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Watt M, Peerani F, Madsen K, Siffledeen J, Kroeker K, Lim A, Tandon P, Hyde A. Exploring Patient Perspectives on a 12-Week Online, Stress Reduction Intervention in Inflammatory Bowel Disease. CROHN'S & COLITIS 360 2022; 4:otac036. [PMID: 36777414 PMCID: PMC9802265 DOI: 10.1093/crocol/otac036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Indexed: 11/14/2022] Open
Abstract
Background Online stress reduction interventions may be useful adjuncts to standard medical therapies for inflammatory bowel disease (IBD). As part of the evaluation of a 12-week randomized control trial (RCT) of an online multicomponent stress reduction program, our aim for the current study was to use qualitative methods to more deeply explore the patient experience with the online programming. Methods Upon completion of the 12-week RCT, all intervention participants were invited to participate in semistructured interviews. A qualitative descriptive approach was used. Interviews were analyzed through a theoretical thematic analysis process, whereby transcripts were coded, and codes then grouped into larger categories and themes. Results A total of 56 interviews were analyzed with the emergence of 3 main themes: (1) IBD as a source of stress and uncertainty, (2) understanding the positive impacts of the stress reduction program, and (3) suggested strategies to enhance program desirability. IBD was described as causing uncertainty, significant disruptions to daily activities, and stress, which in turn worsened symptoms. The online program was associated with a perceived reduction in IBD symptom burden, an increased ability to manage daily and disease-associated stressors, and a more positive mindset. Variation in program content and fostering connections with others in the IBD community were identified as potential strategies to enhance future programming. Conclusions This qualitative companion study highlights the power of the patient voice to deepen our understanding of the impact of IBD, and the potential benefit of an online stress reduction program including suggestions for iterative refinement.
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Affiliation(s)
- Makayla Watt
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Farhad Peerani
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Karen Madsen
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jesse Siffledeen
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Karen Kroeker
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Allen Lim
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Puneeta Tandon
- Address correspondence to: Puneeta Tandon, MD, MSc, FRCPC, University of Alberta, Division of Gastroenterology, 130 University Campus NW, Edmonton, Alberta T6G 2X8, Canada ()
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Philippou A, Sehgal P, Ungaro RC, Wang K, Bagiella E, Dubinsky MC, Keefer L. High Levels of Psychological Resilience Are Associated With Decreased Anxiety in Inflammatory Bowel Disease. Inflamm Bowel Dis 2021; 28:888-894. [PMID: 34448855 PMCID: PMC9165553 DOI: 10.1093/ibd/izab200] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Anxiety and depression are comorbid disorders with IBD and are associated with poor outcomes. Resilience is an innate but modifiable trait that may improve the symptoms of psychological disorders. Increasing resilience may decrease the severity of these comorbid disorders, which may improve IBD outcomes. The aim of this study was to describe the association between resilience, anxiety, and depression in IBD patients. METHODS We performed a cross-sectional study of IBD patients. Patients completed a questionnaire consisting of the Connor-Davidson Resilience Scale (CD-RISC), a measure of resilience, the Generalized Anxiety Disorder 7 (GAD-7), and the Patient Health Questionnaire-9. Primary outcome was severity of anxiety and depression in patients with high resilience. Multivariable linear regression analysis evaluated the association between severity of anxiety and depression and level of resilience. RESULTS A sample of 288 patients was analyzed. Bivariable linear regression analysis showed a negative association between resilience and anxiety (Pearson rho = -0.47; P < .0001) and between resilience and depression (Pearson rho = -0.53; P < .0001). Multivariable linear regression indicated that high resilience is independently associated with lower anxiety and that for every 1-unit increase in CD-RISC, the GAD-7 score decreased by 0.04 units (P = .0003). Unlike anxiety, the association between resilience and depression did not remain statistically significant on multivariable analysis. CONCLUSIONS High resilience is independently associated with lower anxiety in IBD patients, and we report a quantifiable decrease in anxiety score severity for every point of increase in resilience score. These findings suggest that IBD patients with higher resilience may have better coping mechanisms that buffer against the development of anxiety.
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Affiliation(s)
- Alicia Philippou
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Priya Sehgal
- Division of Digestive and Liver Disease, Columbia University Irving Medical Center, New York, New York, USA
| | - Ryan C Ungaro
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kelly Wang
- The Center for Biostatistics at the Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Emilia Bagiella
- The Center for Biostatistics at the Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marla C Dubinsky
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Laurie Keefer
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA,Address correspondence to: Laurie Keefer, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, 17 E. 102nd Street, Box 1134, New York, NY, USA. ()
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Vernon-Roberts A, Rouse E, Gearry RB, Day AS. Systematic Review of Self-Management Assessment Tools for Children With Inflammatory Bowel Disease. JPGN REPORTS 2021; 2:e075. [PMID: 37205965 PMCID: PMC10191491 DOI: 10.1097/pg9.0000000000000075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/24/2021] [Indexed: 05/21/2023]
Abstract
The relapsing pattern of illness and diverse management strategies for children with inflammatory bowel disease (IBD) may inhibit their opportunities to develop self-management skills. Interventions focused on the development of these skills require population-specific outcome measures. We provide a comprehensive overview of self-management skills assessment tools that are available for children with IBD that target processes and behaviors outlined as beneficial for the development of these skills. Seven health literature databases were searched using terms related to self-management, transition, IBD, Crohn's disease, ulcerative colitis, and children. Identified studies underwent a process of title and then full text review. Included studies underwent data extraction using a priori quality assessment criteria related to self-management skills, health literacy, suitability for the target population, validity and reliability testing. The searches identified 523 papers, 123 of which underwent full-text review and 10 included in the final analysis. The assessment tools identified showed great diversity in their development approach, content, methodological rigor, and health literacy considerations. The most frequently included self-management skills were related to adherence, communication, attending clinic, and disease/treatment knowledge. None of the tools satisfied the criteria of selection for use in the target population. While many chronic diseases of childhood follow a predictable disease course with established treatment pathways, IBD presents a unique set of challenges. The development of self-management skills is vital for successful disease management, but these skills should be assessed by a tool appropriate for the population and their diverse needs.
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Affiliation(s)
| | - Emma Rouse
- Department of Medicine, Otago University, Christchurch, New Zealand
| | | | - Andrew S. Day
- From the Department of Paediatrics, Otago University, Christchurch, New Zealand
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Overview of Self-Management Skills and Associated Assessment Tools for Children with Inflammatory Bowel Disease. GASTROINTESTINAL DISORDERS 2021. [DOI: 10.3390/gidisord3020007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Self-management is a multi-modal approach for managing chronic conditions that encompasses a number of different elements; knowledge, adherence, self-regulation, communication, and cognitive factors. Self-management has been shown to be beneficial for adults with inflammatory bowel disease (IBD), and for children with IBD it may help them learn to take control of their complex treatment regimens and lead to positive disease outcomes. The development of self-management skills for children with IBD is vital in order to maximize their potential for health autonomy, but it is still an emergent field in this population. This review provides an over-arching view of the self-management elements specific to children with IBD, and highlights outcome measures that may be used to assess skills within each field as well as the efficacy of targeted interventions.
