Management of refractory irritable bowel syndrome and comorbid mental ill-health: challenges, reflections and patient's perspective of life on the body–mind divide

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This complex case illustrates how blurred the divide between body and mind can be. In a patient with refractory irritable bowel symptoms, the emergence of new social problems exacerbate both psychiatric (anxiety and depression) and physical symptoms. Treatment of the physical symptomatology consisted of acute hospital treatments initially and subsequent primary care consultations. Psychiatric treatment consists of psychopharmacological (venlafaxine and mirtazapine) and psychotherapeutic approaches (cognitive behavioural therapy initially, and clinical hypnosis). The objectives of psychiatric treatment were to stabilise symptoms, reduce hospital admissions and foster self-management. The gains of management are presented. Social difficulties encountered over the period of treatment were legal processes to gain custody of son, bereavement, financial difficulties occasioned by stoppage of welfare benefits and legal processes involved in welfare appeal. Importantly, the patient's perceptive of treatment and care is presented. Detrimental effects that current welfare reforms in the UK may have on health are highlighted.

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