrecognised alcoholics. Follow-up at three and six months and recognition by 80% of the psychogenic group that a psychological explanation was plausible, confirmed the diagnoses, and over half responded favourably to psychiatric management. Features distinguishing the organic and psychogenic groups were delineated. Psychiatric assessment has a place among the investigations of non-acute abdominal pain; certainly it should not be considered simply as "a last resort."

Significant psychological morbidity occurs in irritable bowel syndrome: a case‐control study using a pharmacy reimbursement database

“…For example, Gomez and Dally's uncontrolled study, set in a tertiary hospital's gastroenterology and surgery clinics, estimated that 100% of their cohort with 'non-organic' abdominal pain had a psychological explanation for this, including depression, 'hysterical symptoms' and 'concealed alcoholism'. 52 Early studies frequently focused on psychological stresses that were thought to be important in the aetiology of IBS, such as life events. 52,53 Progress occurred with the development of validated tools to measure personality traits.…”

“…52 Early studies frequently focused on psychological stresses that were thought to be important in the aetiology of IBS, such as life events. 52,53 Progress occurred with the development of validated tools to measure personality traits. 54 The first study to use standardized diagnostic criteria to assess depression and anxiety inpatients with IBS and controls in a tertiary referral centre population was performed by Young and colleagues in 1976, estimating a prevalence of depression in IBS patients and controls at 17% vs. 6% and anxiety at 3.5% vs. 3%.…”

Importance of a Physical Examination for Efficient Differential Diagnosis of Abdominal Pain: Diagnostic Usefulness of Carnett's Test in Psychogenic Abdominal Pain

“…The pain is consistent with the anatomy of the nervous system, and no organic pathological or pathophysiological mechanism can be classified to the physical findings. Patients usually appear well compared with intra-abdominal patients (15,16). In this issue of Internal Medicine, Takada et al evaluated the diagnostic usefulness of Carnett's test for psychogenic abdominal pain, which was established by a retrospective study in 5,399 outpatients with abdominal pain.…”

Diagnostic Usefulness of Carnett's Test in Psychogenic Abdominal Pain

“…It was reported that 85% of patients with recurrent or persistent abdominal pain with no obvious organic causes have psychogenic pain and more than 50% of them respond to psychiatric treatment (21). Thus, the correct identification of psychogenic abdominal pain is important to improve the management of such patients.…”