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Vernon-Roberts A, Frampton C, Gearry RB, Day AS. Development and Validation of a Self-management Skills Assessment Tool for Children With Inflammatory Bowel Disease: The Inflammatory Bowel Disease-Skills Tasks and Abilities Record (IBD-STAR). J Pediatr Gastroenterol Nutr 2021; 72:67-73. [PMID: 32804909 DOI: 10.1097/mpg.0000000000002905] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES For children with inflammatory bowel disease (IBD), the development of self-management skills has the potential to improve disease outcomes. No assessment tools are aimed at measuring self-management skills in this population. A tool was developed called the IBD-Skills Tasks and Abilities Record (IBD-STAR) which measures children's allocation of responsibility for specific skills. IBD-STAR contains 18 items, scored whether completed independently (score 2), with help (score 1) or not at all (score 0). METHODS Children with IBD completed IBD-STAR; one parent and a gastroenterologist completed a series of visual analogue scales that corresponded with each IBD-STAR section. Children's IBD-STAR scores were examined against independent variables and compared with the parent and clinician visual analogue scale scores. Reliability was calculated using Cronbach's alpha. RESULTS Twenty-five Cronbach's alpha with IBD participated, mean age 14 years (standard deviation (SD) 1.7), 14 (56%) were boys, and 21 (84%) had Crohn's disease. The mean IBD-STAR score was 27.1 (SD 5.7), equivalent to a score of 75%. Age was the only independent variable significantly associated with scores (P = 0.017). Parents consistently underestimated their children in all sections, but clinician assessments were more closely aligned. Reliability for IBD-STAR was good with an overall Cronbach's alpha of 0.84. CONCLUSION IBD-STAR reports the allocation of responsibility for self-management skills with good agreement between children and clinician, and with comprehensible differences with their parents. Such a tool may be used to identify children with IBD in need of support or to measure the efficacy of targeted interventions.
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Affiliation(s)
| | - Chris Frampton
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Richard B Gearry
- Department of Medicine, University of Otago, Christchurch, New Zealand
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Davis SP, Bolin LP, Crane PB, Wei H, Crandell J. Non-pharmacological interventions to manage fatigue in adults with inflammatory bowel disease: A systematic review and meta-analysis. Complement Ther Clin Pract 2020; 41:101229. [PMID: 32836107 DOI: 10.1016/j.ctcp.2020.101229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 08/03/2020] [Accepted: 08/08/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE The prevalence of fatigue is higher in adults with inflammatory bowel disease (IBD). There is limited information on the effectiveness of non-pharmacological interventions to manage fatigue. The purposes of this review is to evaluate the effectiveness of these interventions to manage fatigue in adults with IBD. MATERIALS AND METHODS A systematic review was conducted based on the PRISMA guidelines. Comprehensive Meta-Analysis software was used to compute metaanalysis. RESULTS Eleven studies were included in the review. The interventions to manage fatigue included problem-solving therapy, solution-focused therapy, cognitive behavioral therapy, psychoeducational intervention, exercise advice with omega-3 supplements, electro-acupuncture, and AndoSan. The pooled evidence from the metaanalysis demonstrated that non-pharmacological interventions could decrease IBDFatigue (SMD = 0.33, 95% CI [0.10, 0.55], p = 0.005). CONCLUSION The pooled data indicate that non-pharmacological interventions are helpful in managing IBD-Fatigue. Additionally, the non-pharmacological interventions reviewed could be utilized to promote self-management in IBD.
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Affiliation(s)
- Suja P Davis
- School of Nursing, UNC-CH, CB#7460, Chapel Hill, NC, 27599, USA.
| | - Linda P Bolin
- Department of Nursing Science, College of Nursing, East Carolina University, 2205 W 5th St, Greenville, NC, 27889, USA.
| | - Patricia B Crane
- Carol Grotnes Belk Endowed Chair, 9201, University City Blvd, Charlotte, NC, USA.
| | - Holly Wei
- College of Nursing, East Carolina University, 2205 W 5th St, Greenville, NC, 27889, USA.
| | - Jamie Crandell
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
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Craven MR, Quinton S, Taft TH. Inflammatory Bowel Disease Patient Experiences with Psychotherapy in the Community. J Clin Psychol Med Settings 2020; 26:183-193. [PMID: 30136200 DOI: 10.1007/s10880-018-9576-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This study aimed to characterize patient expectations for integrating mental health into IBD treatment, describe experiences with psychotherapy, and evaluate therapy access and quality. Adults with IBD were recruited online and via a gastroenterology practice. Participants, 162 adults with IBD, completed online questionnaires. The sample was primarily middle-aged, White, and female. Sixty percent had Crohn's Disease. Disease severity was mild to moderate; 38% reported utilizing therapy for IBD-specific issues. The greatest endorsed barrier to psychotherapy was its cost. Psychotherapy was perceived as leading to modest gains in quality of life, emotional well-being, and stress reduction. Participants reported a disparity between their desire for mental health discussions and their actual interactions with providers. The majority of participants (81%) stated there are insufficient knowledgeable therapists. A significant number of patients with IBD endorsed the desire for mental health integration into care. Disparities exist in reported provider-patient communication on these topics. There appears to be a dearth of IBD-knowledgeable therapists in the community.
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Affiliation(s)
- Meredith R Craven
- Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Sarah Quinton
- Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tiffany H Taft
- Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Inflammatory Bowel Disease: A Stressed "Gut/Feeling". Cells 2019; 8:cells8070659. [PMID: 31262067 PMCID: PMC6678997 DOI: 10.3390/cells8070659] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/22/2019] [Accepted: 06/28/2019] [Indexed: 12/21/2022] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic and relapsing intestinal inflammatory condition, hallmarked by a disturbance in the bidirectional interaction between gut and brain. In general, the gut/brain axis involves direct and/or indirect communication via the central and enteric nervous system, host innate immune system, and particularly the gut microbiota. This complex interaction implies that IBD is a complex multifactorial disease. There is increasing evidence that stress adversely affects the gut/microbiota/brain axis by altering intestinal mucosa permeability and cytokine secretion, thereby influencing the relapse risk and disease severity of IBD. Given the recurrent nature, therapeutic strategies particularly aim at achieving and maintaining remission of the disease. Alternatively, these strategies focus on preventing permanent bowel damage and concomitant long-term complications. In this review, we discuss the gut/microbiota/brain interplay with respect to chronic inflammation of the gastrointestinal tract and particularly shed light on the role of stress. Hence, we evaluated the therapeutic impact of stress management in IBD.
