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Fowler K. Generalized Anxiety Disorder in Canadian Adults: to what Extent Might Social Support Subdomains and Negative Social Interactions Predict Psychological Distress? Psychiatr Q 2023; 94:655-673. [PMID: 37768501 DOI: 10.1007/s11126-023-10055-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 09/29/2023]
Abstract
Generalized anxiety disorder (GAD) may involve persistent and unwarranted anxiety, fear, and rumination, combined with various somatic symptoms (e.g., fatigue, dizziness, muscle tension, and nausea) which may compel many to withdraw socially. While studies report an inverse relationship between social support and psychological distress among adults with GAD, those that assess the distinct influence of negative social relations, particularly by sex are limited. The primary aims of this study were to (a) assess and compare respondents with a lifetime of GAD in terms of levels of perceived social support (using the Social Provisions Scale - 10 Items (SPS-10) Scale), negative social interactions (using the Negative Social Interaction (NSI) Scale) and psychological distress (using the Kessler Psychological Distress Scale (K10)), and (b) determine whether SPS-10 subdomains and NSIs predict psychological distress. Compared with a matched sample without GAD, respondents with GAD were more likely to be single, divorced, and have lower incomes. Respondents with GAD also had lower overall SPS-10 scores, and lower scores for each subdomain (i.e., 'guidance', 'reliable alliance', 'reassurance of worth', 'attachment', and 'social integration'), and higher NSI and K10 scores. Although no difference in psychological distress was observed between men and women with GAD, men had lower SPS-10 scores (overall and for each subdomain), while women had higher NSIs scores. A subsequent hierarchical regression for respondents with GAD revealed that 'social integration' and 'reassurance of worth' predicted lower psychological distress, while higher NSI scores predicted higher psychological distress. Finding implications and future research are discussed.
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Affiliation(s)
- Ken Fowler
- Student Wellness and Counselling Centre, Memorial University of Newfoundland, St. John's, NL, Canada.
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2
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Layer P, Andresen V, Allescher H, Bischoff SC, Claßen M, Elsenbruch S, Freitag M, Frieling T, Gebhard M, Goebel-Stengel M, Häuser W, Holtmann G, Keller J, Kreis ME, Kruis W, Langhorst J, Jansen PL, Madisch A, Mönnikes H, Müller-Lissner S, Niesler B, Pehl C, Pohl D, Raithel M, Röhrig-Herzog G, Schemann M, Schmiedel S, Schwille-Kiuntke J, Storr M, Preiß JC, Andus T, Buderus S, Ehlert U, Engel M, Enninger A, Fischbach W, Gillessen A, Gschossmann J, Gundling F, Haag S, Helwig U, Hollerbach S, Karaus M, Katschinski M, Krammer H, Kuhlbusch-Zicklam R, Matthes H, Menge D, Miehlke S, Posovszky MC, Schaefert R, Schmidt-Choudhury A, Schwandner O, Schweinlin A, Seidl H, Stengel A, Tesarz J, van der Voort I, Voderholzer W, von Boyen G, von Schönfeld J, Wedel T. Update S3-Leitlinie Reizdarmsyndrom: Definition, Pathophysiologie, Diagnostik und Therapie. Gemeinsame Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Neurogastroenterologie und Motilität (DGNM) – Juni 2021 – AWMF-Registriernummer: 021/016. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 59:1323-1415. [PMID: 34891206 DOI: 10.1055/a-1591-4794] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- P Layer
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland
| | - V Andresen
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland
| | - H Allescher
- Zentrum für Innere Medizin, Gastroent., Hepatologie u. Stoffwechsel, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Deutschland
| | - S C Bischoff
- Institut für Ernährungsmedizin, Universität Hohenheim, Stuttgart, Deutschland
| | - M Claßen
- Klinik für Kinder- und Jugendmedizin, Klinikum Links der Weser, Bremen, Deutschland
| | - S Elsenbruch
- Klinik für Neurologie, Translational Pain Research Unit, Universitätsklinikum Essen, Essen, Deutschland.,Abteilung für Medizinische Psychologie und Medizinische Soziologie, Ruhr-Universität Bochum, Bochum, Deutschland
| | - M Freitag
- Abteilung Allgemeinmedizin Department für Versorgungsforschung, Universität Oldenburg, Oldenburg, Deutschland
| | - T Frieling
- Medizinische Klinik II, Helios Klinikum Krefeld, Krefeld, Deutschland
| | - M Gebhard
- Gemeinschaftspraxis Pathologie-Hamburg, Hamburg, Deutschland
| | - M Goebel-Stengel
- Innere Medizin II, Helios Klinik Rottweil, Rottweil, und Innere Medizin VI, Psychosomat. Medizin u. Psychotherapie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - W Häuser
- Innere Medizin I mit Schwerpunkt Gastroenterologie, Klinikum Saarbrücken, Saarbrücken, Deutschland
| | - G Holtmann
- Faculty of Medicine & Faculty of Health & Behavioural Sciences, Princess Alexandra Hospital, Brisbane, Australien
| | - J Keller
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland
| | - M E Kreis
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Deutschland
| | | | - J Langhorst
- Klinik für Integrative Medizin und Naturheilkunde, Sozialstiftung Bamberg, Klinikum am Bruderwald, Bamberg, Deutschland
| | - P Lynen Jansen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten, Berlin, Deutschland
| | - A Madisch
- Klinik für Gastroenterologie, interventionelle Endoskopie und Diabetologie, Klinikum Siloah, Klinikum Region Hannover, Hannover, Deutschland
| | - H Mönnikes
- Klinik für Innere Medizin, Martin-Luther-Krankenhaus, Berlin, Deutschland
| | | | - B Niesler
- Abteilung Molekulare Humangenetik Institut für Humangenetik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - C Pehl
- Medizinische Klinik, Krankenhaus Vilsbiburg, Vilsbiburg, Deutschland
| | - D Pohl
- Klinik für Gastroenterologie und Hepatologie, Universitätsspital Zürich, Zürich, Schweiz
| | - M Raithel
- Medizinische Klinik II m.S. Gastroenterologie und Onkologie, Waldkrankenhaus St. Marien, Erlangen, Deutschland
| | | | - M Schemann
- Lehrstuhl für Humanbiologie, TU München, Deutschland
| | - S Schmiedel
- I. Medizinische Klinik und Poliklinik Gastroenterologie, Universitätsklinikum Hamburg-Eppendorf, Deutschland
| | - J Schwille-Kiuntke
- Abteilung für Psychosomatische Medizin und Psychotherapie, Medizinische Universitätsklinik Tübingen, Tübingen, Deutschland.,Institut für Arbeitsmedizin, Sozialmedizin und Versorgungsforschung, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - M Storr
- Zentrum für Endoskopie, Gesundheitszentrum Starnberger See, Starnberg, Deutschland
| | - J C Preiß
- Klinik für Innere Medizin - Gastroenterologie, Diabetologie und Hepatologie, Vivantes Klinikum Neukölln, Berlin, Deutschland
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Turkiewicz J, Bhatt RR, Wang H, Vora P, Krause B, Sauk JS, Jacobs JP, Bernstein CN, Kornelsen J, Labus JS, Gupta A, Mayer EA. Altered brain structural connectivity in patients with longstanding gut inflammation is correlated with psychological symptoms and disease duration. Neuroimage Clin 2021; 30:102613. [PMID: 33823388 PMCID: PMC8050027 DOI: 10.1016/j.nicl.2021.102613] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/14/2021] [Accepted: 02/22/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE We aimed to identify differences in network properties of white matter microstructure between asymptomatic ulcerative colitis (UC) participants who had a history of chronic gut inflammation, healthy controls (HCs) and a disease control group without gut inflammation (irritable bowel syndrome; IBS). DESIGN Diffusion weighted imaging was conducted in age and sex-matched participants with UC, IBS, and HCs (N = 74 each), together with measures of gastrointestinal and psychological symptom severity. Using streamline connectivity matrices and graph theory, we aimed to quantify group differences in brain network connectivity. Regions showing group connectivity differences were correlated with measures showing group behavioral and clinical differences. RESULTS UC participants exhibited greater centrality in regions of the somatosensory network and default mode network, but lower centrality in the posterior insula and globus pallidus compared to HCs (q < 0.05). Hub analyses revealed compromised hubness of the pallidus in UC and IBS compared to HCs which was replaced by increased hubness of the postcentral sulcus. Surprisingly, few differences in network matrices between UC and IBS were identified. In UC, centrality measures in the secondary somatosensory cortex were associated with depression (q < 0.03), symptom related anxiety (q < 0.04), trait anxiety (q < 0.03), and symptom duration (q < 0.05). CONCLUSION A history of UC is associated with neuroplastic changes in several brain networks, which are associated with symptoms of depression, trait and symptom-related anxiety, as well as symptom duration. When viewed together with the results from IBS subjects, these findings suggest that chronic gut inflammation as well as abdominal pain have a lasting impact on brain network organization, which may play a role in symptoms reported by UC patients, even when gut inflammation has subsided.
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Affiliation(s)
- Joanna Turkiewicz
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, United States; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, United States; University of California, Irvine School of Medicine, United States
| | - Ravi R Bhatt
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School Medcine at USC, University of Southern California, 4676 Admiralty Way, Marina Del Rey, CA 90292, USA
| | - Hao Wang
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, United States; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, United States; Institute of Fundamental and Frontier Sciences, University of Electronic Science and Technology of China, China
| | - Priten Vora
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, United States; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, United States
| | - Beatrix Krause
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, United States
| | - Jenny S Sauk
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, United States; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, United States; UCLA Microbiome Center, United States
| | - Jonathan P Jacobs
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, United States; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, United States; UCLA Microbiome Center, United States; Division of Gastroenterology, Hepatology and Parenteral Nutrition, United States
| | - Charles N Bernstein
- University of Manitoba IBD Clinical and Research Centre, Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Canada
| | - Jennifer Kornelsen
- University of Manitoba IBD Clinical and Research Centre, Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Canada
| | - Jennifer S Labus
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, United States; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, United States; UCLA Microbiome Center, United States
| | - Arpana Gupta
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, United States; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, United States; UCLA Microbiome Center, United States
| | - Emeran A Mayer
- G. Oppenheimer Center for Neurobiology of Stress and Resilience at UCLA, United States; Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA, United States; UCLA Microbiome Center, United States.
