Stressful life-events, anxiety, depression and coping in patients of irritable bowel syndrome.

A lot of research has pointed to a complex interaction between stressful life events, psychiatric morbidity and the irritable bowel syndrome (IBS). AIM: The present study aimed to determine the: stressful life-events in patients with irritable bowel syndrome patients in comparison to normal controls; effect of these events in causing clinically significant anxiety and depression; and the effect of psychopathology i.e. anxiety and depression on coping skills in these patients. METHODOLOGY: Thirty patients with irritable bowel syndrome were compared with thirty matched normal controls, on the presumptive stressful life events scale and the mechanisms of coping scale. Further, among the irritable bowel syndrome patient group, the anxious and depressed subgroups were separated from the non-anxious and non-depressed subgroups using the hospital anxiety and depression scale. Positive and negative coping mechanisms between these subgroups were compared. RESULTS: Significantly higher stress scores were found in the irritable bowel syndrome patient group than normal controls. Not all, but slightly more than fifty percent of irritable bowel syndrome had definite and clinically significant anxiety and/or depression. Those IBS patients with either definite depression tended to use predominantly negative coping styles as compared to those IBS patients without anxiety or depression. CONCLUSION: Stressful life-event scores are significantly higher in IBS patients than in normal controls. Although not all of these patients have anxiety and/or depression, a significant number of patients show evidence of the same. Presence or absence of anxiety and/or depression influences how the patient with IBS copes with illness. Therefore, though further studies on the issue are required, we suggested that, as a supplement to medical management, recognition and treatment of anxiety and depression in this subgroup of IBS patients with psychotropic drugs and cognitive therapy for gaining more positive coping skills, may require special attention in the management of irritable bowel syndrome.

Poor insight in schizophrenia: neurocognitive basis.

Poor insight in schizophrenia has been recently thought to be a reflection of prominent and enduring neurocognitive impairments. Reports supporting this theory have implicated prefrontal and parietal lobe functions, among other parameters. The results of other studies have negated the role of neuropsychological abnormalities in poor insight. The analogy between poor insight in schizophrenia and anosognosia in neurological illness as proposed by one set of workers has been elucidated in this review and it appears quite promising. However, the drawing of definite conclusions from all this work has been deferred by us, because of the need for more uniform and standardized methodologies for research on the subject. Nevertheless, attempts to improve the cognitive processes, which affect insight in schizophrenia, may be done to gain better treatment outcome in this disorder.