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Tarricone I, Regazzi MG, Bonucci G, Rizzello F, Carini G, Muratori R, Poggioli G, Campieri M. Prevalence and effectiveness of psychiatric treatments for patients with IBD: A systematic literature review. J Psychosom Res 2017; 101:68-95. [PMID: 28867427 DOI: 10.1016/j.jpsychores.2017.07.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 05/23/2017] [Accepted: 07/01/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Higher prevalence of psychiatric disorders, such as anxiety and depression, has been found in people with Crohn's disease and Ulcerative Colitis compared to the general population. Nowadays, international guidelines advocate psychotherapy and psycho-pharmacological treatments as playing an important role in IBD care. The main goal of this systematic literature review was summarize the evidence on the utilization and effectiveness of treatments for depression and anxiety in persons with IBD. METHODS A systematic literature review was conducted using three different electronic databases: MEDLINE, PsychINFO, and EMBASE to identify studies reporting the prevalence and efficacy of psycho-pharmacological and psychotherapeutic treatments for IBD. A quality appraisal was conducted using several scales as appropriate for each study design. A narrative synthesis was also performed. RESULTS Forty-three studies were included. Although a high rate of psychoactive drug use was found in people with IBD, a low proportion of IBD patients have access to psychiatric referral. 1/3 of the studies found that psychotherapy was effective for improving the quality of life, perception of stress, anxiety and depression as well as disease. Antidepressants proved effective in reducing disease activity, gastrointestinal symptoms, anxiety and depression. CONCLUSION Our results suggest that psychiatric treatment should be implemented in IBD care. However, further studies are needed to confirm the findings of our systematic review.
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Affiliation(s)
- Ilaria Tarricone
- Department of Medical and Surgical Sciences, University of Bologna, Italy; Department of Psychiatry and Psychological Addictions, Local Health Authority, Bologna, Italy.
| | | | - Giulia Bonucci
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Fernando Rizzello
- Department of Medical and Surgical Sciences, University of Bologna, Italy; Azienda Ospedaliera Universitaria Sant'Orsola-Malpighi, Italy
| | - Giovanni Carini
- Azienda Ospedaliera Universitaria Sant'Orsola-Malpighi, Italy
| | | | - Gilberto Poggioli
- Department of Medical and Surgical Sciences, University of Bologna, Italy; Azienda Ospedaliera Universitaria Sant'Orsola-Malpighi, Italy
| | - Massimo Campieri
- Department of Medical and Surgical Sciences, University of Bologna, Italy; Azienda Ospedaliera Universitaria Sant'Orsola-Malpighi, Italy
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Abstract
BACKGROUND Successful treatment of patients with inflammatory bowel disease (IBD) requires regular intake of medication. Nonadherence to treatment is associated with increased frequency of relapses, morbidity, and cost. METHODS Pediatric patients with IBD taking oral medication and with access to text messaging (TM) services were included. Children were randomized by age, sex, medication administration responsibility (self vs parent), and disease activity (Pediatric Crohn Disease Activity Index or Pediatric Ulcerative Colitis Activity Index) into TM intervention and standard of care. Prospectively, the interventional group received 2-way TM reminders about medication administration. Failure to confirm intake by the patient resulted in a TM alert to the caregiver and weekly compliance reports were sent to patients, caregivers, and healthcare providers. Patients' medical records were reviewed and an adherence Morisky questionnaire completed at recruitment, 6 and 12 months. RESULTS A total of 51 children were randomized (21 TM and 30 control). The age, sex, diagnosis (ulcerative colitis/Crohn), activity index, ethnicity, insurance, and Morisky score at baseline were similar in both groups. Morisky score improved by 1 and 0.8 points, respectively in the TM group at 6 and 12 months, whereas it did not change in the control group (P = 0.0131 and P = 0.1687, prospectively). CONCLUSIONS TM may be effective in promoting adherence in children with IBD. Larger and longer multicenter studies are required to confirm this finding.
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Berding A, Witte C, Gottschald M, Kaltz B, Weiland R, Gerlich C, Reusch A, Kruis W, Faller H. Beneficial Effects of Education on Emotional Distress, Self-Management, and Coping in Patients with Inflammatory Bowel Disease: A Prospective Randomized Controlled Study. Inflamm Intest Dis 2017; 1:182-190. [PMID: 29922675 DOI: 10.1159/000452989] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 11/01/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) suffer from various physical as well as psychological impairments, and patient education may help improve their well-being. Therefore, we developed a manualized education program for IBD patients addressing medical and psychological issues. This study aimed to evaluate it in a large controlled trial. METHODS A total of 181 IBD outpatients participated in a prospective, randomized, waitlist-controlled trial; assessments were made before as well as 2 weeks and 3 months after intervention. Analysis of covariance was used to assess intervention effects on disease-related worries and concerns (primary outcome), fear of progression, coping with anxiety, health competencies, health-related quality of life (HRQoL), perceived disease activity, symptoms of depression and anxiety, disease-related knowledge, and coping strategies. Participants' satisfaction with the program was also evaluated. RESULTS At 2 weeks and 3 months after intervention, we found significant large effects of our education program on skill and technique acquisition, knowledge, and coping with IBD. Moreover, we found significant medium effects on disease-related worries and concerns, fear of progression, coping with anxiety, constructive attitudes and approaches, as well as coping with disease-related negative emotions. The number of coping strategies used was significantly higher at 3 months. We did not find any effects on perceived disease activity, HRQoL, positive and active engagement in life, or symptoms of anxiety and depression. The program was rated very favorably by the attendees. CONCLUSION Our education program contributed to improvements in psychological distress, self-management skills, and coping and was appreciated by its attendees.
