Anxiety Disorders: Olden KW

Jones MP, Crowell MD, Olden KW, Creed F. · Feinberg School of Medicine, Northwestern University, Chicago, IL 60611-2908, USA. · Psychosomatics. · Pubmed #17329601 links to  free full text

Abstract: Functional gastrointestinal disorders (FGID) are common conditions, with well-established diagnostic criteria. They are associated with impaired health-related quality of life and increased societal and healthcare costs. Their symptoms are probably related to altered 5-HT transmission and central processing of noxious visceral stimuli. Evaluation and treatment are best formulated using a biopsychosocial model that integrates gut function with psychosocial assessment. Psychological therapies may improve overall well-being and appear to help patients without significant psychiatric comorbidity. Antidepressants help comorbid anxiety and depressive disorders and have primary efficacy in improving the symptoms of FGID. Finally, there is a need for greater involvement of psychiatrists in both the evaluation and treatment of patients with FGID as well as the education and training of practitioners caring for these patients.

Levy RL, Olden KW, Naliboff BD, Bradley LA, Francisconi C, Drossman DA, Creed F. · University of Washington, Seattle, Washington 98105, USA. · Gastroenterology. · Pubmed #16678558 No free full text.

Abstract: This report reviews recent research on the psychosocial aspects of the functional gastrointestinal disorders (FGIDs). A review and evaluation of existing literature was conducted by a multidisciplinary committee of experts in this field. This report is a synopsis of a chapter published in the Rome III book. The committee reached consensus in finding considerable evidence supporting the association between psychological distress, childhood trauma and recent environmental stress, and several of the FGIDs but noted that this association is not specific to FGIDs. There is also considerable evidence that psychosocial variables are important determinants of the outcomes of global well-being, health-related quality of life, and health care seeking. In line with these descriptive findings, there is now increasing evidence that a number of psychological treatments and antidepressants are helpful in reducing symptoms and other consequences of the FGIDs in children and adults. The FGIDs are a result of complex interactions between biological, psychological, and social factors, and they can only be treated satisfactorily when all these factors are considered and addressed. Therefore, knowledge about the psychosocial aspects of FGIDs is fundamental and critical to the understanding, assessment, and treatment of these disorders. More extensive physician training is needed if these aspects of treatment are to be used effectively and widely in clinical practice.

Olden KW. · Department of Gastroenterology, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, AZ 85259, USA. · Gastroenterol Clin North Am. · Pubmed #15062438 No free full text.

Abstract: There is some evidence to support a psychosocial link to GERD,although it is a weak one. The little research that has been done in this area is, in general, poor and inconclusive. Better designed studies must be done.The elements that seem to offer the best possibilities for research in GERD are the psychological variables involved in care seeking and the variations between care seekers and non-care seekers. In addition, research on psychosocial predictors of response to proton pump inhibitors, prokinetic agents, and antidepressants and other pain-modulating drugs need to be better understood.The psychosocial link to NCCP is stronger with regard to panic disorder,but much research needs to be done. Despite the paucity of well done,rigorously controlled studies in NCCP patients, that there is a high prevalence of psychiatric disturbance in this group. Parental health and childhood trauma are intriguing areas for further research, particularly in light of the connection between abuse and IBS and other functional GI disorders.Finally, panic disorder has been established as an important comorbidity of NCCP. It also merits more research, particularly into the pathophysiology that may link these two disorders.

Olden KW, Drossman DA. · Department of Medicine, Mayo Clinic Scottsdale, Arizona, USA. · Med Clin North Am. · Pubmed #11026930 No free full text.

Abstract: There has been an explosion in understanding of the psychosocial concomitants of functional gastrointestinal disorders. Detecting psychologic disturbance and eliciting a history of physical or sexual abuse are critical in suggesting comprehensive and efficacious treatment strategies for these patients. The challenge is to define further the use of psychopharmacologic agents, including the newer antidepressants, anticonvulsants, and anxiolytic agents, in the treatment of chronic functional gastrointestinal disorders. Further research to evaluate the usefulness of various forms of psychotherapeutic and behavioral interventions needs to be undertaken. Establishing a multicomponent treatment program delivered by a team of caregivers, each bringing their unique skills (internist, psychiatrist, psychologist, and others) to patients, must be based on further research on the efficacy of these modalities as opposed to empiric treatment.

Olden KW. · Department of Medicine and Psychiatry, Mayo Clinic Scottsdale, AZ 85259, USA. · Semin Gastrointest Dis. · Pubmed #10065771 No free full text.

Abstract: Gastroenterology has always been a collaborative specialty. Through the years, gastroenterologists have created important partnerships with pathologists, radiologists, surgeons, gynecologists, and pediatricians. These collaborative relationships have greatly enhanced patient care and research. This article reviews the literature on psychiatric comorbidity in the medical setting and gastroenterology practice in particular. The ability to recognize psychiatric comorbidity and relate it to the patient's presenting gastrointestinal (GI) complaint can pay great dividends for patients. The ability to apply these observations to help facilitate psychiatric collaboration and specifically, to initiate behavioral treatment, represents a new dimension in the care of chronic GI disorders. Finally, the relationship between physical and sexual abuse and GI illness and the usefulness of psychiatric interventions in the treatment of chronic GI disorders is reviewed in detail.