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Subjective Psychophysical Experiences in the Course of Inflammatory Bowel Disease-A Comparative Analysis Based on the Polish Pediatric Crohn's and Colitis Cohort (POCOCO). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020784. [PMID: 33477658 PMCID: PMC7831504 DOI: 10.3390/ijerph18020784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 12/16/2022]
Abstract
No gold standard is available to evaluate subjective psychophysical experiences in pediatric inflammatory bowel disease (IBD). We aimed to assess pain, anxiety, and limitations in social activities at diagnosis and the worst flare of the disease in relation to clinical expression, treatment and IBD severity. A total of 376 children completed the survey (Crohn’s disease (CD) n = 196; ulcerative colitis (UC) n = 180). The questionnaire included 12 questions regarding pain, anxiety, and social activity, all assessed at recruitment and retrospectively at diagnosis and worst flare using a numeric rating scale. Patients that had ever been treated with systemic glucocorticosteroids scored higher in pain (p < 0.001), anxiety (p = 0.015), and social activity domains (p < 0.016) at worst flare, and the answers correlated with the number of steroid courses (p < 0.0392). The perception of social activity limitations also correlated independently with the number of immunosuppressants (p < 0.0433) and biological agents (p < 0.0494). There was no difference in retrospective perception of pain, anxiety and social activity limitations between CD and UC patients at diagnosis and the worst flare. The level of limitations in social activity correlated with hospitalisations due to relapse, days spent in the hospital, number of relapses, and severe relapses with the strongest association of rho = 0.39 (p = 0.0004). Subjective and retrospective perception of pain, anxiety, and limitations in social activity differs depending on therapy, correlates with treatment modalities, and severity measures such as hospitalisations.
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Berens S, Schaefert R, Baumeister D, Gauss A, Eich W, Tesarz J. Does symptom activity explain psychological differences in patients with irritable bowel syndrome and inflammatory bowel disease? Results from a multi-center cross-sectional study. J Psychosom Res 2019; 126:109836. [PMID: 31627144 DOI: 10.1016/j.jpsychores.2019.109836] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Irritable bowel syndrome (IBS) and inflammatory bowel diseases (IBD) have similar symptoms and are affected by psychological factors via gut-brain-interactions. However, previous studies on IBS and IBD showed inconsistent results regarding psychological factors, potentially because they failed to consider the impact of symptom activity. The aim of this study was 1) to compare psychological distress and psychological risk factors among patients with IBS, IBD and healthy controls (HC), and 2) to assess the impact of symptom activity. METHODS A controlled cross-sectional study was conducted. Patients with IBS and IBD were recruited in several primary, secondary, and tertiary medical care units between 02 and 12/2017 in Germany. Overall, 381 matched participants (127/group, 63% female) were included. For the second analyses, patients with IBD were distinguished in patients with active (n = 93) and non-active (n = 34) symptoms. Psychological distress (somatization, depression, anxiety, and illness anxiety) and risk factors (adverse childhood experiences, attachment style, and mentalizing capacity) were measured. RESULTS Patients with IBS showed higher psychological distress and more psychological risk factors than patients with IBD and HC. However, patients with IBD and active symptoms showed similar psychological distress than patients with IBS, except for lower illness anxiety (p < .001, η2 = 0.069). CONCLUSION With the exception of higher illness anxiety in IBS patients, differences in psychological factors between patients with IBS and IBD were more strongly associated with symptom activity than with the underlying diagnosis. Therefore, this study challenges previous concepts of distinguishing functional and organic gastrointestinal diseases, but highlights the role of symptom activity and illness anxiety. TRIAL REGISTRATION DRKS00011685.
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Affiliation(s)
- Sabrina Berens
- Institute of Psychology, Heidelberg University, Hauptstraße 47-51, D-69117 Heidelberg, Germany; Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany.
| | - Rainer Schaefert
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany; Department of Psychosomatic Medicine, Division of Internal Medicine, University Hospital Basel, Hebelstrasse 2, CH-4031 Basel, Switzerland; Faculty of Medicine, University of Basel, Klingelbergstrasse 61, CH-4056 Basel, Switzerland.
| | - David Baumeister
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany.
| | - Annika Gauss
- Department of Gastroenterology and Hepatology, University Hospital Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany.
| | - Wolfgang Eich
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany.
| | - Jonas Tesarz
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany.
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Yanartaş Ö, Kani HT, Kani AS, Akça ZND, Akça E, Ergün S, Tezcan N, Atug Ö, İmeryüz N, Sayar K. Depression and anxiety have unique contributions to somatic complaints in depression, irritable bowel syndrome and inflammatory bowel diseases. PSYCHIAT CLIN PSYCH 2019. [DOI: 10.1080/24750573.2019.1589177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Ömer Yanartaş
- Department of Psychiatry, Marmara University School of Medicine, Istanbul, Turkey
| | - Haluk Tarik Kani
- Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ayşe Sakallı Kani
- Department of Psychiatry, Marmara University School of Medicine, Istanbul, Turkey
| | | | - Erdoğdu Akça
- Department of Psychiatry, Marmara University School of Medicine, Istanbul, Turkey
| | - Serhat Ergün
- Department of Psychiatry, Marmara University School of Medicine, Istanbul, Turkey
| | - Neslihan Tezcan
- Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Özlen Atug
- Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey
| | - Neşe İmeryüz
- Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey
| | - Kemal Sayar
- Department of Psychiatry, Marmara University School of Medicine, Istanbul, Turkey
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Stagnation Syndrome: Relevance of the Multilayers of Illness Experiences in Chinese Medicine to the Understanding of Functional Somatic Syndrome. Psychosom Med 2019; 80:238-239. [PMID: 29240647 DOI: 10.1097/psy.0000000000000549] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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8
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Geng Q, Zhang QE, Wang F, Zheng W, Ng CH, Ungvari GS, Wang G, Xiang YT. Comparison of comorbid depression between irritable bowel syndrome and inflammatory bowel disease: A meta-analysis of comparative studies. J Affect Disord 2018; 237:37-46. [PMID: 29758449 DOI: 10.1016/j.jad.2018.04.111] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/19/2018] [Accepted: 04/08/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The prevalence of comorbid depression is high in chronic gastrointestinal disorders, including irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). For these two disorders in particular, the findings have not been consistent. This meta-analysis systematically compares the rates and severity of comorbid depression between IBS and IBD patients. METHODS A systematic literature search was conducted using PubMed, PsycINFO, Embase, Cochrane Library, Wan Fang, SinoMed, Chinese National Knowledge Infrastructure from their inception date to September 12, 2017 for comparative studies on IBS and IBD patients. Standardized mean differences (SMDs) and odds ratios (OR) of comorbid depression were calculated using random effect models. Data on comorbid anxiety in the included studies were also extracted and analyzed. RESULTS Altogether, 22 studies with 1,244 IBS and 1,048 IBD patients were included. While there was no significant group difference in the prevalence of depression (10 studies, OR = 1.18, 95%CI: 0.87-1.60, P = 0.29), the IBS group had more severe depression (pooled SMD = 0.18, 95%CI: 0.04-0.33, P = 0.01) and anxiety than the IBD group (pooled SMD = 0.31, 95%CI: 0.14-0.49, P = 0.0006). Sixteen (72.7%) studies were assessed as 'high quality' using the Newcastle-Ottawa Scale (NOS). CONCLUSIONS Although the prevalence of comorbid depression was similar between groups, IBS patients had more severe comorbid depressive and anxiety symptoms compared to IBD patients. Appropriate assessment and treatment of depressive and anxiety symptoms in these patient groups should be implemented.
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Affiliation(s)
- Qin Geng
- Department of Gastroenterology, China-Japan Friendship Hospital, Beijing, China
| | - Qing-E Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Fei Wang
- Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Wei Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Gabor S Ungvari
- University of Notre Dame Australia & Graylands Hospital, Perth, Australia
| | - Gang Wang
- Department of Gastroenterology, China-Japan Friendship Hospital, Beijing, China.
| | - Yu-Tao Xiang
- Faculty of Health Sciences, University of Macau, Macao SAR, China.
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9
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Hollins SL, Brock L, Barreto R, Harms L, Dunn A, Garcia-Sobrinho P, Bruce J, Dickson PW, Walker MM, Keely S, Hodgson DM. A Rodent Model of Anxiety: The Effect of Perinatal Immune Challenges on Gastrointestinal Inflammation and Integrity. Neuroimmunomodulation 2018; 25:163-175. [PMID: 30415249 DOI: 10.1159/000493320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/23/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Gastrointestinal (GI) inflammation and GI integrity deficits are common comorbidities of neuropsychiatric disorders. Ongoing research suggests that these aberrations may be contributing to heightened immune signals that have the potential to disrupt neuronal homeostasis and exacerbate behavioural deficits. The current study aimed to determine whether the well-characterized animal model of neuropsychopathology, the maternal immune activation (MIA) model, produced GI inflammation and integrity disruptions in association with anxiety-like behaviour. METHODS Pregnant Wistar rats were exposed to the viral mimetic polyriboinosinic:polyribocytidilic acid (polyI:C) on gestational days (GD) 10 and 19. Evidence of ANS activation, GI inflammation, and GI barrier integrity was assessed in both neonatal (postnatal day, P7) and adult (P84) offspring. Anxiety-like behaviour was assessed at P100. RESULTS Neonatal MIA offspring exhibited an altered intestinal inflammatory profile and evidence of an increase in lymphoid aggregates. MIA neonates also displayed disruptions to GI barrier tight junction protein mRNA. In addition, adult MIA offspring exhibited an increase in anxiety-like behaviours. CONCLUSION These results indicate that the MIA rat model, which is well documented to produce behavioural, neurochemical, and neuroanatomical abnormalities, also produces GI inflammation and integrity disruptions. We suggest that this model may be a useful tool to elucidate biological pathways associated with neuropsychiatric disorders.
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Affiliation(s)
- Sharon L Hollins
- Laboratory of Neuroimmunology, School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia,
- Priority Research Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, New South Wales, Australia,
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia,
| | - Luke Brock
- Laboratory of Neuroimmunology, School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia
- Priority Research Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, New South Wales, Australia
| | - Rafael Barreto
- Laboratory of Neuroimmunology, School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia
- Priority Research Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, New South Wales, Australia
| | - Lauren Harms
- Laboratory of Neuroimmunology, School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia
- Priority Research Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Ariel Dunn
- Laboratory of Neuroimmunology, School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia
- Priority Research Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, New South Wales, Australia
| | - Pedro Garcia-Sobrinho
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia
| | - Jessica Bruce
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia
| | - Phillip W Dickson
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia
| | - Marjorie M Walker
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia
| | - Simon Keely
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia
| | - Deborah M Hodgson
- Laboratory of Neuroimmunology, School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia
- Priority Research Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
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Jones MP, Tack J, Van Oudenhove L, Walker MM, Holtmann G, Koloski NA, Talley NJ. Mood and Anxiety Disorders Precede Development of Functional Gastrointestinal Disorders in Patients but Not in the Population. Clin Gastroenterol Hepatol 2017; 15:1014-1020.e4. [PMID: 28087404 DOI: 10.1016/j.cgh.2016.12.032] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 12/26/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Understanding the interactions between brain and gastrointestinal disorders requires analysis of the order of disease onset. We analyzed data from 2 independent studies to determine the proportion of individuals with diagnoses of functional gastrointestinal disorders (FGIDs) before diagnoses of mood or anxiety disorders (gut to brain), and vice versa (brain to gut). METHODS We collected data from a retrospective study of 4966 patients diagnosed with a FGID (irritable bowel syndrome, dyspepsia, or constipation) and mood or anxiety disorder at general practices in the United Kingdom (health care seekers) over an average period of 13.1 years; we recorded which diagnosis appeared first and compared these with patients' sex and socioeconomic factors. We also collected data from a population study of 1002 randomly selected individuals in Australia (non-heath care seekers) followed from 1997 through 2009; we determined whether subjects were free of either FGID or an anxiety or mood disorder at baseline but developed either one after a 12-year follow-up period. RESULTS Among the 4966 health care seekers, 3279 patients were diagnosed with a mood or anxiety disorder before an FGID (ratio of 2:1). This ratio increased with socioeconomic disadvantage. The time period between diagnosis of mood or anxiety disorder and FGID was longer (median, 3.5 years) than time period between diagnosis of an FGID and a mood or anxiety disorder (median, 1.8 years). Among non-heath care seekers (population study), equal proportions were diagnosed with a mood or anxiety disorder before versus after an FGID. CONCLUSIONS In an analysis of data from a study of patients and a population-based study of individuals with these diagnoses, we found 2-fold more patients to receive a diagnosis of a mood or anxiety disorder before an FGID, but equal proportions of individuals in the population to be diagnosed with the mood or anxiety disorder before versus after an FGID. Among patients, the mood or anxiety disorder was on average diagnosed more than 3 years before the FGID, offering opportunity for prevention. Our findings support a role for adverse socioeconomic factors in development of FGIDs in patients with psychological disorders.
