Psychiatric Issues; Overview

Psychiatric illness is of considerable significance to all medical practice, especially gastroenterology. The brain and gut share common neurotransmitters and a complex communication network. Historically, many structural gastrointestinal disorders were presumed to have psychosomatic origins, although empirical evidence for this is lacking. On the other hand, functional gastrointestinal disorders are highly associated with psychopathology, but the exact mechanisms behind this association are unclear. The recent reframing of functional gastrointestinal disorders as disorders of gut–brain interaction highlights the importance of the brain–gut axis for future research. The presence of psychiatric illness can lead to increased suffering, disability, higher healthcare utilization, and worse medical outcomes. Therefore, recognition and treatment of psychiatric illness in gastrointestinal disease is an important aspect of providing comprehensive patient care. Diagnosable psychiatric illnesses warrant treatment with evidence-based interventions for the illness, including psychopharmacology and psychological treatments. Patients with complex or refractory symptoms may benefit from referral to a psychiatrist as part of a multi-disciplinary approach to treatment. Many antidepressants and psychological treatments also show benefit for and are used clinically to treat functional gastrointestinal disorders, such as irritable bowel syndrome. Whether these benefits are independent of antidepressant activities are unclear and warrants further research.