pointing to increased psychiatric morbidity among patients with IBS and much of this evidence supports the notion that IBS is a 'forme fruste' of psychiatric.
Indian J. Psychiat., 1995, 37(3).
CORRESPONDENCE ORGANIC GASTROINTESTINAL ILLNESS AND THE IRRITABLE BOWEL SYNDROME Sir, I read with interest the article by Kachhwaha et al (Journal, Oct 1994) on 'Psychiatric morbidity in investigated cases of chronic pain abdomen'. The authors had assessed psychiatric symptoms among patients with abdominal pain using Goldberg's General Health Questionnaire, and report that thirty four of the fifty patients studied had various psychiatric symptoms on the GHQ and sixteen had pure organic disorders. Of the thirty four with psychiatric symptoms, twenty six had a psychiatric illness (scores more than 15 on the GHQ) and eight, a demonstrable gastrointestinal illness. Five out of these eight patients and two of the sixteen with pure organic disorders (italics added) were diagnosed to have the Irritable Bowel Syndrome (IBS). The Irritable Bowel Syndrome has been conceptualized as a psychosomatic illness and no distinct organic cause has yet been found (Lipsitt, 1989). Hence, to view it as a 'pure organic disorder' is fraught with difficulties. There are several studies pointing to increased psychiatric morbidity among patients with IBS and much of this evidence supports the notion that IBS is a 'forme fruste' of psychiatric illness (Young et al, 1976; Ford et al, 1987; Drossman et aL 1988; Walker et al, 1990). In the author's own study, of the seven patients with IBS encountered, five showed various psychiatric symptoms on the GHQ, which further highlight the presence of psychological symptoms in this condition. Psychiatric studies on patients with chronic abdominal pain would do well to veer away from adopting a categorical approach of organic versus
functional illness and instead, view IBS as an illness on a continuum between the two categories, possessing prominent psychological as well as gastrointestinal symptoms. ManiRajagopalanMD, DPM, DNB, Lecturer, Department of Psychiatry, Christian Medical College, Vellore632 002.
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