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Affiliation(s)
- Michael P Jones
- Psychology Department, Macquarie University, North Ryde, New South Wales, Australia.
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders, Division of Gastroenterology, University of Leuven, Leuven, Belgium
| | - Lukas Van Oudenhove
- Translational Research Center for Gastrointestinal Disorders, Division of Gastroenterology, University of Leuven, Leuven, Belgium; University Psychiatric Centre, Liaison Psychiatry, University Hospital Gasthuisberg, Leuven, Belgium
| | - Marjorie M Walker
- Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Gerald Holtmann
- Department of Gastroenterology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Natasha A Koloski
- Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia; Department of Gastroenterology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Nicholas J Talley
- Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
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Selfish brain and selfish immune system interplay: A theoretical framework for metabolic comorbidities of mood disorders. Neurosci Biobehav Rev 2017; 72:43-49. [DOI: 10.1016/j.neubiorev.2016.11.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/06/2016] [Accepted: 11/16/2016] [Indexed: 12/17/2022]
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12
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Ben-Israel Y, Shadach E, Levy S, Sperber A, Aizenberg D, Niv Y, Dickman R. Possible Involvement of Avoidant Attachment Style in the Relations Between Adult IBS and Reported Separation Anxiety in Childhood. Stress Health 2016; 32:463-471. [PMID: 26033751 DOI: 10.1002/smi.2642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 04/15/2015] [Accepted: 04/19/2015] [Indexed: 12/17/2022]
Abstract
Irritable bowel syndrome (IBS) in adults as well as separation anxiety disorder (SAD) and recurrent abdominal pain (RAP) in childhood are associated with anxiety and somatization. Our aim was to examine possible associations between IBS in adulthood and SAD in childhood. Patients with IBS and healthy subjects completed a demographic questionnaire, the Separation Anxiety Symptom Inventory (SASI), the Somatization Subscale of Symptom Checklist-90-R (SCL-90-R), the Attachment Style Questionnaire, and a retrospective self-report questionnaire regarding RAP. Compared with controls, patients with IBS were characterized by an avoidant attachment style and scored higher on the SCL-90-R scale regarding the tendency to somatization (25.35 ± 7.47 versus16.50 ± 4.40, p < 0.001). More patients with IBS (25% versus 7.5%) reported RAP in childhood, but contrary to prediction, also had significantly lower SASI scores. Adults with IBS were characterized by somatization, insecure attachment style and recalled higher rates of RAP and surprisingly less symptoms of SAD in childhood. Based on these results, an etiological model for IBS is suggested, in which an avoidant attachment style and a tendency to somatization play an important role in the development of IBS. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Yuval Ben-Israel
- Clinical Psychology Graduate Program, School of Behavioral Sciences, Tel Aviv-Yaffo Academic College, Tel Aviv, Israel
| | - Eran Shadach
- Clinical Psychology Graduate Program, School of Behavioral Sciences, Tel Aviv-Yaffo Academic College, Tel Aviv, Israel
| | - Sigal Levy
- Clinical Psychology Graduate Program, School of Behavioral Sciences, Tel Aviv-Yaffo Academic College, Tel Aviv, Israel
| | - Ami Sperber
- Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Dov Aizenberg
- Department of Psychogeriatrics, Geha Mental Health Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Niv
- Division of Gastroenterology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ram Dickman
- Division of Gastroenterology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Mak GZ, Lucchetti AR, Drossos T, Fitzsimmons-Craft EE, Accurso EC, Stiles-Shields C, Newman EA, Skelly CL. Pediatric Chronic Abdominal Pain and Median Arcuate Ligament Syndrome: A Review and Psychosocial Comparison. Pediatr Ann 2016; 45:e257-64. [PMID: 27403674 DOI: 10.3928/00904481-20160613-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Chronic abdominal pain (CAP) occurs in children and adolescents with a reported prevalence of 4% to 41% with significant direct and indirect costs to the child, family, and society. Median arcuate ligament syndrome (MALS) is a vascular compression syndrome of the celiac artery that may cause symptoms of epigastric pain and weight loss and is a frequently overlooked cause of CAP in the pediatric population. We have observed that the psychosocial presentation of patients with MALS is notable for various psychiatric comorbidities. In this article, we review MALS as well as our study results of the psychosocial profile of 30 MALS patients. Our data suggest that children and adolescents with MALS have similar psychosocial profiles to children with other gastrointestinal disorders resulting in CAP. The overlap of physical and psychosocial symptoms of patients who have MALS with other CAP disorders leads us to recommend that patients with CAP should be evaluated for MALS. [Pediatr Ann. 2016;45(7):e257-e264.].
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Padhy SK, Mishra S, Sarkar S, Bang LG, Panigrahi M. Comparison of psychiatric morbidity in patients with irritable bowel syndrome and non-ulcer dyspepsia. Ind Psychiatry J 2016; 25:29-34. [PMID: 28163405 PMCID: PMC5248416 DOI: 10.4103/0972-6748.196038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIMS The present study aimed to find psychiatric morbidity, stress, anxiety, and depression in patients with irritable bowel syndrome (IBS) and compare it with patients having non-ulcer dyspepsia (NUD). METHODS This case NUD study compared 50 patients each with IBS and NUD. The two groups were compared on demographic data, psychiatric diagnosis using the Structured Clinical Interview for DSM-IV Axis 1 disorders, anxiety levels using the Hamilton Anxiety Rating Scale (HAM-A), and depression using the Hamilton Depression Rating Scale (HAM-D). The Presumptive Stressful Life Events Scale (PSLES) was used to measure stress. RESULTS The cases of IBS were more likely to be of female gender (P = 0.012), married (P = 0.009), and employed (P < 0.001). Psychiatric diagnoses were more common in the cases of IBS than NUDs (88% vs. 30%, P < 0.001), the most common being major depression and somatization disorder. Symptoms of anxiety and depression were more common in patients with IBS (P < 0.001 for HAM-A and HAM-D). Logistic regression revealed that having IBS and increased age were independent predictors of having a psychiatric diagnosis. CONCLUSIONS IBS is associated with the considerable degree of psychiatric morbidity. Adequate attention should be paid toward comorbid psychiatric illnesses, and prompt treatment should be instituted.
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Affiliation(s)
- Susanta Kumar Padhy
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Siddharth Sarkar
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Late Govind Bang
- Department of Community Medicine, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India
| | - Mahima Panigrahi
- Department of Community Medicine, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India
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15
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Abdullah-Koolmees H, Gardarsdottir H, Yazir D, Stoker LJ, Vuyk J, Egberts TCG, Heerdink ER. Medication Discontinuation in Patients After Discharge From a Psychiatric Hospital. Ann Pharmacother 2015; 49:1085-95. [PMID: 26160969 DOI: 10.1177/1060028015593763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patients discharged from psychiatric hospitals may be at risk for intentional or unintentional discontinuation of their medication. OBJECTIVE To describe and assess the discontinuation of, and changes to, psychiatric and/or somatic medication in patients after discharge from psychiatric hospitals. METHODS A retrospective follow-up study was conducted in patients discharged from 4 psychiatric hospitals in The Netherlands between 2006 and 2009. Patients' medication use during the last 2 days of hospitalization was compared with medication dispensed during the 3 months following discharge. Changes in psychiatric and somatic medication were investigated and defined as medication discontinuation, start, or switch. Patients were classified as continuing users, when there were no changes to the medication after discharge. Relative risks with 95% confidence intervals to measure differences in discontinuation were estimated using Cox regression analysis. RESULTS This study included 1324 patients, 69.8% of whom discontinued medication, and 9.7% switched one or more medications. Nearly half (47.4%) of all patients started a medication other than that dispensed during the last 2 days of hospitalization, and 13.7% of all patients experienced no changes to their medication regimen. Approximately 40% of the patients discontinued one or more medications for chronic conditions. From these, 68% discontinued psychiatric medications and 49.4% discontinued somatic medications. A quarter (25.2%) of the 644 patients discontinued using antipsychotics. More than a quarter (28.4%) of the 292 patients using medications for cardiovascular problems discontinued. Patients using as-needed medication prior to discharge were more likely to discontinue their medication (relative risk = 1.85; 95% confidence interval = 1.55-2.20). CONCLUSIONS Discharge from a psychiatric hospital led to medication discontinuation in approximately 70% of all patients. Approximately 40% of the patients discontinued medications for chronic conditions. Discontinuation of somatic medication was more frequent than discontinuation of psychiatric medication, and risk of discontinuation was lower for patients with depressive and anxiety disorders. Although medication discontinuation can be deliberate it is alarming that a quarter of our patients using antipsychotics and cardiovascular medications discontinued their use, both of which are meant for chronic conditions.
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Affiliation(s)
- Heshu Abdullah-Koolmees
- Utrecht University, Utrecht, The Netherlands Brocacef Ziekenhuisfarmacie, Den Dolder, The Netherlands Diakonessenhuis, Utrecht, The Netherlands
| | - Helga Gardarsdottir
- Utrecht University, Utrecht, The Netherlands University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dilek Yazir
- Utrecht University, Utrecht, The Netherlands
| | | | - Judith Vuyk
- Altrecht Institute for Mental Health Care, Utrecht, The Netherlands
| | - Toine C G Egberts
- Utrecht University, Utrecht, The Netherlands University Medical Center Utrecht, Utrecht, The Netherlands
| | - Eibert R Heerdink
- Utrecht University, Utrecht, The Netherlands University Medical Center Utrecht, Utrecht, The Netherlands Altrecht Institute for Mental Health Care, Utrecht, The Netherlands
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Abstract
Inflammatory bowel disease (IBD) causes severe physical symptoms and is also associated with psychological comorbidities. Abnormal anxiety levels are found in up to 40% of patients with IBD. Anxiety symptoms are often related to flares of IBD but may persist in times of remission. Detection of anxiety disorder (AD) in patients with IBD can be challenging. Patients with anxiety may also exhibit symptoms in keeping with functional gastrointestinal disorders (FGID). Evidence for the effectiveness of pharmacological and psychological therapies for anxiety stems from patients without IBD. Studies in patients with IBD have either been small or shown negative results. In light of this, a combined approach involving IBD physicians to improve disease control and psychologists or psychiatrists to treat anxiety is advised. This review examines the evidence of anxiety issues in IBD with a focus on extent of the problem, risk factors for anxiety, and the effectiveness of interventions.