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Affiliation(s)
- Anja Berding
- German Crohn's and Colitis Association (DCCV e.V.), Berlin, Germany.,Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| | - Christine Witte
- German Crohn's and Colitis Association (DCCV e.V.), Berlin, Germany
| | | | - Birgit Kaltz
- German Crohn's and Colitis Association (DCCV e.V.), Berlin, Germany
| | - Romy Weiland
- Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| | - Christian Gerlich
- Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| | - Andrea Reusch
- Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| | - Wolfgang Kruis
- Department of Internal Medicine, Protestant Hospital Kalk, Cologne, Germany
| | - Hermann Faller
- Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
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Scientometric analysis of psychological interventions based upon the use of Hypnosis. REVISTA IBEROAMERICANA DE PSICOLOGÍA 2017. [DOI: 10.33881/2027-1786.rip.9108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Hypnosis is a therapeutic technique that has developed for centuries, and every time with greater clinical and scientific weight. Currently, hypnosis constitutes a solid support method for treatments against chronic pain and for emotion control under situations that generate fear and anxiety -such as surgery or other type of phobias-, so it is presented as an alternative to the use of medicine/drugs by health specialists. On the other hand within the field of behavioral sciences, apart from controlling fear and anxiety responses, hypnosis serves as support to the various cognitive behavioral techniques by facilitating their assimilation and development. This work presents a scientometric study of the research done on hypnosis over the last fifteen years, from publications -in Spanish and English- in specialized journals, indexed in SCOPUS (a specialized international bibliometric database). The contemporary applications of hypnosis are presented and critically discussed; as well as the fields in which its application has proven successful; its limitations; the research networks generated within the time of the study; plus, probable projections for future research are also mentioned.
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Fan YH, Wang SY. Art of therapy: Focus on psychological health among patients with inflammatory bowel disease. Shijie Huaren Xiaohua Zazhi 2016; 24:2445-2453. [DOI: 10.11569/wcjd.v24.i16.2445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic, recurrent and idiopathic intestinal disorder whose pathogenesis remains unclear. An increasing amount of evidence has shown that psychological factors are closely related to the progression and recurrence of IBD. Psychotherapy can be an important supplement therapy to traditional IBD treatment. In this article we will briefly review the advances in research of IBD-related psychological factors and the corresponding intervention approaches. Clinicians should strengthen their awareness of IBD-related psychological disorders and put emphasis on psychotherapy.
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Conley S, Redeker N. A Systematic Review of Self-Management Interventions for Inflammatory Bowel Disease. J Nurs Scholarsh 2016; 48:118-27. [PMID: 26756193 DOI: 10.1111/jnu.12189] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE To conduct a systematic review of self-management interventions for adults with inflammatory bowel disease (IBD) to (a) describe self-management skills in the interventions and (b) describe the effects of the interventions on the health-related outcomes measured. DESIGN Systematic review of self-management interventions for adults with IBD using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. METHODS The search was conducted using Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and Proquest databases. Search terms were inflammatory bowel disease OR Crohn* disease OR ulcerative colitis AND self-management. We also used additional limits (adults ≥ 18 years of age and published in English). The self-management skills were organized according to Lorig and Holman's five self-management skills. FINDINGS Six reports met the inclusion criteria. One intervention contained all five of the self-management skills. Most interventions contained two skills. Four studies demonstrated positive effects of self-management on disease activity. Two interventions revealed positive effects on disease-specific health-related quality of life (HRQOL), and one intervention revealed positive effects on generic HRQOL. One study showed positive effects of symptoms. CONCLUSIONS The interventions reviewed varied in the approaches, theoretical perspectives, self-management skills, and outcomes measured. Additional research is needed to understand which are the active components of self-management. CLINICAL RELEVANCE Support for self-management skills is an important component of nursing care for people with IBD.
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Affiliation(s)
- Samantha Conley
- Delta Mu, Doctoral Student, Yale School of Nursing, Yale University, West Haven, CT, USA
| | - Nancy Redeker
- Delta Mu, Professor, Yale School of Nursing, Yale University, West Haven, CT, USA
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Tabatabaeian M, Afshar H, Roohafza HR, Daghaghzadeh H, Feizi A, Sharbafchi MR, Tabatabaeian M, Naji F, Adibi P. Psychological status in Iranian patients with ulcerative colitis and its relation to disease activity and quality of life. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2015; 20:577-84. [PMID: 26600833 PMCID: PMC4621652 DOI: 10.4103/1735-1995.165962] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Psychological profile of inflammatory bowel disease patients is not well studied in Iran. We investigated the psychological status of Iranian patients with ulcerative colitis (UC) and its relationship with disease activity and quality of life (QOL). MATERIALS AND METHODS A cross-sectional study was conducted on adult UC patients. The Lichtiger Colitis Activity Index, Hospital Anxiety and Depression Scale, General Health Questionnaire-12, and WHOQOL-BREF, were completed by the patients. RESULTS From 120 studied patients, 35 (29.2%), 48 (40.0%), and 46 (38.3%) had significant anxiety, depression, and psychological distress, respectively. Anxiety, depression, and psychological distress were strongly correlated with disease activity (r = 0.357 to 0.439, P < 0.01). Disease activity was negatively correlated with all QOL dimensions (r = -0.245 to -0.550, P < 0.01). Anxiety, depression, and psychological distress were also negatively correlated with all QOL domains (r = -0.356 to -0.789, P < 0.01). In the regression models, anxiety was independently associated with active disease (β = 4.150, P = 0.049). Furthermore, disease activity was associated with the physical health (β = -0.371, P < 0.001). For almost all of the QOL domains, depression and psychological distress were independent predictors (β = -0.296 to -0.453, P < 0.001). CONCLUSION Anxiety, depression, and psychological distress are highly frequent in UC patients of our society and are strongly associated with disease activity. Depression and psychological distress are important predictors of poor QOL in these patients. Further prospective studies, as well as clinical trials, are warranted in this regard.
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Affiliation(s)
- Mahshid Tabatabaeian
- Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Afshar
- Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Reza Roohafza
- Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamed Daghaghzadeh
- Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Sharbafchi
- Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran ; Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Tabatabaeian
- Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fateme Naji
- Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Peyman Adibi
- Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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16
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Burkhalter H, Stucki-Thür P, David B, Lorenz S, Biotti B, Rogler G, Pittet V. Assessment of inflammatory bowel disease patient's needs and problems from a nursing perspective. Digestion 2015; 91:128-41. [PMID: 25677558 DOI: 10.1159/000371654] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 12/18/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND In this study, we aimed at assessing Inflammatory Bowel Disease patients' needs and current nursing practice to investigate to what extent consensus statements (European Crohn's and Colitis Organization) on the nursing roles in caring for patients with IBD concur with local practice. METHODS We used a mixed-method convergent design to combine quantitative data prospectively collected in the Swiss IBD cohort study and qualitative data from structured interviews with IBD healthcare experts. Symptoms, quality of life, and anxiety and depression scores were retrieved from physician charts and patient self-reported questionnaires. Descriptive analyses were performed based on quantitative and qualitative data. RESULTS 230 patients of a single center were included, 60% of patients were males, and median age was 40 (range 18-85). The prevalence of abdominal pain was 42%. Self-reported data were obtained from 75 out of 230 patients. General health was perceived significantly lower compared with the general population (p < 0.001). Prevalence of tiredness was 73%; sleep problems, 78%; issues related to work, 20%; sexual constraints, 35%; diarrhea, 67%; being afraid of not finding a bathroom, 42%; depression, 11%; and anxiety symptoms, 23%. According to experts' interviews, the consensus statements are found mostly relevant with many recommendations that are not yet realized in clinical practice. CONCLUSION Identified prevalence may help clinicians in detecting patients at risk and improve patient management.
