A group of 80 patients with diseases of the small intestine were given a standardized psychiatric assessment every time they attended the outpatients' department over a period of a year. Forty-six patients with idiopathic steatorrhoea, 23 patients with Crohn's disease, and 11 patients with alactasia were interviewed on 158 occasions. During this time 27 of them (34%) were found to be psychiatrically ill, their illnesses being minor affective disorders. Psychiatric illness was not related either to generalized malabsorption or to deficiencies of specific substances such as folic acid. Although a clear relationship was demonstrated between emotional disturbances and bowel action, diarrhoea was neither sufficient nor necessary for psychiatric illness, and distress associated with diarrhoea was unusual. No single characteristic type of personality was found in any of the patients with the three diseases, but some traits were considerably more commonly associated with some of the diseases than others, and patients with psychiatric illness were shown to attend the outpatients' department more frequently than stable patients. Patients with a family history or a previous history of psychiatric illness, or with depressive traits in their previous personality, were much more likely to fall ill in the survey year. A positive family history of psychiatric illness was significantly more common in idiopathic steatorrhoea. Three patients suffered relapses in the survey year, and in all of these the relapse appeared to be related to emotional factors.
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