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Affiliation(s)
- Ayman S Bannaga
- Department of Gastroenterology, Doncaster Royal Infirmary, Doncaster, UK
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17
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Vela G, Stark P, Socha M, Sauer AK, Hagmeyer S, Grabrucker AM. Zinc in gut-brain interaction in autism and neurological disorders. Neural Plast 2015; 2015:972791. [PMID: 25878905 PMCID: PMC4386645 DOI: 10.1155/2015/972791] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 03/05/2015] [Indexed: 12/27/2022] Open
Abstract
A growing amount of research indicates that abnormalities in the gastrointestinal (GI) system during development might be a common factor in multiple neurological disorders and might be responsible for some of the shared comorbidities seen among these diseases. For example, many patients with Autism Spectrum Disorder (ASD) have symptoms associated with GI disorders. Maternal zinc status may be an important factor given the multifaceted effect of zinc on gut development and morphology in the offspring. Zinc status influences and is influenced by multiple factors and an interdependence of prenatal and early life stress, immune system abnormalities, impaired GI functions, and zinc deficiency can be hypothesized. In line with this, systemic inflammatory events and prenatal stress have been reported to increase the risk for ASD. Thus, here, we will review the current literature on the role of zinc in gut formation, a possible link between gut and brain development in ASD and other neurological disorders with shared comorbidities, and tie in possible effects on the immune system. Based on these data, we present a novel model outlining how alterations in the maternal zinc status might pathologically impact the offspring leading to impairments in brain functions later in life.
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Affiliation(s)
- Guillermo Vela
- Zinpro Corporation, Eden Prairie, MN 55344, USA
- Autismo ABP, 64639 Monterrey, NL, Mexico
| | - Peter Stark
- Zinpro Corporation, Eden Prairie, MN 55344, USA
| | | | - Ann Katrin Sauer
- WG Molecular Analysis of Synaptopathies, Neurology Department, Neurocenter of Ulm University, 89081 Ulm, Germany
| | - Simone Hagmeyer
- WG Molecular Analysis of Synaptopathies, Neurology Department, Neurocenter of Ulm University, 89081 Ulm, Germany
| | - Andreas M. Grabrucker
- WG Molecular Analysis of Synaptopathies, Neurology Department, Neurocenter of Ulm University, 89081 Ulm, Germany
- Institute for Anatomy and Cell Biology, Ulm University, 89081 Ulm, Germany
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18
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Rosenblat JD, Cha DS, Mansur RB, McIntyre RS. Inflamed moods: a review of the interactions between inflammation and mood disorders. Prog Neuropsychopharmacol Biol Psychiatry 2014; 53:23-34. [PMID: 24468642 DOI: 10.1016/j.pnpbp.2014.01.013] [Citation(s) in RCA: 390] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 12/22/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023]
Abstract
Mood disorders have been recognized by the World Health Organization (WHO) as the leading cause of disability worldwide. Notwithstanding the established efficacy of conventional mood agents, many treated individuals continue to remain treatment refractory and/or exhibit clinically significant residual symptoms, cognitive dysfunction, and psychosocial impairment. Therefore, a priority research and clinical agenda is to identify pathophysiological mechanisms subserving mood disorders to improve therapeutic efficacy. During the past decade, inflammation has been revisited as an important etiologic factor of mood disorders. Therefore, the purpose of this synthetic review is threefold: 1) to review the evidence for an association between inflammation and mood disorders, 2) to discuss potential pathophysiologic mechanisms that may explain this association and 3) to present novel therapeutic options currently being investigated that target the inflammatory-mood pathway. Accumulating evidence implicates inflammation as a critical mediator in the pathophysiology of mood disorders. Indeed, elevated levels of pro-inflammatory cytokines have been repeatedly demonstrated in both major depressive disorder (MDD) and bipolar disorder (BD) patients. Further, the induction of a pro-inflammatory state in healthy or medically ill subjects induces 'sickness behavior' resembling depressive symptomatology. Potential mechanisms involved include, but are not limited to, direct effects of pro-inflammatory cytokines on monoamine levels, dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, pathologic microglial cell activation, impaired neuroplasticity and structural and functional brain changes. Anti-inflammatory agents, such as acetyl-salicylic acid (ASA), celecoxib, anti-TNF-α agents, minocycline, curcumin and omega-3 fatty acids, are being investigated for use in mood disorders. Current evidence shows improved outcomes in mood disorder patients when anti-inflammatory agents are used as an adjunct to conventional therapy; however, further research is needed to establish the therapeutic benefit and appropriate dosage.
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Affiliation(s)
- Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada; Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Danielle S Cha
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada; Interdisciplinary Laboratory of Clinical Neuroscience (LINC), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil; Program for Recognition and Intervention in Individuals in At-Risk Mental States (PRISMA), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada.
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20
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Xu JR, Shang L, Si WL, Song Y, Wang Y, Ma JL, Liu J. A population-based study of associations between functional gastrointestinal disorders and psychosocial characteristics in Xi'an, China. Neurogastroenterol Motil 2013; 25:617-e467. [PMID: 23552020 DOI: 10.1111/nmo.12124] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 03/04/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Functional gastrointestinal disorders (FGIDs) are disorders with chronic and recurring gastrointestinal symptoms. This study investigated the prevalence of FGIDs, assessed the association between FGIDs and psychosocial factors, and identified potential risk factors for FGIDs in a population in Xi'an, China. METHODS Of 752 recruited residents in Xi'an, 720 were selected for an epidemiological survey using a cluster sampling method. All subjects were interviewed face-to-face to complete the Chinese version of ROME III FGIDs questionnaire, the Symptom Check-List-90, the Eysenck Personality Questionnaire, a Life Event Scale, and a questionnaire regarding personal childhood adversity. The prevalence of FGIDs and associations between FGIDs and psychosocial factors were determined using EpiData Software. Logistic regression analysis was performed to identify the potential risk factors for FGIDs. KEY RESULTS The prevalence of FGIDs in this sample population was 14.3% (103/720). There were 13 (1.8%) cases of overlap of different FGIDs. No significant difference in the prevalence of FGIDs was observed between men and women. Alcohol intake and smoking habits were significantly associated with the presence of FGIDs. The presence of FGIDs was significantly associated with psychological factors and influences such as personality type, life events, childhood adversity, and psychopathology. The potential risk factors for contracting FGIDs were certain life events, childhood adversity, somatization, and a hostile affect (P < 0.001). CONCLUSIONS & INFERENCES The prevalence of FGIDs and overlap syndrome in Xi'an, China was lower than that reported in other countries. There was a strong correlation between specific lifestyle habits and psychosocial characteristics and the presence of FGIDs.
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Affiliation(s)
- J-R Xu
- Department of Gastroenterology, Xi'an Central Hospital, College of Medicine, Xi'an Jiaotong University, Xi'an, Shanxi, China.
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Bereza BG, Machado M, Papadimitropoulos M, Sproule B, Ravindran AV, Einarson TR. A markov model approach assessing the cost of illness of generalized anxiety disorder in Canada. Neurol Ther 2012; 1:1. [PMID: 26000207 PMCID: PMC4389036 DOI: 10.1007/s40120-012-0001-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Generalized anxiety disorder (GAD) is a chronic disease with waxing and waning of symptoms. This is the first comprehensive economic model developed to reflect the nature and course of GAD. METHODS An incidence-based probabilistic Markov model was developed reflecting nine GAD health states (HS): clinical assessments (three HS), maintenance therapies (four HS), discontinuation (one HS), and death (one HS). A probability curve of the GAD onset (ages 18-80) determined entry into the model and assumed patients retained the diagnoses until death. Canadian Psychiatric Association (CPA) guidelines determined pharmacotherapy, with revisions/validation by an expert panel. Direct costs (clinician, pharmacotherapy, hospitalization) were retrieved from government publications. Remission was based on pooled-analysis of CPA-cited evidence. Remaining clinical rates, absenteeism, and hospitalization were retrieved from the literature. Direct costs were attributed throughout the model except for the discontinuation and death HS. Indirect costs (wage rate) were retrieved from government publications and the literature (absenteeism), and were attributed to patients with GAD ≤65 years of age. Results were discounted at 5% and results expressed in 2008 Canadian dollars. RESULTS The mean lifetime cost of illness (COI) was estimated to be $31,213 (SD $9,100) per patient. The cost of absenteeism accounted for 96% of the mean COI. The mean age of onset was 31 years and approximately 19% did not respond to pharmacotherapy. Over 85% of patients discontinued treatment by the fourth cycle (2nd year of therapy). Over the course of the model, a mean of 53% of patients relapsed, with an average rate of 0.79 relapses per patient. On average and over a lifetime, the disorder went unmanaged over a period of 14 (SD 9) years. The model was most sensitive to absenteeism. CONCLUSION GAD is a costly disease with a lifetime COI <$32k/patient, with absenteeism exerting a significant impact.
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Affiliation(s)
- Basil G. Bereza
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON M5S 3M2 Canada
| | - Márcio Machado
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON M5S 3M2 Canada
- Toronto Health Technology Assessment Collaborative, University of Toronto, Toronto, ON Canada
| | - Manny Papadimitropoulos
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON M5S 3M2 Canada
- Eli Lilly Canada Inc., 3650 Danforth Avenue, Toronto, ON M1N 2E8 Canada
| | - Beth Sproule
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON M5S 3M2 Canada
- Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8 Canada
| | - Arun V. Ravindran
- Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8 Canada
- Department of Psychiatry, University of Toronto, 33 Russell Street, Toronto, ON M5S 2S1 Canada
| | - Thomas R. Einarson
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON M5S 3M2 Canada
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Shaw AD, Brooks JL, Dickerson JW, Davies GJ. Dietary triggers in irritable bowel syndrome. Nutr Res Rev 2012; 11:279-309. [PMID: 19094251 DOI: 10.1079/nrr19980019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Irritable bowel syndrome (IBS) is a frequently occurring, benign functional gastrointestinal disorder with a complex poorly understood pathology which appears to be multifactorial in nature. There is no association with structural or biochemical abnormalities in the gastrointestinal tract. Functional variations in myoelectrical activity, visceral hypersensitivity and illness behaviours have all been observed in patients experimentally. In conjunction with environmental, psychological and alimentary factors, these mechanisms have been proposed as the major determinants of symptom genesis. Certainly, dietary factors are frequently perceived by sufferers as powerful symptom triggers, with many reporting multiple food intolerance. Physicians, however, remain divided upon the relevance of food to the disorder, with many eschewing a nutritional connection. This is unsurprising as, despite much experimental work to determine the clinical relevance of food intolerance and allergy to the aetiology of the disorder, the vast range of foodstuffs available for testing, inherent procedural problems with test foods, methodological insufficiencies and the continually evolving knowledge of the disorder, particularly the subgrouping of sufferers, have restricted the scientific validity of current findings. At the present time, it is difficult to make informed judgement upon the importance of food in IBS, and rigorously designed, large scale trials devised in the light of recent knowledge are required before conclusions can be drawn.
