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Psychiatric aspects on acute abdominal pain
Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för kemi och biomedicin (KOB).ORCID-id: 0000-0001-5825-3340
2021 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Introduction: Psychiatric comorbidity is estimated to occur in up to 40% of all patients with somatic disorders, and it can have an influence on patient morbidity and mortality. Approximately 20% of patients who seek care for abdominal pain receive the diagnosis nonspecific abdominal pain, and later develop chronic abdominal pain. This condition and other abdominal conditions without organic explanation are sometimes called diseases of gut-braininteraction, and psychosocial factors (personality, psychiatric conditions, etc.) have been suggested to play an important role. Organic dyspepsia (which in this thesis is limited to pepticulcer, gastritis and gastro-esophageal reflux disease, or GERD) has previously been reported to be associated with personality traits and psychiatric conditions. Despite these known associations, few studies have specifically investigated psychiatric comorbidity in patients with acute abdominal conditions.The aim of this thesis is to investigate the prevalence of psychiatric comorbidity in patients with acute abdominal pain conditions in the emergency setting and to evaluate the possible longterm psychiatric problems of these patients.

Methods: Consecutive patients with who came to emergency care with acute abdominal pain conditions were divided into three diagnostic groups: acid-dependent organic dyspepsia (pepticulcer, gastritis and GERD), specific abdominal diagnoses, and non-specific abdominal pain.These groups were evaluated for personality traits, psychiatric symptoms, and self-rated health.A follow-up study explored prescription of antidepressant and anxiolytic (anti-anxiety) medications in this patients 10–15 years after the initial visit to emergency care.

Results: Among the various diagnostic groups, patients with acid-dependent organic dyspepsia had significantly more anxiety-related personality traits, less mature characters, significantly more psychiatric symptoms, and poorer self-rated health. Patients with nonspecific abdominal pain also had more personality traits associated with anxiety, although to a lesser extent. Personality factors were significantly associated with poor self-rated health. The long-term follow-up showed that patients with organic dyspepsia and non-specific abdominal pain were prescribed antidepressants and anxiolytic drugs statistically more often than patients with specific abdominal diagnoses.

Conclusion: Patients with abdominal pain who seek emergency care have enhanced psychiatric comorbidity, more anxiety-related personality traits, and poorer perceived health.This trend is particularly evident in patients with a diagnosis of acid-dependent organicdyspepsia, and to a lesser degree, patients with a diagnosis of non-specific abdominal pain.These factors also predict future prescription of depression and anxiety medications. These results suggest that patients who come to emergency care with acute abdominal pain could potentially benefit from psychiatric consultation.

Ort, förlag, år, upplaga, sidor
Kalmar: Linnaeus University Dissertations, 2021. , s. 98
Serie
Linnaeus University Dissertations
Nationell ämneskategori
Gastroenterologi och hepatologi
Forskningsämne
Naturvetenskap, Medicin
Identifikatorer
URN: urn:nbn:se:lnu:diva-106102ISBN: 9789189460133 (tryckt)ISBN: 9789189460140 (digital)OAI: oai:DiVA.org:lnu-106102DiVA, id: diva2:1583688
Disputation
2021-08-27, Azur, Universitetsplatsen 1, 392 31 Kalmar, Kalmar, 09:00 (Engelska)
Opponent
Handledare
Forskningsfinansiär
Forskningsrådet i Sydöstra Sverige, FORSSTillgänglig från: 2021-08-09 Skapad: 2021-08-09 Senast uppdaterad: 2025-03-04Bibliografiskt granskad
Delarbeten
1. Temperament and character in patients with acute abdominal pain
Öppna denna publikation i ny flik eller fönster >>Temperament and character in patients with acute abdominal pain
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2018 (Engelska)Ingår i: Comprehensive Psychiatry, ISSN 0010-440X, E-ISSN 1532-8384, Vol. 87, s. 128-133Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Several conditions presenting with abdominal pain are associated with specific personality factorsalthough it is unclear if this is true also in emergency clinic settings.Objective: To study personality factors among patients with acute abdominal pain in an emergency ward.Methods: Consecutive patients (N=165) with abdominal symptoms at an emergency clinicwere administratedthe Temperament and Character Inventory (TCI). Threemain groups were identified; specific abdominal diagnoses,(N = 77), non-specific abdominal pain, (N = 67) and organic dyspepsia (N = 21). TCI results were comparedbetween clinical groups and a control group (N=122).Results: As compared to individuals with specific abdominal diagnoses and controls, those with organic dyspepsiawere significantly more anxious (harm avoidance), (p = 0.003), and had lower ability to cooperate (cooperativeness)(p=0.048 and p=0.004 respectively). They were also significantlymore unpretentious (self-transcendence)compared to individuals with specific abdominal diagnoses (p=0.048), non-specific abdominal pain (p=0.012)and controls (p=0.004) and evidenced lessmature character (sumof self-directedness and cooperativeness) comparedto those with specific abdominal diagnoses and controls (p =0.003).Conclusion: Individuals seeking care at an emergency clinic with organic dyspepsia showed a distinguishable patternof personality features that distinguished them from the other comparison groups. Therefore an evaluation of personalityfactorsmay add a new dimension to the diagnostic investigation in the emergency care of abdominal painand contribute to the optimization of the treatment of organic dyspepsia.

