Rationale: Although some of the early investigators considered
ulcerative colitis (UC) merely the end result of chronic and persistent
diarrhea of the type seen in the irritable colon syndrome (ICS) , there is
little or no objective evidence to support this view, and it is essential that
the physician keeps well in mind the pathologic features of the disease when
postulating relationships to emotional factors. Psychodynamic interpretations
of psychosomatic disease, which may determine treatment and management strategy
should be correlated with physiological knowledge of the disease if any
significant contributions are to be made to understanding etiologic factors.

Results: we noted that in the 15 cases of chronic UC or ICS
resistant to classic therapy with antispasmodics, antimotility drugs and
low-dose antidepressants, 7 patients were definitely neurotic and had
pronounced emotional disturbances. In the other 8, it was noted that
“allergic and psychologic” features were prominent. In 7 cases it was
possible to attribute the relapses in this series to emotional disturbances; in
2 cases to infections of the respiratory tract, in 2 cases the causes were
identified in a wrong diet and in 4 cases to physical fatigue.

Conclusions: Psychological assessment should be instituted early
and must be skillful and often it may have to extend deep into the emotional
substrate. Being able to successfully combine psychological help, lifestyle
major adjustment and drugs will help to stem, or solve, the problem and contain
the costs.