title: 'Idiopathic' intestinal failure--the importance of identifying and treating primary psychopathology.
abstract: BACKGROUND
  Gastrointestinal neuromuscular disorders (GINMD) are an important cause of intestinal failure (IF). We present six cases of IF in whom a diagnosis of GINMD was initially suspected, but in whom psychopathology was discovered to be the primary etiology.
  
  
  METHODS
  (i) Six consecutive cases referred to our unit with IF, initially presumed to be due to GINMD, were selected. Informed consent was obtained from all patients. Case notes were reviewed for salient clinical information. (ii) A literature search was performed to ascertain the epidemiology of psychopathology in IF and the current evidence for the management of severe functional GI disorders with a multidisciplinary psychiatric approach.
  
  
  RESULTS
  (i)All six cases required multidisciplinary psychiatric management in a specialized psychiatric unit that included the use of antidepressants, antipsychotics, mood stabilizers, and Electroconvulsive therapy in addition to nutritional support via enteral or parenteral routes. (ii) The evidence base for the treatment of severe FGIDs is sparse.
  
  
  CONCLUSIONS
  There is a need for additional reporting of such cases and further research. Our experience would suggest that a delay in the involvement of a specialist liaison psychiatrist has the potential to be life threatening in such cases. This may be more likely with greater severity, where the apparent predominance of 'physical' symptoms generates reluctance in both patient and physician to consider a psychiatric etiology and also appears to occur due to a lengthier investigative process than existed previously. We therefore propose that the provision of a specialist psychiatric assessment for all patients presenting with IF is indicated at the point of initial clinical contact, based upon the substantial clinical benefit it has the potential to confer upon a significant minority. This process need not delay investigation, which can continue as indicated in parallel, but can be life-saving.
authors.affiliation: Centre for Psychiatry, The Wolfson Institute for Preventive Medicine, Barts and The London School of Medicine and Dentistry, London, UK. j.bourke@qmul.ac.uk
authors.forename: J
authors.initials: J
authors.lastname: Bourke
authors.forename: J
authors.initials: J
authors.lastname: Soldan
authors.forename: D B A
authors.initials: DB
authors.lastname: Silk
authors.forename: Q
authors.initials: Q
authors.lastname: Aziz
authors.forename: G W
authors.initials: GW
authors.lastname: Libby
mesh_terms: D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use; D004565:Electroconvulsive Therapy; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications*; D008875:Middle Aged; D011599:Psychopathology
chemical_list: D014150:Antipsychotic Agents