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Affiliation(s)
- A D Shaw
- Nutrition Research Centre, School of Applied Science, South Bank University, 103 Borough Road, London SEl OAA
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Myrtveit SM, Skogen JC, Wenzel HG, Mykletun A. Somatic symptoms beyond those generally associated with a whiplash injury are increased in self-reported chronic whiplash. A population-based cross sectional study: the Hordaland Health Study (HUSK). BMC Psychiatry 2012; 12:129. [PMID: 22935146 PMCID: PMC3476995 DOI: 10.1186/1471-244x-12-129] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 08/14/2012] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Chronic whiplash leads to considerable patient suffering and substantial societal costs. There are two competing hypothesis on the etiology of chronic whiplash. The traditional organic hypothesis considers chronic whiplash and related symptoms a result of a specific injury. In opposition is the hypothesis that chronic whiplash is a functional somatic syndrome, and related symptoms a result of society-induced expectations and amplification of symptoms. According to both hypotheses, patients reporting chronic whiplash are expected to have more neck pain, headache and symptoms of anxiety and depression than the general population. Increased prevalence of somatic symptoms beyond those directly related to a whiplash neck injury is less investigated. The aim of this study was to test an implication derived from the functional hypothesis: Is the prevalence of somatic symptoms as seen in somatization disorder, beyond symptoms related to a whiplash neck injury, increased in individuals self-reporting chronic whiplash? We further aimed to explore recall bias by comparing the symptom profile displayed by individuals self-reporting chronic whiplash to that among those self-reporting a non-functional injury: fractures of the hand or wrist. We explored symptom load, etiologic origin could not be investigated in this study. METHODS Data from the Norwegian population-based "Hordaland Health Study" (HUSK, 1997-99); N = 13,986 was employed. Chronic whiplash was self-reported by 403 individuals and fractures by 1,746. Somatization tendency was measured using a list of 17 somatic symptoms arising from different body parts and organ systems, derived from the research criteria for somatization disorder (ICD-10, F45). RESULTS Chronic whiplash was associated with an increased level of all 17 somatic symptoms investigated (p<0.05). The association was moderately strong (group difference of 0.60 standard deviation), only partly accounted for by confounding. For self-reported fractures symptoms were only slightly elevated. Recent whiplash was more commonly reported than whiplash-injury a long time ago, and the association of interest weakly increased with time since whiplash (r = 0.016, p = 0.032). CONCLUSIONS The increased prevalence of somatic symptoms beyond symptoms expected according to the organic injury model for chronic whiplash, challenges the standard injury model for whiplash, and is indicative evidence of chronic whiplash being a functional somatic syndrome.
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Affiliation(s)
- Solbjørg Makalani Myrtveit
- Faculty of medicine and dentistry, University of Bergen (UoB), Bergen, Norway,Division of Mental Health, Department of Public Mental Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Jens Christoffer Skogen
- Research Unit on Mental Health Epidemiology, Department of Health Promotion and Development, Faculty of Psychology, UoB, Bergen, Norway
| | - Hanne Gro Wenzel
- Division of Psychiatry, St Olav University Hospital, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arnstein Mykletun
- Division of Mental Health, Department of Public Mental Health, Norwegian Institute of Public Health, Bergen, Norway,Research Unit on Mental Health Epidemiology, Department of Health Promotion and Development, Faculty of Psychology, UoB, Bergen, Norway,University of New South Wales, School of Psychiatry, Sydney, Australia
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Bourke J, Soldan J, Silk DBA, Aziz Q, Libby GW. 'Idiopathic' intestinal failure--the importance of identifying and treating primary psychopathology. Neurogastroenterol Motil 2012; 24:242-51. [PMID: 22188396 DOI: 10.1111/j.1365-2982.2011.01847.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gastrointestinal neuromuscular disorders (GINMD) are an important cause of intestinal failure (IF). We present six cases of IF in whom a diagnosis of GINMD was initially suspected, but in whom psychopathology was discovered to be the primary etiology. METHODS (i) Six consecutive cases referred to our unit with IF, initially presumed to be due to GINMD, were selected. Informed consent was obtained from all patients. Case notes were reviewed for salient clinical information. (ii) A literature search was performed to ascertain the epidemiology of psychopathology in IF and the current evidence for the management of severe functional GI disorders with a multidisciplinary psychiatric approach. KEY RESULTS (i)All six cases required multidisciplinary psychiatric management in a specialized psychiatric unit that included the use of antidepressants, antipsychotics, mood stabilizers, and Electroconvulsive therapy in addition to nutritional support via enteral or parenteral routes. (ii) The evidence base for the treatment of severe FGIDs is sparse. CONCLUSIONS & INFERENCES There is a need for additional reporting of such cases and further research. Our experience would suggest that a delay in the involvement of a specialist liaison psychiatrist has the potential to be life threatening in such cases. This may be more likely with greater severity, where the apparent predominance of 'physical' symptoms generates reluctance in both patient and physician to consider a psychiatric etiology and also appears to occur due to a lengthier investigative process than existed previously. We therefore propose that the provision of a specialist psychiatric assessment for all patients presenting with IF is indicated at the point of initial clinical contact, based upon the substantial clinical benefit it has the potential to confer upon a significant minority. This process need not delay investigation, which can continue as indicated in parallel, but can be life-saving.
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Affiliation(s)
- J Bourke
- Centre for Psychiatry, The Wolfson Institute for Preventive Medicine, Barts and The London School of Medicine and Dentistry, London, UK.
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25
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Vicario M, Alonso C, Guilarte M, Serra J, Martínez C, González-Castro AM, Lobo B, Antolín M, Andreu AL, García-Arumí E, Casellas M, Saperas E, Malagelada JR, Azpiroz F, Santos J. Chronic psychosocial stress induces reversible mitochondrial damage and corticotropin-releasing factor receptor type-1 upregulation in the rat intestine and IBS-like gut dysfunction. Psychoneuroendocrinology 2012; 37:65-77. [PMID: 21641728 DOI: 10.1016/j.psyneuen.2011.05.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 03/11/2011] [Accepted: 05/09/2011] [Indexed: 02/06/2023]
Abstract
The association between psychological and environmental stress with functional gastrointestinal disorders, especially irritable bowel syndrome (IBS), is well established. However, the underlying pathogenic mechanisms remain unknown. We aimed to probe chronic psychosocial stress as a primary inducer of intestinal dysfunction and investigate corticotropin-releasing factor (CRF) signaling and mitochondrial damage as key contributors to the stress-mediated effects. Wistar-Kyoto rats were submitted to crowding stress (CS; 8 rats/cage) or sham-crowding stress (SC; 2 rats/cage) for up to 15 consecutive days. Hypothalamic-pituitary-adrenal (HPA) axis activity was evaluated. Intestinal tissues were obtained 1h, 1, 7, or 30 days after stress exposure, to assess neutrophil infiltration, epithelial ion transport, mitochondrial function, and CRF receptors expression. Colonic response to CRF (10 μg/kg i.p.) and hyperalgesia were evaluated after ending stress exposure. Chronic psychosocial stress activated HPA axis and induced reversible intestinal mucosal inflammation. Epithelial permeability and conductance were increased in CS rats, effect that lasted for up to 7 days after stress cessation. Visceral hypersensitivity persisted for up to 30 days post stress. Abnormal colonic response to exogenous CRF lasted for up to 7 days after stress. Mitochondrial activity was disturbed throughout the intestine, although mitochondrial response to CRF was preserved. Colonic expression of CRF receptor type-1 was increased in CS rats, and negatively correlated with body weight gain. In conclusion, chronic psychosocial stress triggers reversible inflammation, persistent epithelial dysfunction, and colonic hyperalgesia. These findings support crowding stress as a suitable animal model to unravel the complex pathophysiology underlying to common human intestinal stress-related disorders, such as IBS.
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Affiliation(s)
- María Vicario
- Department of Gastroenterology, Institut de Recerca Vall d'Hebron, CIBERehd, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Departament of Medicine, Barcelona, Spain
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26
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Katsamanis M, Lehrer PM, Escobar JI, Gara MA, Kotay A, Liu R. Psychophysiologic treatment for patients with medically unexplained symptoms: a randomized controlled trial. PSYCHOSOMATICS 2011; 52:218-29. [PMID: 21565593 PMCID: PMC3403725 DOI: 10.1016/j.psym.2011.01.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 09/29/2010] [Accepted: 10/20/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients presenting with medically unexplained physical symptoms (MUPS) typically present with significant distress and marked impairment in functioning and pose a unique challenge to health care providers. The purpose of this study was to examine the efficacy of a psychophysiological treatment (PT) for MUPS. METHODS Thirty-eight participants meeting criteria for subthreshold somatization disorder (abridged somatization) were randomly assigned to one of two conditions: (1) standard medical care augmented by a psychiatric consultation intervention (wait-list) or (2) a 10-session, manualized, individually-administered PT added to the psychiatric consultation intervention. Assessments were conducted at baseline, at midpoint (after four sessions), and after completing the last session. The primary outcome measure was the severity scale of the Clinical Global Impression Scale anchored for Somatic Symptoms (CGI-SD). Secondary outcome measures were responder status as determined by clinical ratings, self-report measures of mental and physical functioning. RESULTS At the end of the trial, the severity (and frequency) of physical symptoms improved significantly more (p<0.05) in the intervention group. The average improvement in the CGI-SD was 0.80 points greater in the intervention group than in the wait-list group. PT was also associated with greater improvements in self-reported functioning and depressive symptomatology. The effect sizes at the final assessment point indicate that this intervention had a robust effect on complex somatic symptom presentations. CONCLUSION For patients with high levels of MUPS (abridged somatization), PT produces significant improvements in symptoms and functional status.
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Affiliation(s)
- Maria Katsamanis
- Department of Psychiatry, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Piscataway, NJ 08854, USA.