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Affiliation(s)
- Hanna Burkhalter
- Department of Abdominal Surgery, University Hospital Zurich, Zurich, Switzerland
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17
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Peters SL, Muir JG, Gibson PR. Review article: gut-directed hypnotherapy in the management of irritable bowel syndrome and inflammatory bowel disease. Aliment Pharmacol Ther 2015; 41:1104-15. [PMID: 25858661 DOI: 10.1111/apt.13202] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 10/12/2014] [Accepted: 03/28/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Gut-directed hypnotherapy is being increasingly applied to patients with irritable bowel syndrome (IBS) and to a lesser extent, inflammatory bowel disease (IBD). AIM To review the technique, mechanisms of action and evidence for efficacy, and to identify gaps in the understanding of gut-directed hypnotherapy as a treatment for IBS and IBD. METHODS A review of published literature and a systematic review of clinical trials in its application to patients with IBS and IBD were performed. RESULTS Gut-directed hypnotherapy is a clearly described technique. Its potential mechanisms of action on the brain-gut axis are multiple with evidence spanning psychological effects through to physiological gastrointestinal modifications. Six of seven randomised IBS studies reported a significant reduction (all P < 0.05) in overall gastrointestinal symptoms following treatment usually compared to supportive therapy only. Response rates amongst those who received gut-directed hypnotherapy ranged between 24% and 73%. Efficacy was maintained long-term in four of five studies. A therapeutic effect was also observed in the maintenance of clinical remission in patients with ulcerative colitis. Uncontrolled trials supported the efficacy and durability of gut-directed hypnotherapy in IBS. Gaps in understanding included to whom and when it should be applied, the paucity of adequately trained hypnotherapists, and the difficulties in designing well controlled-trials. CONCLUSIONS Gut-directed hypnotherapy has durable efficacy in patients with IBS and possibly ulcerative colitis. Whether it sits in the therapeutic arsenal as a primary and/or adjunctive therapy cannot be ascertained on the current evidence base. Further research into efficacy, mechanisms of action and predictors of response is required.
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Affiliation(s)
- S L Peters
- Department of Gastroenterology, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, Vic., Australia
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18
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Tamara VDS. "Role of Psychosocial Factors on the Course of Inflammatory Bowel Disease and Associated Psychotherapeutic Approaches. A Fresh Perspective and Review". ACTA ACUST UNITED AC 2015. [DOI: 10.15406/ghoa.2015.02.00038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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19
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Bharadwaj S, Barber MD, Graff LA, Shen B. Symptomatology of irritable bowel syndrome and inflammatory bowel disease during the menstrual cycle. Gastroenterol Rep (Oxf) 2015; 3:185-93. [PMID: 25788484 PMCID: PMC4527267 DOI: 10.1093/gastro/gov010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 02/03/2015] [Indexed: 12/17/2022] Open
Abstract
Gender-related physiological variations in gastrointestinal (GI) symptomatology have been observed in women of reproductive age. Many women experience cyclical changes in GI symptomatology during their menstrual cycle, particularly alteration in their bowel habits. Physiological studies of healthy women during the menstrual cycle showed a prolonged GI transit time during the luteal phase, either in the oro-cecum route or in the colon. Worsened GI symptoms, such as abdominal pain, bloating or diarrhea are observed in patients with irritable bowel syndrome (IBS) during menses. This may be due to elevated prostaglandin levels during menses, with an enhanced perception of viscera-somatic stimuli resulting in nausea, abdominal distension and pain. Also patients with IBS or IBD demonstrate a cyclical pattern more closely related to their bowel habits than healthy controls. Women with inflammatory bowel disease (IBD) also have exacerbated symptoms during menses; however, it is unclear whether this relates to physiological variation or disease exacerbation in IBS or IBD. Studies examining the association of the menstrual cycle and GI symptomatology in patients with IBS or IBD, have not yet clarified the underlying mechanisms. Moreover medications—such as non-steroidal anti-inflammatory drugs and oral contraceptive pills used for dysmenorrhea and menstrual migraine in those patients have not well been controlled for in the previous studies, which can contribute to further bias. Understanding changes in GI symptomatology during the menstrual cycle may help to determine the true extent of disease exacerbation and proper management strategy.
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Affiliation(s)
- Shishira Bharadwaj
- Departments of Gastroenterology/Hepatology, the Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Matthew D Barber
- Department of Obstetrics and Gynecology, the Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Lesley A Graff
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Bo Shen
- Departments of Gastroenterology/Hepatology, the Cleveland Clinic Foundation, Cleveland, OH, USA
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20
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Abstract
PURPOSE OF REVIEW The purpose of this review is to highlight recent work and provide recommendations on the approach for diagnosis and management of chronic cough in a gastroenterology clinic. RECENT FINDINGS Chronic cough is a burdensome symptom affecting a large number of patients and contributes significant cost to the healthcare system. Recent work has shown that select patients may benefit from acid-suppressive therapy and even surgery when there is true pathologic evidence of reflux disease with cough. However, judicious use and proper interpretation of diagnostic testing for gastroesophageal reflux in the setting of cough is important to avoid unnecessary or inappropriate therapy. SUMMARY Chronic cough remains a vexing problem for many physicians, including gastroenterologists. It is important that physicians approach refractory cough in a multidisciplinary manner. Future research is needed to better understand the likely central hypersensitivity response mediating reflux-related cough and potential alternative approaches to therapy.
