Digestive Diseases and Sciences

, Volume 27, Issue 6, pp 513–518 | Cite as

A controlled study of the association between ulcerative colitis and psychiatric diagnoses

  • John E. Helzer
  • Wayne A. Stillings
  • Sabah Chammas
  • Charles C. Norland
  • David H. Alpers
Original Articles

Abstract

Fifty consecutive patients with ulcerative colitis were personally examined to determine the lifetime prevalence of specific psychiatric diagnoses. A personality assessment and a tabulation of recently occurring stressful events were done. A matched control sample with chronic nongastrointestinal medical illnesses was evaluated in the same way. The two groups were compared so as to quantify the relative association and impact of psychiatric disorder in ulcerative colitis. We found no greater frequency of diagnosable psychiatric disorder in ulcerative colitis patients than in the control population. Those with ulcerative colitis and a psychiatric illness did not appear to have more serious gastrointestinal involvement, nor did severity of the ulcerative colitis predict more frequent or more serious psychiatric disorder. Personality profiles were similar in probands and controls, and there was no correlation between the frequency of potentially stressful life events within the six months prior to interview and severity of ulcerative colitis at the time of interview. We did find slightly higher levels of obsessional symptomatology in ulcerative colitis cases, but this association appeared to be weak and unrelated to the severity of the gastrointestinal disorder. Despite the fact that more than a quarter of the ulcerative colitis patients had some diagnosable psychiatric illness, the occurrence of psychiatric disorder was rarely documented in the medical charts.

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References

  1. 1.
    Sloan WP Jr, Bargen JA, Gage RB: Life histories of patients with chronic ulcerative colitis: A review of 2,000 cases. Gastroenterology 54 (Suppl):819–822, 1968Google Scholar
  2. 2.
    Mendeloff AI, Monk M, Siegel CI, Lilienfeld A: Illness experience and life stresses in patients with irritable colon and with ulcerative colitis. N Engl J Med 282:14–17, 1970Google Scholar
  3. 3.
    Esler MD, Goulston KJ: Levels of anxiety in colonic disorders. N Engl J Med 288:16–20, 1973Google Scholar
  4. 4.
    Feldman F, Cantor D, Soll S, Bachrach W: Psychiatric study of a consecutive series of 34 patients with ulcerative colitis. Br Med J 3:14–17, 1967Google Scholar
  5. 5.
    Fava GI, Pavan L: Large bowel disorders. II. Psychopathology and alexithymia. Psychother Psychosom 27:100–105, 1976–1977Google Scholar
  6. 6.
    Feighner JP, Robins E, Guze SB, Woodruff RA Jr, Winokur G, Munoz R: Diagnostic crieteria for use in psychiatric research. Arch Gen Psychiatry 26:57–63, 1972Google Scholar
  7. 7.
    DSM-III: Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. American Psychiatric Association, 1980Google Scholar
  8. 8.
    Wing JK, Cooper JE, Sartorius N: Measurement and Classification of Psychiatric Symptoms. London, Cambridge University Press, 1974, pp 10–20Google Scholar
  9. 9.
    Spitzer RL, Endicott J: Schedule for Affective Disorders and Schizophrenia (SADS) 2nd ed. New York, New York State Psychiatric Institute, 1975.Google Scholar
  10. 10.
    Helzer JE, Clayton PJ, Pambakian R: Reliability of psychiatric diagnosis. II. The test/retest reliability of diagnostic classification. Arch Gen Psychiatry 34:136–141, 1977Google Scholar
  11. 11.
    Helzer JE, Robins LN, Taibleson M, Woodruff RA Jr, Reich T, Wish ED: Reliability of psychiatric diagnosis. I. A methodological review. Arch Gen Psychiatry 34:129–133, 1977Google Scholar
  12. 12.
    Spitzer RL, Fleiss JL: A real analysis of the reliability of psychiatric diagnosis. Br J Psychiatry 125:341–347, 1974Google Scholar
  13. 13.
    Helzer JE, Clayton PJ, Pambakian R, Woodruff RA Jr: Concurrent diagnostic validity of a structured psychiatric interview. Arch Gen Psychiatry 35:849–853, 1978Google Scholar
  14. 14.
    Robins E, Guze SB: Establishment of diagnostic validity in psychiatric illness: Its application in schizophrenia. Am J Psychiatry 126:983–987, 1970Google Scholar
  15. 15.
    Koran LM: The reliability of clinical methods, data and judgments: Part I. N Engl J Med 293:642–646, 1975Google Scholar
  16. 16.
    Koran LM: The reliability of clinical methods, data and judgments: Part II. N Engl J Med 293:695–701, 1975Google Scholar
  17. 17.
    Eysenck HJ, Eysenck SBG: Eysenck Personality Questionnaire. San Diego. Educational and Industrial Testing Service, 1975Google Scholar
  18. 18.
    Paykel ES, Prusoff BA, Uhlenhuth EH: Scaling of life events. Arch Gen Psychiatry 25:340–347, 1971Google Scholar
  19. 19.
    Best WR, Becktel JM, Singleton JW, Kern F Jr: Development of a Crohn's disease activity index. Gastroenterology 70:439–444, 1976Google Scholar
  20. 20.
    Eysenck HJ, Eysenck SBG: Manual for the Eysenck Personality Questionnaire. San Diego, Education and Industrial Testing Service, 1975, p 9Google Scholar
  21. 21.
    Bellini M, Tansella M: Obsessional scores and subjective general psychiatric complaints of patients with duodenal ulcer or ulcerative colitis. Psychol Med 6:461–467, 1976Google Scholar
  22. 22.
    Cooper J: The Leyton obsessional inventory. Psychol Med 1:48–64, 1970Google Scholar
  23. 23.
    MacMahon B, Pugh TF: Epidemiology. Boston, Little Brown 1970, pp 241–282Google Scholar
  24. 24.
    Young SJ, Alpers DH, Norland C, Woodruff RA Jr: Psychiatric illness and the irritable bowel syndrome. Gastroenterology 70:162–166, 1976Google Scholar
  25. 25.
    Levitan HL: Psychological factors in the etiology of ulcerative colitis: Objectlessness and rage. Int. J Psychiatry Med 7:221–228, 1976–1977Google Scholar

Copyright information

© Digestive Disease Systems, Inc 1982

Authors and Affiliations

  • John E. Helzer
    • 1
    • 2
  • Wayne A. Stillings
    • 1
    • 2
  • Sabah Chammas
    • 1
    • 2
  • Charles C. Norland
    • 1
    • 2
  • David H. Alpers
    • 1
    • 2
  1. 1.Department of PsychiatryWashington University School of MedicineSaint Louis
  2. 2.Division of GastroenterologyWashington University School of MedicineSaint Louis

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