Severe sexual dysfunction in women with the irritable bowel syndrome: comparison with inflammatory bowel disease and duodenal ulceration.
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Coitus↗
Biomedical subjects
E Guthrie
Publications and source records attributed to E Guthrie.
Psychological factors in the irritable bowel syndrome.
This paper reviews recent psychological studies of patients with the irritable bowel syndrome (IBS) or 'functional abdominal pain'. Many studies have used unreliable or invalid methods of assessment and some have confused personality with treatable psychiatric illness. Reliable and valid measures have indicated that 40-50% of patients with recently diagnosed functional abdominal pain have demonstrable psychiatric illness; these patients have a worse prognosis than those who are psychologically normal. When psychiatric disorder is diagnosed in a patient with IBS there are three possibilities: (1) The patient may have developed abdominal and psychiatric symptoms simultaneously in which case treatment of the latter may relieve the bowel symptoms. (2) Psychiatric disorder may precipitate increased concern about bowel symptoms, and consequent attendance at the gastroenterology clinic, of those with chronic mild symptoms. In this case it is illness behaviour, rather than abdominal symptoms, that is caused by the anxiety/depression. (3) Those with chronic neurotic symptoms as part of their personality must be screened for organic disease if they have a fresh onset of bowel symptoms; but they are at high risk of becoming persistent clinic attenders. Further research is needed to clarify when psychological abnormalities play a role in the aetiology of IBS and when they are coincidental, but lead to illness behaviour. The role of psychological factors in the aetiology of the irritable bowel syndrome (IBS) is far from clear, but a review of the literature suggests that some consistent patterns are emerging in spite of methodological problems. There have been three major defects with studies that have linked IBS with neurotic symptomatology. First, the measurement of psychological factors has generally been imprecise. Second, most studies have considered IBS patients as a single group, without making allowance for differing symptom patterns. Third, conclusions have been drawn about hospital samples and extrapolated to all IBS subjects, without taking account of factors which affect consulting behaviour. Most studies have been concerned with psychological factors so these will be considered in most detail.
Colonic Diseases, Functional↗
Functional evolution of the Myb oncogene family.
Three Myb-related genes (A-Myb, B-Myb, and c- Myb) have been found in all vertebrates examined thus far including mammals, birds, and amphibians. Two invertebrates, the sea urchin and the fruit fly, have only one Myb-related gene. Our laboratory has used Drosophila as a model system to explore the function of its sole Myb gene. We have also reintroduced the three different vertebrate Myb genes into Drosophila in order to begin to understand how their different functions may have arisen following gene duplication during evolution.
Animals↗
The Talbot Hospice Foundation bereavement program: a history.
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Attitude to Death↗
Presenting a talk at an academic meeting.
Presenting a paper at an academic meeting or giving a lecture is a small but significant part of a doctor's work. Nearly all doctors initially dread such a prospect, but with practice and experience it need not be such an ordeal.
Audiovisual Aids↗
The psychological care of medical patients: a challenge for undergraduate medical education.
A recent joint report by the Royal College of Physicians and the Royal College of Psychiatrists has argued the case for improving the psychological and psychiatric care of medical patients. It makes a number of suggestions about staff education and training but does not specifically address undergraduate medical teaching. Following recommendations by the General Medical Council, UK medical schools are reorganising their undergraduate curricula with a new emphasis on equipping students for the preregistration year. These two important sets of recommendations present a challenge to medical education. In this article we report on a meeting which considered what the newly qualified doctor needs to know about psychological and psychiatric aspects of general patient care, how far the current psychiatric curriculum meets those needs, and how it could be improved.
Curriculum↗
Predictors of mortality and morbidity following admission with chest pain.
This study aimed to identify the predictors of outcome in 102 patients following their first admission with acute chest pain. Outcome was measured at three months by interview and at five years by questionnaire. Chest pain, change in physical activity, return to work, smoking, psychiatric disorder, and mortality were assessed. The principal predictors of chest pain and smoking were previous psychiatric disorder and a diagnosis of non-specific chest pain; a previous history of psychiatric disorder was associated with a five-fold increase in the risk of continued chest pain at five-year follow-up (95% CI = 1.1-25.0). Psychiatric disorder at five years was predicted by psychiatric disorder at admission (adjusted odds ratio (adj OR) = 3.2; 95% CI 1.0-11.0) and non-specific chest pain (adj OR = 7.5; 95% CI = 1.7-32.1). Mortality at five-year follow-up was independently associated with older age (adj OR = 1.1; 95% CI = 1.01-1.2), an elevated Norris score (adj OR = 1.41; 95% CI = 1.01-1.96) and a previous history of psychiatric disorder (adj OR = 5.06; 95% CI = 1.13-22.0). These findings suggest that prediction of outcome, irrespective of underlying diagnosis, requires careful assessment of previous or current psychiatric symptoms in patients admitted with chest pain. Early intervention with psychological treatment for patients with non-specific chest pain should be considered; this may also involve help to reduce smoking. The study provides further evidence that mortality following myocardial infarction is closely linked to psychiatric disorder, but suggests that prior psychiatric disorder may be more important than 'post-infarction' depression. A larger study is needed to confirm these results.
Adult↗