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Outcome in severe irritable bowel syndrome with and without accompanying depressive, panic and neurasthenic disorders

JOY RATCLIFFE, MRCPsych

School of Psychiatry and Behavioural Science, University of Manchester

LAKSHMI FERNANDES, MRCPsych

Department of Psychiatry, University of Sheffield

STEPHEN PALMER, MSc

Centre for Health Economics, University of York

CHRISTINE RIGBY, MSc, BARBARA TOMENSON, MSc and ELSPETH GUTHRIE, MD, MRCPsych

School of Psychiatry and Behavioural Science, University of Manchester

NICHOLAS READ, MD, FRCP

Institute of General Practice, Northern General Hospital, Sheffield

DAVID G. THOMPSON, FRCP

Section of Gastrointestinal Science, Hope Hospital, University of Manchester, Manchester, UK

North of England IBS Research Group

Correspondence: Professor Francis Creed, School of Psychiatry and Behavioural Science, Rawnsley Building, Oxford Road, Manchester M13 9WL, UK. Tel: +44 (0)161 276 5331/5397; fax: +44 (0)161 273 2135; e-mail: francis.creed{at}man.ac.uk

Declaration of interest F.H.C. has consultancy links with Eli Lilly and Lundbeck; S.P. has consultancy links with AstraZeneca and Eli Lilly.

Background Irritable bowel syndrome often leads to impaired functioning.

Aims To assess the contribution of psychiatric disorders to impaired outcome in severe irritable bowel syndrome.

Method Patients with severe irritable bowel syndrome entering a psychological treatment trial (n=257) were interviewed using the Schedules for Clinical Assessment in Neuropsychiatry. Outcomes were number of days of restricted activity, role limitation (physical) score of the Short Form Health Survey and costs.

Results At baseline, depressive disorder (29% of patients), panic (12%) and neurasthenia (35%) were associated with impairment; number of psychiatric disorders was associated in a dose-response fashion (P=0.005). At follow-up, depressive disorder and neurasthenia were associated with role limitation score. Improved depression was associated with improved role functioning.

Conclusions Depressive, panic and neurasthenic disorders contribute to poor outcomes in severe irritable bowel syndrome, and appropriate treatment should be available to these patients.

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