A bio-psychological analysis of functional gastrointestinal disorders and a clinical trial of its treatment using psychodrama

Detta är en avhandling från Stockholm : Karolinska Institutet, Department of Public Health Sciences

Sammanfattning: Functional disorders of the gut are regarded as the result of a complex interaction between factors of biological, social and psychological origin. Psychosocial interventions are expected to play a role in the management of patients with this type of symptom. The primary aim was to evaluate the outcome of a group treatment methodology, psychodrama, that has rarely been used for patients with gut disorders. Furthermore the aim was to study the co-variation between some personality functioning and some physiological variables related to functional gastrointestinal disorders. The treatment group consisted of 22 patients with the diagnosis colon irritable, irritable bowel syndrome (IBS) or non-ulcer dyspepsia (NUD) who were investigated before treatment, after the treatment and at the three year follow-up. They were recruited from a catchment area in the southern parts of Stockholm. The group consisted of 17 women and 5 men. Mean age was 47 years. The control group consisting of 28 patients was recruited in the same and was investigated at three occasions with the same time interval. The group consisted of 16 women and 12 men. Mean age was 42 years. Two groups of healthy subjects also took part in the study. Personality factors were measured with the Karolinska scales of personality and the Bergman scales of self-confidence and social dependency. Symptom change was measured with a questionnaire regarding symptoms from the upper and lower abdomen. Worry and tension was rated by means of a three graded scale and therapeutic factors with a modified version of the Yalom questionnaire. Blood tests were analysed with regard to the concentrations of gastrin, somatostatin and oxytocin. Symptom levels decreased at 3-months after termination of treatment and tended to increase at the 3 year follow-up for both treatment and control groups. Worry and tension decreased in the treatment group at 3 months in a way that was not observed in the control group. Subjects who had learned a new coping behaviour during treatment reported fewer symptoms three years later. It was concluded that important factors for a successful outcome of psychodrama treatment seemed to be the patients active involvement in the treatment and social support outside treatment as well as a positive situation in the treatment, including group status, relation to the therapist and feed-back from the other group members. To learn new coping behaviours, however, seemed to be central for a positive outcome. The studies on the relationship between personality, stress stimulation and gastrointestinal hormones seemed to support the assumption that patients with functional gastrointestinal disorders have problems to find a balance between the expression of attachment and aggression. This psychological conflict was reflected in a different pattern of gastrointestinal hormones as compared to healthy subjects.

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