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Vogelaar L, van't Spijker A, Timman R, van Tilburg AJP, Bac D, Vogelaar T, Kuipers EJ, van Busschbach JJV, van der Woude CJ. Fatigue management in patients with IBD: a randomised controlled trial. Gut 2014; 63:911-8. [PMID: 23884638 DOI: 10.1136/gutjnl-2013-305191] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess the effectiveness of solution-focused therapy (SFT) on fatigue and quality of life (QoL) in patients with fatigued inflammatory bowel disease (IBD). DESIGN Randomised controlled trial in two Dutch hospitals. Patients with IBD with quiescent IBD and with a Checklist Individual Strength--Fatigue (CIS--fatigue) score of ≥ 35 were enrolled. Patients were 1:1 randomised to receive SFT or care as usual (CAU) for 3 months. Patients were followed for a further 6 months after the SFT. Primary endpoint was defined as changes in fatigue and QoL during follow-up. Secondary endpoints included change in anxiety and depression, medication use, side effects to medication, disease activity, laboratory parameters (C-reactive protein, leucocytes and haemoglobin) and sleep quality. RESULTS Ninety-eight patients were included, of whom 63% were women, mean age was 40.1 years. After the SFT course, 17 (39%) patients in the SFT group had a CIS-fatigue score below 35 compared with eight (18%) of patients in the CAU group (p=0.03). The SFT group also showed a greater reduction in fatigue across the first 6 months compared with the CAU group (CIS-fatigue: p=<0.001 and CIS-total: p=0.001). SFT was associated with a significant higher mean IBD questionnaire change at 3 months (p=0.020). At 9 months, no significant differences between the two groups were observed. CONCLUSIONS SFT has a significant beneficial effect on the severity of fatigue and QoL in patients with quiescent IBD. However, this effect diminished during follow-up.
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Affiliation(s)
- Lauran Vogelaar
- Department of Gastroenterology and Hepatology, Erasmus MC, , Rotterdam, The Netherlands
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22
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Szymanska S, Lördal M, Rathnayake N, Gustafsson A, Johannsen A. Dental caries, prevalence and risk factors in patients with Crohn's disease. PLoS One 2014; 9:e91059. [PMID: 24608416 PMCID: PMC3946651 DOI: 10.1371/journal.pone.0091059] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 02/07/2014] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The present study tested the hypothesis that patients with Crohn's disease (CD) have a higher prevalence and risk for caries compared to people without CD. MATERIAL AND METHODS Patients with CD were divided into groups; 71 patients (50.7 ± 13.9 years) who had gone through resective intestinal surgery and 79 patients (42.0 ± 14.4 years) who had not. The patients were compared to 75 controls (48.6 ± 13.4 years) regarding DMF-T and DMF-S, Lactobacilli (LB), Streptococcus mutans (SM), salivary flow and dental plaque. Statistical methods including ANOVA or Chi-square test for calculation of demographic differences between groups, analysis of covariance (ANCOVA) to compare the clinical variable and Post hoc analyses were done with Fischers Least Significant Difference test or Chi-square. Non-parametric Spearman's correlation matrix coefficient was estimated between clinical variables and disease duration. RESULTS CD patients who had been subjected to resective surgery had a higher DMF-S score (50.7 versus 36.5; p = 0.01) compared to the control group after adjusting for age, gender and smoking. These patients had higher counts of SM (1.5 versus 0.9; p = 0.04) and LB (10000.0 versus 1000.0; p = 0.01), and more dental plaque (53.7 versus 22.6; p = 0.001). CD patients reported a more frequent consumption of sweetened drinks between meals compared to controls (p = 0.001). CONCLUSIONS The present study shows that patients with CD who had undergone resective surgery had a higher DMFs score, and higher salivary counts of Lactobacilli and Streptococcus mutans compared to the control group.
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Affiliation(s)
- Sara Szymanska
- Department of Dental Medicine, Division of Periodontology, Karolinska Institutet, Huddinge, Sweden
| | - Mikael Lördal
- Department of Medicine, Division of Gastroenterology and Hepathology at Karolinska Institutet, Huddinge, Sweden; Stockholm Gastro Center, Sophiahemmet, Stockholm, Sweden
| | - Nilminie Rathnayake
- Department of Dental Medicine, Division of Periodontology, Karolinska Institutet, Huddinge, Sweden
| | - Anders Gustafsson
- Department of Dental Medicine, Division of Periodontology, Karolinska Institutet, Huddinge, Sweden
| | - Annsofi Johannsen
- Department of Dental Medicine, Division of Periodontology, Karolinska Institutet, Huddinge, Sweden
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Huang VW, Reich KM, Fedorak RN. Distance management of inflammatory bowel disease: Systematic review and meta-analysis. World J Gastroenterol 2014; 20:829-842. [PMID: 24574756 PMCID: PMC3921492 DOI: 10.3748/wjg.v20.i3.829] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 09/15/2013] [Accepted: 09/29/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To review the effectiveness of distance management methods in the management of adult inflammatory bowel disease (IBD) patients.
METHODS: A systematic review and meta-analysis of randomized controlled trials comparing distance management and standard clinic follow-up in the management of adult IBD patients. Distance management intervention was defined as any remote management method in which there is a patient self-management component whereby the patient interacts remotely via a self-guided management program, electronic interface, or self-directs open access to clinic follow up. The search strategy included electronic databases (Medline, PubMed, CINAHL, The Cochrane Central Register of Controlled Trials, EMBASE, KTPlus, Web of Science, and SCOPUS), conference proceedings, and internet search for web publications. The primary outcome was the mean difference in quality of life, and the secondary outcomes included mean difference in relapse rate, clinic visit rate, and hospital admission rate. Study selection, data extraction, and risk of bias assessment were completed by two independent reviewers.
RESULTS: The search strategy identified a total of 4061 articles, but only 6 randomized controlled trials met the inclusion and exclusion criteria for the systematic review and meta-analysis. Three trials involved telemanagement, and three trials involved directed patient self-management and open access clinics. The total sample size was 1463 patients. There was a trend towards improved quality of life in distance management patients with an end IBDQ quality of life score being 7.28 (95%CI: -3.25-17.81) points higher than standard clinic follow-up. There was a significant decrease in the clinic visit rate among distance management patients mean difference -1.08 (95%CI: -1.60--0.55), but no significant change in relapse rate or hospital admission rate.
CONCLUSION: Distance management of IBD significantly decreases clinic visit utilization, but does not significantly affect relapse rates or hospital admission rates.
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McCombie AM, Mulder RT, Gearry RB. Psychotherapy for inflammatory bowel disease: a review and update. J Crohns Colitis 2013; 7:935-49. [PMID: 23466412 DOI: 10.1016/j.crohns.2013.02.004] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 02/05/2013] [Accepted: 02/06/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Psychotherapy may be a useful intervention for inflammatory bowel disease (IBD) patients. We systematically reviewed all randomized controlled trials that have been performed in psychotherapy for inflammatory bowel disease patients. METHODS Systematic searches were undertaken on 1 and 8 March, 2012 of studies of psychotherapy for IBD. RESULTS Eighteen studies (19 papers) were included in this review. Psychotherapy was found to have minimal effect on measures of anxiety, depression, QOL and disease progression although shows promise in reducing pain, fatigue, relapse rate and hospitalisation, and improving medication adherence. It may also be cost effective. CONCLUSIONS The effects of psychotherapy on IBD is mixed: future studies should determine whether patient screening or measuring different dependent variables improves outcomes and whether particular psychotherapies are superior over others.
