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Gastrointestinal symptoms, depression and trait anxiety in young adults seeking psychiatric care
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background and aim: Patients with functional gastrointestinal (GI) disorders have a high psychiatric co-morbidity, especially for mood and anxiety disorders. This study aimed to investigate and characterise GI symptoms in relation to depressive symptoms and trait anxiety in a well-defined population of young adult outpatients seeking psychiatric care.

Material and methods: Patients, aged 18-25 years from the Uppsala Psychiatric Patient Samples (UPP) cohort seeking psychiatric care for primarily mood and anxiety disorders (n=491) were compared with healthy controls (n=85) for GI symptoms (measured using the Gastrointestinal Symptom Rating Scale for Irritable Bowel Syndrome, GSRS-IBS and depressive symptoms (measured using the Montgomery-Åsberg Depression Rating Scale – Self-Assessment, MADRS-S. Personality traits were assessed using the Swedish Universities Scales of Personality (SSP), in which three anxiety-related personality traits (stress susceptibility, psychic trait anxiety somatic trait anxiety) were assessed.

Results: Patients, both on psychotropic medication and those not currently on psychotropic medication reported more GI symptoms than controls (median 30 vs. 22, p<0.001). GI symptom burden was higher in women than men (median 32 vs. 28, p<0.001). A principal component analysis produced a six-factor structure explaining 63% of the total variance in the data set. A cluster analysis was performed that allowed the identification of six cluster groups, characterised by the varying levels of these factors. The total GSRS-IBS score significantly correlated with depressive symptom severity (r=0.391, p<0.001), a relationship that remained after adjusting for possible confounders (sex, body mass index, bulimia). The total GSRS-IBS score correlated with the three SSP subscales: somatic trait anxiety (r=0.313, p<0.001), psychic trait anxiety (r=0.147, p=0.001) and stress susceptibility (r=0.233, p<0.001).

Conclusion: GI symptoms are highly prevalent in young adult psychiatric outpatients compared with controls, regardless of whether the patient is currently on psychotropic medication or not. Depressive symptom severity and degree of trait anxiety are independently related to the total IBS symptoms score.

Keywords [en]
IBS, human, mood disorder, depression, anxiety, personality
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
URN: urn:nbn:se:uu:diva-397086OAI: oai:DiVA.org:uu-397086DiVA, id: diva2:1370886
Funder
Stiftelsen Söderström - Königska sjukhemmetSwedish Society of MedicineErik, Karin och Gösta Selanders FoundationAvailable from: 2019-11-18 Created: 2019-11-18 Last updated: 2019-11-20Bibliographically approved
In thesis
1. Melatonin in the gastrointestinal tract
Open this publication in new window or tab >>Melatonin in the gastrointestinal tract
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Melatonin is recognised as the pineal hormone regulating sleep and circadian rhythm. It has also been identified in peripheral tissues (mainly in animals) and thought to display a variety of actions, including anti-inflammatory properties, regulation of gastrointestinal (GI) functions, glucose homeostasis and beneficial effects in different tumour types. Patients with irritable bowel disorder commonly exhibit psychiatric co-morbidity and disturbances of the gut-brain axis have been proposed to play a role in these disorders. The focus of this thesis was to study melatonin and melatonin receptors in the normal human GI tract, the pancreas and small intestinal neuroendocrine tumours. The thesis also explores the complex relationship between GI symptoms and underlying psychiatric traits in the context of elevated levels of peripheral melatonin during waking hours.

In paper I-II, tissue samples from the normal human GI tract and pancreas and tumour tissue from small intestinal neuroendocrine tumours were analysed for expression of melatonin and melatonin receptors using immunohistochemistry. For tumour patients, melatonin was also analysed in plasma and set in relation to symptoms and outcome. In paper III-IV, a cohort of young adults (18-25 years) seeking psychiatric care was examined for GI symptoms, melatonin levels in saliva, depressive symptoms and anxiety traits. Psychiatric assessments were performed using structured or semi structured interviews. Depressive symptoms were measured using the self-rating version of the Montgomery-Åsberg Depression Rating Scale; GI symptoms were measured using the Gastrointestinal Symptoms Rating Scale for Irritable Bowel Syndrome; and personality traits were evaluated using the Swedish Universities Scales of Personality.

Melatonin and melatonin receptors were widely expressed in the normal human gut and pancreas (paper I) but even in small intestinal neuroendocrine tumours known to produce serotonin (paper II). The intensity of the melatonin immunoreactivity in tumour tissue was found to correlate with lower proliferation index. After treatment, plasma levels of melatonin were reduced in tumour patients. Young adult patients seeking psychiatric care reported more GI symptoms than healthy controls, regardless of the currently active psychotropic medication. The level of GI symptoms was associated with severity of depressive symptoms and trait anxiety (paper III). Higher postprandial levels of melatonin were associated with the GI symptoms of bloating and pain (paper IV).

In summary, these findings demonstrate the widespread presence of melatonin in the human gut and confirm a link between melatonin, psychiatric health and GI symptoms.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2019. p. 63
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1616
Keywords
melatonin, MT1, MT2, gastointestinal tract, small intestinal neuroendocrine tumours, IBS, depression, anxiety, personality and affective disorder
National Category
Psychiatry Endocrinology and Diabetes Gastroenterology and Hepatology Cancer and Oncology
Research subject
Medical Science; Psychiatry
Identifiers
urn:nbn:se:uu:diva-396347 (URN)978-91-513-0814-2 (ISBN)
Public defence
2020-01-17, Humanistiska teatern, Thunbergsvägen 3, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2019-12-18 Created: 2019-11-18 Last updated: 2020-01-13

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Söderquist, FannySyk, MikaelaJust, DavidNovicic, Zorana KurbalijaJacobson, AnnicaHellström, Per M.Ramklint, MiaCunningham, Janet

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