Presented by Hong Kong College of Psychiatrists
Speaker: Professor Wai-keung Leung
MD, FRCP
Director & Consultant Physician
Union Gastrointestinal & Liver Centre, Union Hospital
Chairperson and Speaker: Dr Roger Ng
FRCPsych (UK)
Consultant (Psychiatry)
Department of Psychiatry, Kowloon Hospital
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Synopsis
Holistic management of irritable bowel syndrome: combination of pharmacological and psychological treatments
A 30 year-old divorced lady presented with a 6-month history of abdominal pain, irregular bowel habits and fatigue. Her condition did not relieve despite extensive visit to family physicians. She was referred to gastroenterologist for further investigation and care. She was diagnosed as suffering from irritable bowel syndrome. Her symptoms responded poorly to conventional medication and suffered from significant side effects of the medication. After discussion with patient, she agreed to try herbal medicine. Her irregular bowel habit and abdominal pain improved with herbal medicine. However she then developed increasing fatigue and loss of interest, necessitating referral to a psychiatrist.
Careful investigation revealed that she had abdominal pain since adolescence and had dissociative symptoms (derealization, depersonalization and numbness) while having sexual activity. Subsequent discussion revealed past histor y of repeated physical and sexual abuse by her alcoholic father during childhood.
In this presentation, we will discuss how we managed this patient using a multidisciplinary approach, including the management of her bowel symptoms and her psychiatric symptoms. In particular we will discuss the diagnostic criteria and clinical characteristics of irritable bowel syndrome, and the use of conventional and herbal treatment in irritable bowel syndrome. Furthermore, psychological management of her dissociative symptoms (using cognitive-behavioral and schema-focused strategies) would also be discussed.