Ort, förlag, år, upplaga, sidor
Elsevier, 2018
Nationell ämneskategori
Gastroenterologi och hepatologi
Identifikatorer
urn:nbn:se:lnu:diva-106100 (URN)10.1016/j.comppsych.2018.09.008 (DOI)
Forskningsfinansiär
Forskningsrådet i Sydöstra Sverige, FORSS
Tillgänglig från: 2021-08-09 Skapad: 2021-08-09 Senast uppdaterad: 2025-02-11Bibliografiskt granskad
2. Psychiatric symptoms among patients with acute abdominal pain Patients with organic dyspepsia report more psychiatric symptoms and rate poorer general health compared to patients with other specific abdominal diagnoses and non-specific abdominal pain at an emergency ward
Öppna denna publikation i ny flik eller fönster >>Psychiatric symptoms among patients with acute abdominal pain Patients with organic dyspepsia report more psychiatric symptoms and rate poorer general health compared to patients with other specific abdominal diagnoses and non-specific abdominal pain at an emergency ward
Visa övriga...
2020 (Engelska)Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 55, nr 7, s. 769-776Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background:Abdominal pain is a common cause of visits to emergency facilities. It is related to psychiatric disorders in primary care, but it is unclear if this also holds in emergency departments. Objective:Is to explore potential differences between diagnostic groups in patients with acute abdominal pain in an emergency ward regarding concurrent somatic-and psychiatric symptoms, 'Length of stay' (LOS) and perceived health. Method:The patients (N = 137) were divided into three groups; organic dyspepsia, specific abdominal diagnoses, and non-specific abdominal pain. The Prime-MD results for extra gastrointestinal symptoms (outside the gastrointestinal tract), psychiatric symptoms, frequency of symptoms, self-reported health, and LOS within the month before admittance were compared between the diagnostic groups. Results: There was a significant positive correlation between the number of physical extra gastrointestinal and psychiatric symptoms (p < .001), especially regarding anxiety (p < .001) and depression (p = .002). Patients with organic dyspepsia reported significantly more total (p = .016), extragastrointestinal (p = .026) (chest pain;p = .017, dizziness;p = .004, palpitations;p = .005, insomnia;p = .005 and worries;p = .001), and summarized anxiety and depression symptoms (p = .001-0.002) besides poorer general health (p < .001) compared to other abdominal conditions. Also, organic dyspepsia patients needed longer hospital stay than the non-specific abdominal group (p = .002) but similar to the specific abdominal disorders group. Conclusion:Organic dyspepsia is accompanied by more co-occurring physical, anxiety and depression symptoms as well as poorer perceived health than other abdominal pain conditions and comparably increased LOS. This suggests that psychiatric consultations might be beneficial for diagnosing and treating psychiatric comorbidity in emergency care.

Ort, förlag, år, upplaga, sidor
Taylor & Francis Group, 2020
Nyckelord
Anxiety, depression, emergency ward, health, organic dyspepsia, prime-MD
Nationell ämneskategori
Gastroenterologi och hepatologi
Forskningsämne
Naturvetenskap, Medicin
Identifikatorer
urn:nbn:se:lnu:diva-97671 (URN)10.1080/00365521.2020.1782464 (DOI)000549647200001 ()32603609 (PubMedID)2-s2.0-85087567516 (Scopus ID)
Tillgänglig från: 2020-08-26 Skapad: 2020-08-26 Senast uppdaterad: 2025-02-11Bibliografiskt granskad

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