Dr. DANISH HUSSAIN PAMPORI

Dr. DANISH HUSSAIN PAMPORI

SYNOPSIS

OF

DISSERTATION

Dr. DANISH HUSSAIN PAMPORI

DEPT OF PSYCHIATRY

VYDEHI INSTITUTE OF MEDICAL SCIENCES & RESEARCH CENTRE

WHITEFIELD, BANGALORE
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 / NAME AND ADDRESS OF THE CANDIDATE / Dr. Danish Hussain Pampori
PG, Department of Psychiatry,
Vydehi Institute of Medical Sciences & Research Centre Whitefield, Bangalore, Karnataka.
2 / NAME OF THE INSTITUTION / Vydehi Institute of Medical Sciences & Research Centre Whitefield, Bangalore, Karnataka.
3 / COURSE OF STUDY AND SUBJECT / MD Psychiatry
4 / DATE OF ADMISSION / 06-06-2013
5 / TITLE OF THE TOPIC / Psychiatric morbidity in patients with irritable bowel syndrome.

6. BRIEF RESUME OF THE INTENDED WORK:

6.1 NEED FOR THE STUDY

Irritable bowel syndrome (IBS) belongs to a group of chronic gastrointestinal (GI) diseases referred to as functional bowel disorders (FBD) as classified by the Rome foundation,(1) an international organization dedicated to research and education in the field of functional GI disorders. In the last two decades, IBS has gained considerable attention in the health-care field due to its increasingly high prevalence, sometimes debilitating effects and diverse symptom representation.(2) Many psychological and social variables have been recognized over the years as significant factors in IBS predisposition, precipitation, and perpetuation. Although these factors are recognized as important by most clinicians, they often are not evaluated effectively or addressed in IBS treatment. Patients suffering from IBS have more somatic and psychiatric co-morbidity and use more health-care services for co-morbid conditions than do other patients. IBS accounts for a huge proportion of referrals to gastroenterology clinics and the cost associated with IBS to an individual and to the society are substantial. Psychiatric disorders co-morbid with IBS adds to their disability as well as cost to the individual and the society.

There is very little research looking into the prevalence of these psychiatric disorders in patients with IBS in a developing country like India. Given the fact that there are significant socio-cultural differences, it is difficult to generalize research findings from developed countries and this has necessitated the current study.

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6.2 REVIEW OF LITERATURE

Irritable bowel syndrome is considered to be the most common GI dysfunction with an estimated prevalence of 8-22% in general population(3) and an Indian study done by Uday C Ghoshal et al, estimates its prevalence at 4.2%.(4) IBS is characterized by recurrent abdominal pain improved with defecation, alternating constipation and diarrhoea, bloating and passing mucus per rectum in the absence of evidence of serious organic disease. Intestinal dysmotility, visceral hypersensitivity and psychological stress may all have aetiological roles in IBS. (5)

Psychological co-morbidity has a complex interrelationship with IBS; estimates of the proportion of patients who meet criteria for any Axis I psychiatric diagnosis have ranged from 40% to 94%.(6) Right from the earliest report by Bockus, Bank and Willkinson in 1928, who reported that 46% of patients with "Neurogenic Mucous Colitis" had depression and 46%, had 'marked emotional instability'. Other authors have consistently reported an increased prevalence of psychological symptoms, notably depressive and anxiety symptoms. (3,5,6,7,8,9) Various studies have shown that as many as 30-40% of patient with IBS have co-morbid depression or anxiety disorder. (3) Literature review have indicated that patients with IBS have elevated levels of neuroticism, which is a stable personality trait characterized by distress-proneness and negative bias in thinking. (6) Studies have also reported a greater lifetime diagnoses of major depression, somatization disorder, generalized anxiety disorder, panic disorder and phobic disorder among IBS patients. (5,6,7,8,9) Studies on psychiatric co-morbidity in IBS have found between a quarter and a third of IBS patients to meet criteria for somatization disorder , which is much higher than in the normal population. (6)

6.3 OBJECTIVES

1, To study the psychiatric morbidity in patients with irritable bowel syndrome.

2, To study the correlation of the psychiatric morbidities with different subtypes of IBS.

7. MATERIAL AND METHODS

7.1 SOURCE OF DATA

Patients attending to gastroenterology department of Vydehi Institute of Medical Sciences and Research Centre, Bangalore with a diagnosis of IBS as per Rome III criteria.

SAMPLE SIZE: 100

DURATION: January 2014 to December 2014

AGE GROUP & SEX: 18-65 years of either sex.

7.2 METHOD OF COLLECTION OF DATA

SAMPLE PROCEDURE: 100 consecutive cases in the age group of 18-65 years of either sex diagnosed with IBS as per Rome III criteria by the consultant gastroenterologist will be included in the study after obtaining a written informed consent. Patients fulfilling the inclusion and exclusion criteria will be assessed in the department of psychiatry VIMS & RC. The clinical and demographic variables will be recorded in a proforma designed for the study. Psychiatric morbidity will be assessed using Mini International Neuropsychiatric Interview (M.I.N.I. PLUS) and diagnosis as per ICD-10 classification of Mental and Behavioural disorders will be made.

INSTRUMENTS:

1, Semi structured composite socio demographic and IBS proforma.

2, Mini International Neuropsychiatric Interview (M.I.N.I. PLUS)- English Version 5.0.0

7.3 STUDY DESIGN

Observational cross-sectional clinical study.

