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Biomedical subjects

K W Olden

Publications and source records attributed to K W Olden.

11 recordsLinked to original sources
PubMed1999

Psychosocial aspects of the functional gastrointestinal disorders.

The functional gastrointestinal disorders (FGID) are the most frequent conditions seen in gastroenterology practice and comprise a major portion of primary care. Psychosocial factors are important in these disorders with regard to: (1) their effects on gut physiology; (2) their modulation of the symptom experience; (3) their influence on illness behavior; (4) their impact on outcome; and (5) the choice of the therapeutic approach. This paper provides a review and consensus of the existing literature by gastroenterologists, psychiatrists, psychologists, physiologists, and health services investigators. Evidence is provided to support the biopsychosocial model as a basis for understanding and treating these disorders, and epidemiological and clinical information on the relations of psychosocial factors to gut physiology, symptom presentation, health behavior, and outcome is offered. Features of motility, personality, abuse history, health concerns, and treatment-seeking differ between patients with FGID and healthy controls, but they are not specific to FGID. They occur in other patients with chronic medical conditions and/or psychiatric disorders. Review of treatment trials indicates clear support for psychotherapeutic treatments, especially in the long term, as well as some evidence for the benefit of antidepressants in FGID, even in the absence of improvements in mood.

Colonic Diseases, Functional↗
PubMed1999

Refractory gastrointestinal symptoms: a combined medical psychiatric approach.

Gastroenterology has always been a collaborative specialty. Through the years, gastroenterologists have created important partnerships with pathologists, radiologists, surgeons, gynecologists, and pediatricians. These collaborative relationships have greatly enhanced patient care and research. This article reviews the literature on psychiatric comorbidity in the medical setting and gastroenterology practice in particular. The ability to recognize psychiatric comorbidity and relate it to the patient's presenting gastrointestinal (GI) complaint can pay great dividends for patients. The ability to apply these observations to help facilitate psychiatric collaboration and specifically, to initiate behavioral treatment, represents a new dimension in the care of chronic GI disorders. Finally, the relationship between physical and sexual abuse and GI illness and the usefulness of psychiatric interventions in the treatment of chronic GI disorders is reviewed in detail.

Adult↗
PubMed1998

Are psychosocial factors of aetiological importance in functional dyspepsia?

The causes of functional dyspepsia remain unclear. Research has linked other functional gastrointestinal disorders, particularly irritable bowel syndrome, to a history of physical or sexual abuse, psychosocial distress and certain psychiatric disorders. In functional dyspepsia, there is a possibility of certain psychiatric disorders, particularly alcohol abuse and eating disorders, indirectly influencing the development of functional dyspepsia-like symptoms. However, the literature on possible psychosocial correlates in functional dyspepsia is not as mature as the literature on irritable bowel syndrome. This paper critically reviews the psychosocial dimensions and implications for the psychotherapeutic treatment of functional dyspepsia.

Dyspepsia↗
PubMed1998

Rational management of chronic abdominal pain.

Patients presenting with chronic abdominal pain are a diagnostic and therapeutic challenge. Recent advances in classification of the various chronic abdominal pain disorders and recent evidence supporting the advantages of adopting a multimodal therapeutic approach can often prove quite helpful.

Abdominal Pain↗
PubMed1995

Sexual and physical abuse and gastrointestinal illness. Review and recommendations.

OBJECTIVES: To summarize the existing data on abuse history and gastrointestinal illness, suggest a conceptual scheme to explain these associations, suggest ways to identify patients at risk, and provide information about mental health referral. DATA SOURCES: Review of the pertinent literature by clinicians and investigators at referral centers who are involved in the care of patients with complex gastrointestinal illness and who have experience in the diagnosis and care of patients with abuse history in these settings. STUDY SELECTION: All research articles and observational data that addressed abuse history in gastroenterologic settings. Articles were identified through a MEDLINE search. DATA EXTRACTION: Independent extraction by multiple observers. DATA SYNTHESIS: On the basis of literature review and consensus, it was determined that abuse history is associated with gastrointestinal illness and psychological disturbance; appears more often among women, patients with functional gastrointestinal disorders, and patients seen in referral settings; is not usually known by the physician; and is associated with poorer adjustment to illness and adverse health outcome. Although the mechanisms for this association are unknown, psychological factors (somatization, response bias, reinforcement of abnormal illness behavior) and physiologic factors (psychophysiologic response, enhanced visceral sensitivity) probably contribute. On the basis of these data, recommendations are made on how to identify patients at risk, how to obtain this information, and, if needed, how to make appropriate referrals. CONCLUSIONS: The authors agree with existing data on the association between abuse history and gastrointestinal illness. Physicians should ask patients with severe or refractory illness about abuse history. Appropriate referral to a mental health professional may improve the clinical outcome.

Domestic Violence↗
PubMed1993

A "facilitated" model of inpatient psychiatric care.

The authors describe a model for an effective partnership between a large health maintenance organization and a fee-for-service acute inpatient psychiatric unit. They present data from five years of experience with the model on a unit serving a catchment area of one million plan members. The model, which is based on "facilitated" care rather than managed care, emphasizes crisis intervention and a strong medical orientation. The HMO contracted with seven psychiatrists to provide treatment and helped develop a value system shared by the physicians and hospital staff. A clinician represented the HMO on the unit and played a key decision-making role in patient care. A total of 4,945 patients were admitted over five years. Costs per admission were reduced 47 percent during this period; the readmission rate was 16.9 percent. Implementation of the model resulted in the delivery of high-quality cost-effective care.

Adolescent↗