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27
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Tanaka Y, Kanazawa M, Fukudo S, Drossman DA. Biopsychosocial model of irritable bowel syndrome. J Neurogastroenterol Motil 2011. [PMID: 21602989 DOI: 10.5056/jnm.2011.17.2.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Irritable bowel syndrome (IBS) is a common chronic disorder seen in gastroenterology and primary care practice. It is characterized by recurrent abdominal pain or discomfort associated with disturbed bowel function. It is a heterogeneous disorder with varying treatments, and in this regard physicians sometimes struggle with finding the optimal approach to management of patients with IBS. This disorder induces high health care costs and variably reduces health-related quality of life. IBS is in the class of functional gastrointestinal disorders, and results from dysregulation of central and enteric nervous system interactions. Psychosocial factors are closely related to their gut physiology, associated cognitions, symptom manifestations and illness behavior. Therefore, it is important for the physician to recognize the psychosocial issues of patients with IBS and in addition to build a good patient-physician relationship in order to optimize treatment. This review focuses on the interaction between psychological and physiological factors associated with IBS by using a biopsychosocial model. In this article, we describe (1) the predisposing psychological features seen in early life; (2) the psychological factors associated with life stress, the symptom presentation, and their associated coping patterns; (3) gut pathophysiology with emphasis on disturbances in motility, visceral hypersensitivity and brain-gut interactions; and finally (4) the clinical outcomes and effective treatments including psychotherapeutic methods.
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Affiliation(s)
- Yukari Tanaka
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
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28
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Tanaka Y, Kanazawa M, Fukudo S, Drossman DA. Biopsychosocial model of irritable bowel syndrome. J Neurogastroenterol Motil 2011; 17:131-9. [PMID: 21602989 PMCID: PMC3093004 DOI: 10.5056/jnm.2011.17.2.131] [Citation(s) in RCA: 171] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 04/04/2011] [Accepted: 04/08/2011] [Indexed: 12/12/2022] Open
Abstract
Irritable bowel syndrome (IBS) is a common chronic disorder seen in gastroenterology and primary care practice. It is characterized by recurrent abdominal pain or discomfort associated with disturbed bowel function. It is a heterogeneous disorder with varying treatments, and in this regard physicians sometimes struggle with finding the optimal approach to management of patients with IBS. This disorder induces high health care costs and variably reduces health-related quality of life. IBS is in the class of functional gastrointestinal disorders, and results from dysregulation of central and enteric nervous system interactions. Psychosocial factors are closely related to their gut physiology, associated cognitions, symptom manifestations and illness behavior. Therefore, it is important for the physician to recognize the psychosocial issues of patients with IBS and in addition to build a good patient-physician relationship in order to optimize treatment. This review focuses on the interaction between psychological and physiological factors associated with IBS by using a biopsychosocial model. In this article, we describe (1) the predisposing psychological features seen in early life; (2) the psychological factors associated with life stress, the symptom presentation, and their associated coping patterns; (3) gut pathophysiology with emphasis on disturbances in motility, visceral hypersensitivity and brain-gut interactions; and finally (4) the clinical outcomes and effective treatments including psychotherapeutic methods.
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Affiliation(s)
- Yukari Tanaka
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
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29
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Logue MW, Bauver SR, Kremen WS, Franz CE, Eisen SA, Tsuang MT, Grant MD, Lyons MJ. Evidence of overlapping genetic diathesis of panic attacks and gastrointestinal disorders in a sample of male twin pairs. Twin Res Hum Genet 2011; 14:16-24. [PMID: 21314252 DOI: 10.1375/twin.14.1.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We explored the comorbidity between panic attacks (PA), whose symptoms can include gastrointestinal discomfort, and gastrointestinal disorders (GD). Structural equation modeling was used to analyze data from 1,874 MZ and 1,498 DZ male-male twin pairs from the Vietnam Era Twin Registry. PA and GD were associated (relative risk for GD = 2). The percentage of liability due to genetic factors was estimated to be 37% for PA and 31% for GD. There was significant correlation between the genetic risk factors for PA and GD (estimated r = .55, 95% CI of 34% to 82%) and no evidence of correlation between the environmental causes of PA and GD. Therefore, PA and GD comorbidity can be explained by overlapping genetic factors and not overlapping environmental factors. Although these data cannot identify a biological pathway for such a shared liability, it suggests the presence of GD may be informative for genetic studies of panic.
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Affiliation(s)
- Mark W Logue
- Genetics Program, Boston University School of Medicine, Boston, United States of America
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30
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Chen YH, Lin HC. Patterns of psychiatric and physical comorbidities associated with panic disorder in a nationwide population-based study in Taiwan. Acta Psychiatr Scand 2011; 123:55-61. [PMID: 20156213 DOI: 10.1111/j.1600-0447.2010.01541.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study aims to document a range of risk of psychiatric and physical comorbidities among PD patients using a nationwide population-based dataset in Taiwan. METHOD A total of 3672 patients with at least three consensus diagnoses with PD were included, together with 18 360 matched controls without PD. Logistic regression analyses were performed after adjusting for sociodemographic characteristics. RESULTS After adjusting for the patients' sex, age and geographic region, patients with PD were more likely to have major depressive disorder (OR = 23.45), bipolar disorder (OR = 15.54), cardiac dysrhythmia (OR = 15.12), coronary heart disease (OR = 7.69), myocardial infarction (OR = 6.55), irritable bowel syndrome (OR = 4.82), peptic ulcers (OR = 4.30), cerebrovascular disease (OR = 3.61), hypertension (OR = 3.31), epilepsy (OR = 3.07), hepatitis (OR = 2.70), hyperlipidemia (OR = 2.20), asthma (OR = 2.17), schizophrenia (OR = 2.14), neoplasms (OR = 2.02), renal disease (OR = 1.89) and diabetes (OR = 1.26), compared to patients in the comparison cohort. CONCLUSION We conclude that PD is associated with an array of psychiatric and physical illnesses.
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Affiliation(s)
- Y-H Chen
- Taipei Medical University, Taiwan
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31
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Jerndal P, Ringström G, Agerforz P, Karpefors M, Akkermans LM, Bayati A, Simrén M. Gastrointestinal-specific anxiety: an important factor for severity of GI symptoms and quality of life in IBS. Neurogastroenterol Motil 2010; 22:646-e179. [PMID: 20367800 DOI: 10.1111/j.1365-2982.2010.01493.x] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gastrointestinal (GI)-specific anxiety (GSA) has been proposed to influence symptom severity and quality of life (QOL) in patients with irritable bowel syndrome (IBS). The Visceral Sensitivity Index (VSI) is a recently developed, reliable and valid measure of GSA. Our aim was to evaluate the association between GSA, GI symptom severity, and QOL in IBS patients. METHODS Sixty healthy subjects and 306 patients fulfilling the Rome II criteria for IBS were studied. Demographic and disease-related factors were assessed. Patients completed VSI and GI Symptom Rating Scale (GSRS) and questionnaires to determine psychological symptom severity (Hospital Anxiety and Depression Scale), QOL (Short form 36), and presence of functional GI disorders (Rome II Modular Questionnaire). KEY RESULTS Compared with healthy subjects, patients with IBS had more severe GSA (34.7 +/- 16.9 vs. 2.2 +/- 4.4 [mean +/- standard deviation]; P < 0.0001). In the IBS group, more severe GSA was seen in patients with more severe GI symptoms (P < 0.0001), general anxiety (P < 0.0001) and depression (P < 0.0001), and with lower socioeconomic status (P < 0.05). In a regression analysis, GSA was the strongest predictor for GI symptom severity (GSRS total score), followed by number of Rome II diagnoses, presence of meal-related IBS symptoms, and gender (R(2) = 0.34). Gastrointestinal-specific anxiety was also, together with general anxiety, depression, socioeconomic status, and gender, found to be independently associated with mental QOL (R(2) = 0.62). CONCLUSIONS & INFERENCES Gastrointestinal-specific anxiety seems to be an important factor for GI symptom severity and QOL in patients with IBS.
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Affiliation(s)
- P Jerndal
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, S-41345 Göteborg, Sweden
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Johnson SK, Schmaling KB, Dmochowski J, Bernstein D. An investigation of victimization and the clinical course of chronic fatigue syndrome. J Health Psychol 2010; 15:351-61. [DOI: 10.1177/1359105309349453] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Medically unexplained syndromes, including chronic fatigue syndrome (CFS), have been associated with victimization in childhood and adulthood. The purpose of this study was to examine the associations of victimization experiences in childhood and adulthood with functional status and illness severity in a sample of patients with CFS using longitudinal data. In the sample of 93 patients with CFS, childhood abuse and neglect had greater impact than adulthood victimization. Overall, victimization experiences in childhood demonstrated modest associations with clinical outcomes in CFS, although several victimization experiences were in the opposite direction of expectations. Victimization predicted worse outcomes, but not worsening outcomes over time.
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33
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Cognitive Behavioural Therapy for Medically Unexplained Physical Symptoms: A Pilot Study. Behav Cogn Psychother 2009. [DOI: 10.1017/s1352465800016799] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of the study was to develop a cognitive behavioural treatment model for medically unexplained physical symptoms and assess its feasibility and effect in a small sample of patients. This study was the first step in the realization of a randomized controlled trial. The study population consisted of consecutive patients presenting at a general medical outpatient clinic, whose symptoms could not be explained by objective abnormal findings. The treatment was based on a general model of the disorder, consisting of the physical symptoms, the patient's attribution and perceived control and the cognitive, behavioural, physical and social consequences. It incorporated record keeping concerning physical symptoms and emotions, identification of cognitions about the symptoms, challenging dysfunctional thoughts and behavioural experiments. At 6–months follow-up, four of the five treated patients were improved with regard to frequency and intensity of the symptoms, psychological distress and functional impairment. The improvement was sustained at 1–year follow-up.
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Becker J, Fliege H, Kocalevent RD, Bjorner JB, Rose M, Walter OB, Klapp BF. Functioning and validity of a Computerized Adaptive Test to measure anxiety (A-CAT). Depress Anxiety 2009; 25:E182-94. [PMID: 18979458 DOI: 10.1002/da.20482] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the Computerized Adaptive Test to measure anxiety (A-CAT), a patient-reported outcome questionnaire that uses computerized adaptive testing to measure anxiety. METHODS The A-CAT builds on an item bank of 50 items that has been built using conventional item analyses and item response theory analyses. The A-CAT was administered on Personal Digital Assistants to n=357 patients diagnosed and treated at the department of Psychosomatic Medicine and Psychotherapy, Charité Berlin, Germany. For validation purposes, two subgroups of patients (n=110 and 125) answered the A-CAT along with established anxiety and depression questionnaires. RESULTS The A-CAT was fast to complete (on average in 2 min, 38 s) and a precise item response theory based CAT score (reliability>.9) could be estimated after 4-41 items. On average, the CAT displayed 6 items (SD=4.2). Convergent validity of the A-CAT was supported by correlations to existing tools (Hospital Anxiety and Depression Scale-A, Beck Anxiety Inventory, Berliner Stimmungs-Fragebogen A/D, and State Trait Anxiety Inventory: r=.56-.66); discriminant validity between diagnostic groups was higher for the A-CAT than for other anxiety measures. CONCLUSIONS The German A-CAT is an efficient, reliable, and valid tool for assessing anxiety in patients suffering from anxiety disorders and other conditions with significant potential for initial assessment and long-term treatment monitoring. Future research directions are to explore content balancing of the item selection algorithm of the CAT, to norm the tool to a healthy sample, and to develop practical cutoff scores.