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Affiliation(s)
- Andrew M McCombie
- Department of Medicine, University of Otago, Christchurch, New Zealand.
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25
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Keefer L, Taft TH, Kiebles JL, Martinovich Z, Barrett TA, Palsson OS. Gut-directed hypnotherapy significantly augments clinical remission in quiescent ulcerative colitis. Aliment Pharmacol Ther 2013; 38:761-71. [PMID: 23957526 PMCID: PMC4271841 DOI: 10.1111/apt.12449] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 06/20/2013] [Accepted: 07/19/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND Psychotherapy is not routinely recommended for in ulcerative colitis (UC). Gut-directed hypnotherapy (HYP) has been linked to improved function in the gastrointestinal tract and may operate through immune-mediated pathways in chronic diseases. AIMS To determine the feasibility and acceptability of HYP and estimate the impact of HYP on clinical remission status over a 1-year period in patients with an historical flare rate of 1.3 times per year. METHODS A total of 54 patients were randomised at a single site to seven sessions of gut-directed HYP (n = 26) or attention control (CON; n = 29) and followed for 1 year. The primary outcome was the proportion of participants in each condition that had remained clinically asymptomatic (clinical remission) through 52 weeks post treatment. RESULTS One-way analysis of variance comparing HYP and CON subjects on number of days to clinical relapse favoured the HYP condition [F = 4.8 (1, 48), P = 0.03] by 78 days. Chi-squared analysis comparing the groups on proportion maintaining remission at 1 year was also significant [χ²(1) = 3.9, P = 0.04], with 68% of HYP and 40% of CON patients maintaining remission for 1 year. There were no significant differences between groups over time in quality of life, medication adherence, perceived stress or psychological factors. CONCLUSION This is the first prospective study that has demonstrated a significant effect of a psychological intervention on prolonging clinical remission in patients with quiescent ulcerative colitis (Clinical Trial # NCT00798642).
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Affiliation(s)
- Laurie Keefer
- Northwestern University, Feinberg School of Medicine, Division of Gastroenterology, Chicago, IL,Northwestern University, Center for Psychosocial Research in GI, Chicago, IL,Northwestern University, Feinberg School of Medicine, Division of Psychiatry and Behavioral Sciences Chicago, IL
| | - Tiffany H Taft
- Northwestern University, Feinberg School of Medicine, Division of Gastroenterology, Chicago, IL,Northwestern University, Center for Psychosocial Research in GI, Chicago, IL
| | - Jennifer L Kiebles
- Edward Hines, Jr. VA Hospital, Mental Health / Rehabilitation Services, Hines, IL
| | - Zoran Martinovich
- Northwestern University, Feinberg School of Medicine, Division of Psychiatry and Behavioral Sciences Chicago, IL
| | - Terrence A Barrett
- Northwestern University, Feinberg School of Medicine, Division of Gastroenterology, Chicago, IL
| | - Olafur S Palsson
- University of North Carolina Center for Functional GI and Motility Disorders, Chapel Hill, NC
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Pajak R, Lackner J, Kamboj SK. A systematic review of minimal-contact psychological treatments for symptom management in irritable bowel syndrome. J Psychosom Res 2013; 75:103-12. [PMID: 23915765 DOI: 10.1016/j.jpsychores.2013.05.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 05/13/2013] [Accepted: 05/14/2013] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Psychological treatments are effective in alleviating symptoms of IBS but are not widely available. The need for wider dissemination of treatments has encouraged the development of 'minimal-contact' therapies requiring fewer resources than existing psychological treatments which rely on face-to-face contact. METHOD Using comprehensive search terms, the Embase, Medline and PsychInfo databases (all years) were searched. RESULTS Twelve studies--nine RCTs and three non-controlled preliminary studies - meeting inclusion criteria were reviewed and assessed for quality using objective criteria. Apart from one study of expressive writing, all interventions were based on cognitive (and/or) behavioural principles or hypnosis and tended to be adaptations of existing therapist-led interventions. Compared to control conditions, minimal-contact interventions were efficacious, the majority of studies showing statistically significant improvements by the end of treatment. For cognitive-behaviour-therapy-based interventions effects sizes were large. The two studies that compared minimal-contact with therapist-delivered interventions broadly suggest comparable outcomes between these modalities. CONCLUSIONS Minimal-contact cognitive-behavioural interventions show promise in the treatment of IBS. Because of the lower quality of studies of hypnosis and those involving interventions delivered entirely remotely, further support is needed before such approaches can be recommended for widespread use. More generally, future research should use representative samples, active control conditions, and intention to treat analysis. Nonetheless, existing high quality studies suggest that minimal-contact therapies may be a safe, effective means of achieving scaleability of psychological treatments for IBS.
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Affiliation(s)
- Rosanna Pajak
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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27
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Triantafillidis JK, Merikas E, Gikas A. Psychological factors and stress in inflammatory bowel disease. Expert Rev Gastroenterol Hepatol 2013; 7:225-38. [PMID: 23445232 DOI: 10.1586/egh.13.4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The role of psychological distress and personality as predisposing factors for the development of inflammatory bowel disease (IBD) remains controversial. Attempts to investigate the role of psychological factors in IBD exhibited rather conflicting results. Among the studies concerning the effects of stress or depression on the course of IBD, the majority suggest that stress worsened IBD, the rest giving either negative or inconclusive results. However, application of strategies, including avoidance of coping and training patients in problem solving or emotion-oriented, could influence the course of IBD. Large controlled clinical trials are needed in order to clarify the impact of psychological interventions on the quality of life and the course of disease.
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Affiliation(s)
- John K Triantafillidis
- Department of Gastroenterology, Center for Inflammatory Bowel Disease, Saint Panteleimon General Hospital, Nicea, Greece.
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28
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Meng J, Agrawal A, Whorwell PJ. Refractory inflammatory bowel disease-could it be an irritable bowel? Nat Rev Gastroenterol Hepatol 2013; 10:58-61. [PMID: 22965430 DOI: 10.1038/nrgastro.2012.173] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Patients with IBD who are apparently in remission-as indicated by normal blood tests, endoscopic findings and ultrasonography results-often continue to experience symptoms. Furthermore, despite these negative findings, there is a temptation to increase their anti-inflammatory medication in the hope that this approach would lead to some improvement. However, this strategy often seems to fail and can sometimes lead to adverse events. Consequently, when evidence of continuing inflammatory activity is lacking it might be appropriate to consider the possibility of co-existent IBS in these patients and to treat them for this condition. Dietary manipulation, antispasmodic agents, antidepressants (especially of the tricyclic variety) and even behavioural treatments might result in a worthwhile improvement of symptoms.
