North Carol S, Hong Barry A, Alpers David H
World J Gastroenterol. 2007 Apr 14;13(14):2020-7. doi: 10.3748/wjg.v13.i14.2020.
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 IBS, 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). Most 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 psychoform symptoms that sound similar to those seen in psychiatric disorders may not have the same significance in patients with IBS.
本文重新审视了精神病理学与功能性胃肠疾病（如肠易激综合征（IBS））之间的联系，讨论了抗抑郁药的合理使用以及IBS管理的非药物方法，并基于当前知识状态从跨学科角度提出了IBS的治疗指南。回顾了关于IBS背景下精神疾病（尤其是躯体化障碍）的相关已发表文献以及为管理提供指导的文献，并根据文献中的发现提供了新的方向。IBS是一种异质性综合征，其临床表现有多种潜在机制。IBS通常伴有精神问题、无法解释的症状以及其他器官系统的功能性综合征。大多数IBS患者有多种无明确病因的主诉，这些症状可能涉及肠道以外的系统，如骨骼和关节（纤维肌痛、颞下颌关节综合征）、心脏（非心源性胸痛）、血管（绝经后综合征）和大脑（焦虑、抑郁）。大多数IBS患者本身没有精神疾病，但伴有一系列心因性（无精神障碍的心理主诉）症状，这些症状伴随他们的躯体形式（无医学疾病的身体症状）主诉。将IBS患者标记为精神疾病患者（除了那些更难治疗的真正躯体化障碍患者）是不正确的。单一的治疗模式不太可能普遍有效或解决大多数症状。心理治疗或认知行为治疗技术可以让IBS患者更容易应对他们的疾病。抑郁或焦虑障碍的特定发作可以根据这些情况进行适当处理。旨在改善焦虑或抑郁的药物对IBS患者的精神主诉并非都有用，因为听起来与精神疾病中所见症状相似的心因性症状在IBS患者中可能没有相同的意义。