7.4 STATISTICAL METHOD USED

Statistical analysis will be carried out using SPSS package. Continuous variables will be compared with one sample t-test and independent-sample t-test. Dichotomous variables will be analyzed with Fisher’s test. Within the bivariate statistics, the chi-square test will be used for qualitative variables, one-way analysis of variance for quantitative-qualitative variables, and the Pearson correlation coefficient for cases of two quantitative variables. Any other suitable technical measures will be used at the time of data analysis if required.

7.5 INCLUSION CRITERIA

1. Patients who have consented for the study

2. 18-65 years of either sex

3. Diagnosis of IBS as per Rome III criteria

7.6 EXCLUSION CRITERIA

1. Patients who have not consented for the study

2. Co-morbid chronic physical illnesses involving other systems.

  • Endocrine disorders: Diabetes Mellitus, Hypothyroidism, Hyperthyroidism
  • Cardiovascular disorders: Hypertension, MI
  • Neurological disorders: Epilepsy, Cerebrovascular accidents, Traumatic brain injury, CNS tumours.
8. Does the study require any investigations or interventions to be conducted on patients or other humans or animals?

NO

8.1 Has ethical clearance been obtained from your institution in case of 8?

YES

9. LIST OF REFERENCES

1. Drossman DA. Introduction. The Rome Foundation and Rome III.

Neurogastroenterol. Motil. 2007; 19: 783–6.

2. Longstreth GF. Definition and classification of irritable bowel

syndrome: current consensus and controversies. Gastroenterol. Clin.

North Am. 2005; 34: 173–87.

3. Kabra N, Nadkarni A. Prevalence of depression and anxiety in irritable bowel syndrome: A

clinic based study from India. Indian J Psychiatry 2013;55:77-80.

4. Ghoshal UC, Abraham P, Bhatt C, Choudhuri G, Bhatia SJ, Shenoy KT, et al.

Epidemiological and clinical profile of irritable bowel syndrome in India: report of the

Indian Society of Gastroenterology Task Force. Indian J Gastroenterol 2008; 27:22-8.

5. Canavan JB, Bennett K, Feely J, O’moráin, O’connor HJ. Significant psychological

morbidity occurs in irritable bowel syndrome: a case-control study using a pharmacy

reimbursement database. Alimentary Pharmacology & Therapeutics. 2009;29:440–9.

6. Palsson OS, Drossman DA. Psychiatric and Psychological Dysfunction in Irritable Bowel

Syndrome and the Role of Psychological Treatments.

Gastroenterol Clin N Am. 2005;34(2):281–303.

7. Vandvik PO, Wilhelmsen I, Ihlebæk C, Farup PG. Comorbidity of irritable bowel

syndrome in general practice: a striking feature with clinical implications. Alimentary

Pharmacology & Therapeutics. 2004;20:1195–1203.

8. Jones R, Latinovic R, Charlton J, Gulliford M. Physical and psychological co-morbidity in

irritable bowel syndrome: a matched cohort study using the General Practice Research

Database. Alimentary Pharmacology & Therapeutics. 2006;24: 879–886.

9. Mikocka-Walus A, Turnbull D, Moulding N, Wilson I, Andrews JM, Holtmann G.

Psychological comorbidity and complexity of gastrointestinal symptoms in clinically

diagnosed irritable bowel syndrome patients. Journal of Gastroenterology and Hepatology.

2008;23: 1137–1143.

10. / Signature of Candidate
11. / Remarks of the guide / The topic selected is relevant and therefore recommended.
12. / Name and Designation of
12.1 Guide /

Dr. FIAZ AHMED SATTAR

PROFESSOR AND HOD
Vydehi Institute of Medical Sciences & Research Centre Whitefield, Bangalore, Karnataka.
12.2 Signature
12.3 Co-guide(if any)
12.4 Signature
12.5 Head of Department /

Dr. FIAZ AHMED SATTAR

PROFESSOR AND HOD
Vydehi Institute of Medical Sciences & Research Centre Whitefield, Bangalore, Karnataka.
12.6 Signature
13. / 13.1 Remarks of the Chairman and Principal
13.2 Signature

VYDEHI INSTITUTE OF MEDICAL SCIENCES & RESEARCH CENTRE

WHITEFIELD, BANGALORE

(Recognised by Medical Council of India & Affiliated to Bangalore University/R.G.U.H.S)

______

Ref No VIMS/PRI/ /2013-2014

TO,

The Registrar.

R.G.U.H.S. Jayanagar, 4th block,

Bangalore-560011. KARNATAKA.

Respected Sir,

SUB: Departmental Ethical Clearance

With regard to subject mentioned above the dissertation subject titled “Psychiatric morbidity in patients with irritable bowel syndrome” is justifiable & has taken ethical clearance from the department.

Thanking you,

Yours Faithfully.

Dr.F.A.Sattar,

Prof. & H. O. D.

Department of Psychiatry

Vydehi Institute of Medical Sciences,

Whitefield, Bangalore.

VYDEHI INSTITUTE OF MEDICAL SCIENCES & RESEARCH CENTRE

WHITEFIELD, BANGALORE

(Recognised by Medical Council of India & Affiliated to Bangalore University/R.G.U.H.S)

______

Ref No VIMS/PRI/ /2013-2014

TO,

The Registrar.

R.G.U.H.S. Jayanagar, 4th block,

Bangalore-560011. KARNATAKA.

Respected Sir,

SUB: Departmental Ethical Clearance

With regard to subject mentioned above the dissertation subject titled “Psychiatric morbidity in patients with irritable bowel syndrome” is justifiable & has taken ethical clearance from the department.

Thanking you,

Yours Faithfully.

Principal

Vydehi Institute of Medical Sciences,

Whitefield, Bangalore .

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