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Affiliation(s)
- Jie Meng
- Department of Gastroenterology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, 100078 China
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Todorovic V. Providing holistic support for patients with inflammatory bowel disease. Br J Community Nurs 2012; 17:466, 468-72. [PMID: 23124372 DOI: 10.12968/bjcn.2012.17.10.466] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Inflammatory bowel diseases such as ulcerative colitis and Crohn's disease are life-long, complex conditions. They are characterised by periods of exacerbation and remission and surgical intervention may be required in severe cases. Drugs employed in the management of IBD are used to induce remission and maintain remission. IBD has a physical, psychological and sociological impact on individuals and IBD quality standards have been developed to provide a framework for addressing the services and care that should be available for them. Complementary and alternative medicine (CAM) therapies play an important role in the holistic approach to management of IBD as they are being increasingly used alongside conventional medical treatments. Community nurses have an important role to play in the management and care of individuals with IBD and in supporting them in making informed and appropriate choices that support their wellbeing and quality of life.
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Sajadinejad MS, Molavi H, Asgari K, Kalantari M, Adibi P. Personality dimensions and type D personality in female patients with ulcerative colitis. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2012; 17:898-904. [PMID: 23825986 PMCID: PMC3698645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 08/01/2012] [Accepted: 08/18/2012] [Indexed: 12/02/2022]
Abstract
AIM Psychological factors such as personality traits may affect the adjustment capacity and Quality of Life (QOL) in Ulcerative Colitis (UC) patients. Type D personality has some similarities with general personality traits of UC patients. The aims of this study were to compare NEO personality profile and type D personality between healthy normal group and UC patients; and to determine the possible relationship between type D personality and QOL in UC patients. MATERIALS AND METHODS The sample of study comprised of 58 UC patients and 59 healthy control subjects (from their family members). All participants were requested to fill out NEO-FFI, Type D personality (Ds14) Scale and WHO-Quality of Life Questionnaire. RESULTS The findings indicated that UC patients scored higher in neuroticism (P<0/01); lower in extraversion (P<0/01) and openness (P<0/05) than healthy controls but their differentiation were not significant in agreeableness and conscientiousness. The findings showed that 59% of UC patients and 33% of the control subjects had type D personality; and the differences in frequency of type D between the two groups were significant (P<0/05). The mean QOL scores of type D personality in UC patients was significantly lower than patients without type D personality (F= 7/55, P<0/01). Type D personality could better predict QOL of UC patients than NEO dimensions. CONCLUSIONS Differences were observed between UC patients and their healthy family members, in terms of personality factors. Type D personality may be regarded as an important factor that may bring about some adverse effects in QOL among UC patients.
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Affiliation(s)
- Marzieh Sadat Sajadinejad
- Department Psychology, College of Educational Science and Psychology, University of Isfahan, Isfahan, Iran
| | - Hossein Molavi
- Department Psychology, College of Educational Science and Psychology, University of Isfahan, Isfahan, Iran
| | - Karim Asgari
- Department Psychology, College of Educational Science and Psychology, University of Isfahan, Isfahan, Iran
| | - Mehrdad Kalantari
- Department Psychology, College of Educational Science and Psychology, University of Isfahan, Isfahan, Iran
| | - Peyman Adibi
- Department of Internal Medicine, Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Prof. Adibi Peyman, Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
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Psychological issues in inflammatory bowel disease: an overview. Gastroenterol Res Pract 2012; 2012:106502. [PMID: 22778720 PMCID: PMC3388477 DOI: 10.1155/2012/106502] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 04/18/2012] [Accepted: 04/19/2012] [Indexed: 12/20/2022] Open
Abstract
Inflammatory bowel disease (IBD) including Crohn's disease (CD) and ulcerative colitis (UC) is a chronic and disabling disease with unknown etiology. There have been some controversies regarding the role of psychological factors in the course of IBD. The purpose of this paper is to review that role. First the evidence on role of stress is reviewed focusing on perceived stress and patients' beliefs about it in triggering or exacerbating the course of IBD. The possible mechanisms by which stress could be translated into IBD symptoms, including changes in motor, sensory and secretory gastrointestinal function, increase intestinal permeability, and changes in the immune system are, then reviewed. The role of patients' concerns about psychological distress and their adjustment to disease, poor coping strategies, and some personality traits that are commonly associated with these diseases are introduced. The prevalence rate, the timing of onset, and the impact of anxiety and depression on health-related quality of life are then reviewed. Finally issues about illness behavior and the necessity of integrating psychological interventions with conventional treatment protocols are explained.
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Keefer L, Doerfler B, Artz C. Optimizing management of Crohn's disease within a project management framework: results of a pilot study. Inflamm Bowel Dis 2012; 18:254-60. [PMID: 21351218 PMCID: PMC3111841 DOI: 10.1002/ibd.21679] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 01/17/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Psychotherapy for Crohn's disease (CD) has focused on patients with psychological distress. Another approach to optimize management of CD is to target patients who do not exhibit psychological distress but engage in behaviors that undermine treatment efficacy / increase risk for flare. We sought to determine the feasibility/acceptability and estimate the effects of a program framed around Project Management (PM) principles on CD outcomes. METHODS Twenty-eight adults with quiescent CD without a history of psychiatric disorder were randomized to PM (n = 16) or treatment as usual (TAU; n = 12). Baseline and follow-up measures were Inflammatory Bowel Disease Questionnaire (IBDQ), Medication Adherence Scale (MAS), Perceived Stress Questionnaire (PSQ), and IBD Self-Efficacy Scale (IBD-SES). RESULTS There were significant group × time effects favoring PM on IBDQ-Total Score (F(1) = 15.2, P = 0.001), IBDQ-Bowel (F(1) = 6.5, P = 0.02), and IBDQ-Systemic (F(1) = 9.3, P = 0.007) but not IBDQ-Emotional (F(1) = 1.9, P = ns) or IBDQ-Social (F(1) = 2.4, P = ns). There was a significant interaction effect favoring PM with respect to PSQ (F(1) = 8.4, P = 0.01) and IBD-SES (F(1) = 12.2, P = 0.003). There was no immediate change in MAS (F(1) = 4.3, P = ns). Moderate effect sizes (d > 0.30) were observed for IBDQ total score (d = 0.45), IBDQ bowel health (d = 0.45), and systemic health (d = 0.37). Effect sizes for PSQ (d = 0.13) and IBDSES (d = 0.17) were smaller. CONCLUSIONS Behavioral programs that appeal to patients who may not seek psychotherapy for negative health behaviors may improve quality of life and potentially disease course and outcomes.
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Affiliation(s)
- Laurie Keefer
- Northwestern University, Division of Gastroenterology, Chicago, Illinois 60611, USA.
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