title: Association between gastrointestinal symptoms and affectivity in patients with bipolar disorder.
abstract: OBJECTIVE
  To study if anxiety, depression and experience of stress are associated with gastrointestinal (GI) symptoms in patients with bipolar disorder.
  
  
  METHODS
  A total of 136 patients with bipolar disorder (mean age 49.9 years; 61% women) and 136 controls from the general population (mean age 51.0 years; 60% women) were included in the study. GI symptoms were assessed with The Gastrointestinal Symptom Rating Scale-irritable bowel syndrome (GSRS-IBS), level of anxiety and depression with The Hospital Anxiety and Depression Scale (HADS) and stress-proneness with Perceived Stress Questionnaire. Over a ten year period, all visits in primary care were retrospectively recorded in order to identify functional GI disorders.
  
  
  RESULTS
  In subjects with low total HADS-score, there were no significant differences in GI-symptoms between patients and controls (GSRS-IBS 7.0vs6.5,P= 0.513). In the patients with bipolar disorder there were significant correlations between all GSRS and HADS subscores for all symptom clusters except for "constipation" and "reflux". Factors associated to GI symptoms in the patient group were female sex (adjusted OR = 2.37, 95%CI: 1.07-5.24) and high HADS-Depression score (adjusted OR = 3.64, 95%CI: 1.07-12.4). These patients had also significantly more visits for IBS than patients with low HADS-Depression scores (29%vs8%,P= 0.008). However, there was no significant differences in consulting behaviour for functional GI disorders between patients and controls (25%vs17%,P= 0.108).
  
  
  CONCLUSIONS
  Female patients and patients with high HADS depression score reported significantly more GI symptoms, whereas patients with low HADS scores did not differ from control subjects.
authors: Pontus Karling, Department of Public Health and Clinical Medicine, Umeå University, S-90185 Umeå, Sweden.
authors: Pontus
authors: P
authors: Karling
authors: Pontus Karling, Department of Public Health and Clinical Medicine, Umeå University, S-90185 Umeå, Sweden.
authors: Martin
authors: M
authors: Maripuu
authors: Pontus Karling, Department of Public Health and Clinical Medicine, Umeå University, S-90185 Umeå, Sweden.
authors: Mikael
authors: M
authors: Wikgren
authors: Pontus Karling, Department of Public Health and Clinical Medicine, Umeå University, S-90185 Umeå, Sweden.
authors: Rolf
authors: R
authors: Adolfsson
authors: Pontus Karling, Department of Public Health and Clinical Medicine, Umeå University, S-90185 Umeå, Sweden.
authors: Karl-Fredrik
authors: KF
authors: Norrback
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000150:complications; D001714:Bipolar Disorder / Q000150:complications* / Q000523:psychology; D016022:Case-Control Studies; D003248:Constipation; D003863:Depression / Q000150:complications*; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D013315:Stress, Psychological; D011795:Surveys and Questionnaires
keywords: Anxiety; Bipolar disorder; Brain-Gut axis; Depression; Dyspepsia; Functional gastrointestinal disorder; Gastrointestinal Symptom Rating Scale- irritable bowel syndrome; Hospital Anxiety and Depression Scale; Irritable bowel syndrome; Stress