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Affiliation(s)
- Janine Becker
- Department of Psychosomatic Medicine and Psychotherapy, Charité Universitätsmedizin, Berlin, Germany.
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Benasayag Lecuona R. [Functional gastrointestinal disorders: when and why might psychotherapy be useful in functional digestive disorders?]. GASTROENTEROLOGIA Y HEPATOLOGIA 2009; 32:59-60. [PMID: 19174102 DOI: 10.1016/j.gastrohep.2008.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Accepted: 10/26/2008] [Indexed: 05/27/2023]
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Arebi N, Gurmany S, Bullas D, Hobson A, Stagg A, Kamm M. Review article: the psychoneuroimmunology of irritable bowel syndrome--an exploration of interactions between psychological, neurological and immunological observations. Aliment Pharmacol Ther 2008; 28:830-40. [PMID: 18637004 DOI: 10.1111/j.1365-2036.2008.03801.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The pathogenesis of irritable bowel syndrome (IBS) is founded on interactive mechanisms. Disentangling these processes is a prerequisite for the development of effective drug therapy. AIM To identify the interaction between the various factors implicated in IBS. METHODS Articles pertaining to IBS pathogenesis focusing on psychoneuroimmunology were identified using following search terms: IBS, animal models, microbiota, probiotics, immunology, visceral hypersensitivity, imaging, psychology and visceral pain. RESULTS Cerebral imaging using MRI and proton emission tomography scanning has revealed differential regional cerebral activation, whereas stimuli induced activation has been captured by both MRI and cortical evoked potentials. At the peripheral neurological level, the concept of visceral hypersensitivity has been challenged as perhaps representing psychological traits with symptom over-reporting or hyper-vigilance. Gut mucosal immunology is thought to be relevant with immunological changes reflected as peripheral blood cytokine level changes. Molecular technology advances suggest a role for microbiota by activating the gut immunological system. These interactions have been examined in IBS animal models. CONCLUSIONS Translation of animal model findings to humans is needed to link the various psychological, neurological and immunological changes noted in IBS. This analysis may identify patient sub-groups, which will ultimately be critical for drug testing to be focused accordingly.
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Affiliation(s)
- N Arebi
- Imperial College, St Mark's Campus, Harrow, London, UK.
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Seres G, Kovács Z, Kovács Á, Kerékgyártó O, Sárdi K, Demeter P, Mészáros E, Túry F. Different Associations of Health Related Quality of Life with Pain, Psychological Distress and Coping Strategies in Patients with Irritable Bowel Syndrome and Inflammatory Bowel Disorder. J Clin Psychol Med Settings 2008; 15:287-95. [DOI: 10.1007/s10880-008-9132-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2007] [Accepted: 09/06/2008] [Indexed: 02/07/2023]
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Mikocka-Walus AA, Turnbull DA, Andrews JM, Moulding NT, Holtmann GJ. The effect of functional gastrointestinal disorders on psychological comorbidity and quality of life in patients with inflammatory bowel disease. Aliment Pharmacol Ther 2008; 28:475-83. [PMID: 18532989 DOI: 10.1111/j.1365-2036.2008.03754.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Symptoms of functional gastrointestinal disorders (FGIDs) are common in patients with inflammatory bowel disease (IBD). Psychological comorbidities of anxiety and depression are also highly prevalent in IBD. AIM To quantify the burden of FGIDs in a hospital-based cohort of patients with IBD and to determine whether there is any inter-relationship between the presence and number of FGIDs and patients' quality of life or psychological status. METHODS A cross-sectional survey of 61 out-patients was performed. Data on psychological status, quality of life, disease activity and functional symptoms according to Rome III criteria were collected. RESULTS Overall, 49 (80%) participants met Rome III criteria for a functional bowel disorder and 52% of participants met criteria for more than one FGID. Participants with no FGID had significantly better physical quality of life than those with more than two FGIDs (P = 0.025). However, there was no relationship among the number of FGIDs, mental quality of life, anxiety or depression. CONCLUSIONS Functional gastrointestinal disorders are highly prevalent in out-patients with IBD. Somewhat unexpectedly, the presence of anxiety and/or depression did not appear to correlate with either the presence or the number of FGIDs.
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Affiliation(s)
- A A Mikocka-Walus
- School of Population Health and Clinical Practice, University of Adelaide, Adelaide, SA, Australia.
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Mikocka-Walus A, Turnbull D, Moulding N, Wilson I, Andrews JM, Holtmann G. Psychological comorbidity and complexity of gastrointestinal symptoms in clinically diagnosed irritable bowel syndrome patients. J Gastroenterol Hepatol 2008; 23:1137-43. [PMID: 18070012 DOI: 10.1111/j.1440-1746.2007.05245.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIM The prevalence of psychological disorders is high in patients with irritable bowel syndrome (IBS) but their role in symptom reporting is uncertain. It is thus interesting whether the number of functional gastrointestinal disorders (FGID) determines the load of psychological comorbidity. The Rome III criteria have not been used to evaluate such a relationship as yet. Moreover, not many studies have examined the sensitivity of the Rome III criteria in detecting IBS. Our aims were therefore: (i) to determine whether those IBS participants with more FGID had a tendency to greater psychological comorbidity than those with fewer FGID; and (ii) to assess the performance of the Rome III criteria in detecting IBS versus the diagnosis of the gastroenterologist. METHODS A cross-sectional survey of 32 consecutive outpatients with clinically diagnosed IBS was performed. The Hospital Anxiety and Depression Scale (HADS), the Short Form 12 Health Survey (SF-12), and the Rome III criteria questionnaire (BDQ-6) were administered. Multiple linear regression was conducted to detect associations among FGID, anxiety, depression and quality of life. RESULTS Overall, 50% of participants were anxious and 12% were depressed. Forty-four percent of participants had >two FGID; however, the number of FGID did not correlate with scores for anxiety, depression or quality of life. Amazingly, only 50% (CI: 33-67) of participants clinically diagnosed with IBS met Rome III criteria for IBS. CONCLUSION Contrary to our expectations, a greater load of FGID did not correlate with a greater load of psychological comorbidity. Surprisingly, the Rome III criteria detected only 50% of clinical cases of IBS.
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Affiliation(s)
- Antonina Mikocka-Walus
- Discipline of General Practice and School of Psychology, University of Adelaide, Adelaide, South Australia, Australia.
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Wolfe BJ, Sirois FM. Beyond standard quality of life measures: the subjective experiences of living with inflammatory bowel disease. Qual Life Res 2008; 17:877-86. [PMID: 18521720 DOI: 10.1007/s11136-008-9362-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Accepted: 05/18/2008] [Indexed: 12/13/2022]
Abstract
INTRODUCTION In order to facilitate our understanding of health-related quality of life (HRQoL) for inflammatory bowel disease (IBD) patients, it is critical to explore their subjective experiences with the disease. Research has suggested that current modes of assessing HRQoL (i.e., generic and disease-specific measures) may not fully represent all dimensions of patients' HRQoL. The purpose of this study was to examine IBD patients' subjective experiences of the daily impact of IBD, and categorize dimensions of their HRQoL affected by IBD, as identified by the patients themselves. METHODS Two hundred and eighty-two patients with IBD provided answers to the qualitative question "How has IBD affected your daily activities?" A content analysis using NVivo 2.0 was conducted on the participants' responses to this question to reveal dimensions of their HRQoL. RESULTS The analysis yielded six dimensions and several subdimensions of HRQoL, including physical (systemic functioning, daily functioning, energy/vitality, pain), emotional, social, cognitive (functioning, attending to disease), self-regulation (taking control, loss of control, and neutral), and practical functioning. DISCUSSION These results reflect previous findings, but also reveal several dimensions of HRQoL not included in current measures of HRQoL for IBD patients (i.e., cognitive, self-regulation, and practical). The implications of these findings for future measurement of HRQoL and research with IBD patients are discussed.
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Affiliation(s)
- Barat J Wolfe
- Department of Psychology, University of Windsor, 176 Chrysler Hall South, 401 Sunset Ave., Windsor, ON, Canada N9B 3P4.
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Mikocka-Walus AA, Turnbull DA, Andrews JM, Moulding NT, Wilson IG, Harley HAJ, Hetzel DJ, Holtmann GJ. Psychological problems in gastroenterology outpatients: A South Australian experience. Psychological co-morbidity in IBD, IBS and hepatitis C. Clin Pract Epidemiol Ment Health 2008; 4:15. [PMID: 18500977 PMCID: PMC2430958 DOI: 10.1186/1745-0179-4-15] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Accepted: 05/23/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND In independent studies, IBD, IBS and HCV have each been associated with a substantially increased risk of psychological problems such as depression and anxiety and impairment of quality of life compared to the general healthy population. However, the relative psychological burden for each of these diagnoses is unknown as it has never been compared contemporaneously at one institution. Current local data are therefore needed to enable an evidence-based allocation of limited clinical psychological resources. METHODS Overall, 139 outpatients (64 IBD, 41 HCV, and 34 IBS) were enrolled in this cross-sectional study. The HADS, SCL90, SF-12 and appropriate disease-specific activity measures were administered. Differences between groups were assesed with ANOVA, the Chi-Square test and the independent samples t-test (two-tailed). RESULTS Each of the three groups had significantly lower quality of life than the general population (p < 0.05). Overall, a total of 58 (42%) participants met HADS screening criteria for anxiety and 26 (19%) participants for depression. The HCV group had a significantly higher prevalence of depression than either of the other groups (HCV = 34%, IBS = 15% and IBD = 11%, p = 0.009). In the SCL90, the three disease groups differed on 7 out of 12 subscales. On each of these subscales, the HCV group were most severely affected and differed most from the general population. CONCLUSION Patients with these common chronic gastrointestinal diseases have significant impairment of quality of life. Anxiety is a greater problem than depression, although patients with HCV in particular, should be regularly monitored and treated for co-morbid depression. Evaluation of specific psychological interventions targeting anxiety is warranted.
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Affiliation(s)
- Antonina A Mikocka-Walus
- Department of Epidemiology & Preventive Medicine, Monash University, The Alfred, Level 3, Burnet Tower, 89 Commercial Rd, Melbourne 3004, VIC, Australia
| | - Deborah A Turnbull
- School of Psychology, University of Adelaide, Level 4, Hughes Building, Adelaide 5005, SA, Australia
| | - Jane M Andrews
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Wing Q7, Adelaide 5005, SA, Australia
| | - Nicole T Moulding
- School of Social Work and Social Policy, University of South Australia, Magill Campus, H1-32, Magill 5068, SA, Australia
| | - Ian G Wilson
- School of Medicine, University of Western Sydney, Locked Bag 1797, Penrith South DC NSW 1797, Australia
| | - Hugh AJ Harley
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Wing Q7, Adelaide 5005, SA, Australia
| | - David J Hetzel
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Wing Q7, Adelaide 5005, SA, Australia
| | - Gerald J Holtmann
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Wing Q7, Adelaide 5005, SA, Australia
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Karling P, Danielsson A, Adolfsson R, Norrback KF. No difference in symptoms of irritable bowel syndrome between healthy subjects and patients with recurrent depression in remission. Neurogastroenterol Motil 2007; 19:896-904. [PMID: 17973640 DOI: 10.1111/j.1365-2982.2007.00967.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
There is bidirectional comorbidity between anxiety/depression and irritable bowel syndrome (IBS). To investigate the prevalence of IBS symptoms, and factors associated with gastrointestinal symptoms in patients with recurrent depressive disorder. Patients (n = 95) with recurrent type of major depression according to DSM-IV criteria and sex- and age-matched controls (n = 190) were sent questionnaires investigating symptoms of IBS [Gastrointestinal Symptom Rating Scale (GSRS)-IBS] and symptoms of anxiety and depression [Hospital Anxiety and Depression Scale (HADS)]. Medical records were checked over a 10-year period for chronic somatic symptoms or diseases. Seventy-three patients with unipolar disorder (mean age 63.6 years SD 13.8; range 23-86 years) and 156 controls (mean age 59.2 years SD 11.6, range 21-85 years) responded. Patients with recurrent depression had higher GSRS-IBS scores and showed a strong correlation between symptoms of IBS and anxiety-depression (r(s) = 0.54; P < 0.001). IBS symptoms were also associated with multiple pain symptoms, higher health-seeking behaviour and selective-serotonin-reuptake inhibitor intake. However, patients with recurrent depression (n = 46) in remission (HADS-Depression score <8) did not have more symptoms of IBS than controls (GSRS-IBS median score 6.0 vs 6.5; P = 0.46). There is a strong association between symptoms of IBS and symptoms of anxiety and depression, whereas depressive patients in remission do not have more IBS symptoms than controls.
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Affiliation(s)
- P Karling
- Department of Medicine/Gastroenterology, University Hospital of Umeå, Umeå, Sweden.
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Mikocka-Walus AA, Turnbull DA, Moulding NT, Wilson IG, Andrews JM, Holtmann GJ. "It doesn't do any harm, but patients feel better": a qualitative exploratory study on gastroenterologists' perspectives on the role of antidepressants in inflammatory bowel disease. BMC Gastroenterol 2007; 7:38. [PMID: 17892587 PMCID: PMC2040148 DOI: 10.1186/1471-230x-7-38] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Accepted: 09/24/2007] [Indexed: 02/08/2023] Open
Abstract
Background Interest in psychological factors in patients with inflammatory bowel disease (IBD) has increased in recent years. It has even been proposed that treating psychological co-morbidities with antidepressants may control disease activity and improve quality of life. Despite this, there is no data on gastroenterologists' attitudes to, and experiences with, antidepressant therapy in patients with IBD. Methods We conducted semi-structured interviews with 18 gastroenterologists associated with metropolitan teaching hospitals. Qualitative content analysis was used to examine their responses. Results Seventy-eight percent of gastroenterologists had treated IBD patients with antidepressants for pain, depression and/or anxiety, and insomnia. Antidepressants were reported to be useful in improving psychosocial well-being, quality of life, and self-management of the disease by patients. However, in this group of gastroenterologists, there appears to be skepticism towards psychological disorders themselves or antidepressant therapy having a central role in either the causation of IBD or its clinical course. Nevertheless, these gastroenterologists were receptive to the idea of conducting a trial of the role of antidepressants in IBD. Conclusion While the majority of specialists have treated IBD patients with antidepressants, there is considerable skepticism with regard to efficacy of antidepressive therapy or the role of psychological factors in the outcome of IBD patients.
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Affiliation(s)
- Antonina A Mikocka-Walus
- School of Psychology, University of Adelaide, Adelaide, SA, Australia
- School of Population Health & Clinical Practice, Discipline of General Practice, University of Adelaide, Adelaide, SA, Australia
- Department of Gastroenterology, Hepatology and General Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - Nicole T Moulding
- School of Population Health & Clinical Practice, Discipline of General Practice, University of Adelaide, Adelaide, SA, Australia
| | - Ian G Wilson
- School of Medicine, University of Western Sydney, Sydney, NSW, Australia
| | - Jane M Andrews
- Department of Gastroenterology, Hepatology and General Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Gerald J Holtmann
- Department of Gastroenterology, Hepatology and General Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
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Korczak DJ, Goldstein BI, Levitt AJ. Panic disorder, cardiac diagnosis and emergency department utilization in an epidemiologic community sample. Gen Hosp Psychiatry 2007; 29:335-9. [PMID: 17591510 DOI: 10.1016/j.genhosppsych.2007.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Revised: 03/20/2007] [Accepted: 03/22/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We examined the association between panic disorder (PD), physician-diagnosed cardiac disease (CD), and the interaction of these variables in relation to health care utilization, as measured by emergency department (ED) visitations, in an epidemiologic sample. METHODS Subjects were identified from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative sample of 43,093 adult respondents from the United States who completed face-to-face computer-assisted structured clinical interviews. RESULTS Among patients with CD, the 12-month prevalence of PD (6.0%; 613/10,239) was significantly higher than that among non-CD subjects (3.4%; 1106/32,854; adjusted odds ratio=2.4; 95% confidence interval=2.2-2.7). CD patients with PD had a significantly greater prevalence of angina, tachycardia and alcohol use disorders as compared with PD-negative patients. PD-positive patients reported significantly greater mean 12-month ED visits (1.2) as compared with the PD-negative patients (0.6; P<.001). PD and tachycardia were found to have a significant interaction effect on ED visits for males (F=25.1; df=1,7; P<.001) but not for females (F=1.2; df=1,7; P=.28), with age, income, race and alcohol use included as covariates. CONCLUSIONS Epidemiological data support a relationship between PD and CD that impacts ED utilization. These findings have potential implications for medical, psychiatric and ED-based screening and interventions.
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Affiliation(s)
- Daphne J Korczak
- Department of Psychiatry, The University of Toronto, Toronto, Ontario, Canada M5S 1A1.
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Faresjö A, Grodzinsky E, Johansson S, Wallander MA, Timpka T, Akerlind I. Psychosocial factors at work and in every day life are associated with irritable bowel syndrome. Eur J Epidemiol 2007; 22:473-80. [PMID: 17484023 DOI: 10.1007/s10654-007-9133-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Accepted: 03/30/2007] [Indexed: 12/14/2022]
Abstract
The etiology of irritable bowel syndrome (IBS) tends to be complex and multi-factorial and there is still a lack of understanding of how different psychosocial factors are associated with the syndrome. Our aim was to examine the occurrence of psychosocial and behavioural factors among patients diagnosed with IBS in primary care. The study had an epidemiological population-based case-control design comparing 347 IBS cases to 1041 age and sex matched controls from the general population. A survey was directed to cases and controls based on validated questions asking for mood status, job strain, family history of IBS, and sleeping habits as well as education, nutritional and exercise habits and medication. In multivariate analyses, independent associations were found between IBS and lack of influence on work planning, a family history of IBS, anxiety, and sleeping disturbances. Important factors associated with IBS diagnosis among females were anxiety as well as family history of IBS and lack of co-determination at work. For males, only lack of influence on working pace and family history of IBS remained independently associated with an IBS diagnosis. The causal associations of the complex risk factor panorama for IBS warrants further study. This study indicates that there should be a special focus on investigating the psychosocial working conditions and their associations to IBS.
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Affiliation(s)
- Ashild Faresjö
- Department of Social Medicine and Public Health Science, Linköping University, Linkoping, 581 83, Sweden.
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Sayuk GS, Elwing JE, Lustman PJ, Clouse RE. High somatic symptom burdens and functional gastrointestinal disorders. Clin Gastroenterol Hepatol 2007; 5:556-62. [PMID: 17258513 DOI: 10.1016/j.cgh.2006.11.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Unexplained, multi-system somatic symptoms and syndromes, the hallmark features of somatization, are prevalent in patients with functional gastrointestinal disorders (FGIDs). We studied outpatients attending a gastroenterology clinic to see whether current somatic symptom burdens (a somatization state measure) or number of prior functional diagnoses (a somatization trait measure) could predict the presence of an FGID over structural gastrointestinal disease, and whether the predictive value was dependent on comorbid depression or anxiety disorders. METHODS Clinical data from 327 consecutive new referrals to an outpatient gastroenterology practice were reviewed, 187 with an FGID and 140 with a structural illness. Somatization state and trait were measured by using self-reported current symptoms and functional diagnoses recorded in the medical history, respectively. Psychiatric comorbidity (depression or anxiety disorders) was extracted from chart review. RESULTS FGID subjects endorsed more somatization state symptoms, had more somatization trait diagnoses, and had greater likelihood of psychiatric comorbidity (P < .001 for each). Logistic regression analysis adjusting for age and sex differences showed that each of these features independently predicted the likelihood of an FGID over structural disease (P < .05 for each). When high ratings on the somatization measures were present together with psychiatric comorbidity, the positive predictive value exceeded 0.95. CONCLUSIONS Higher burdens of either current somatic symptoms or functional diagnoses in the medical history are strong predictors of an FGID in outpatients presenting with gastrointestinal complaints. The mechanism is not solely dependent on a relationship with affective disorders, which independently predicts FGID, at least in part, through another path.
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Affiliation(s)
- Gregory S Sayuk
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
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Ruigómez A, García Rodríguez LA, Panés J. Risk of irritable bowel syndrome after an episode of bacterial gastroenteritis in general practice: influence of comorbidities. Clin Gastroenterol Hepatol 2007; 5:465-9. [PMID: 17445753 DOI: 10.1016/j.cgh.2007.02.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Given the discrepant estimates of incidence rates of irritable bowel syndrome (IBS) after gastroenteritis (GE), we performed a cohort study to quantify this risk in community subjects and to identify factors acting as modifiers of this effect. METHODS In a previous study, we identified patients aged 20-74 years with a first ever episode of bacterial GE during 1992-2001. We excluded patients with a history of bowel disease and cancer, resulting in a cohort of 5894 individuals with GE. From the same source population, a control group free of GE was sampled. We followed up the 2 cohorts to identify incident cases of IBS. A nested case-control analysis was performed to quantify the role of potential risk factors. RESULTS During a mean follow-up period of 4.1 years, 1105 patients developed IBS. The incidence rate of IBS after an episode of bacterial GE was 98.2 per 10,000 person-years, and 45.3 per 10,000 person-years in the comparison cohort. The adjusted relative risk of IBS associated with bacterial GE was 2.2 (1.5-2.9) compared with the control cohort. The nested case-control analysis adjusting for additional risk factors produced similar results (odds ratio, 1.8; 95% confidence interval, 1.5-2.1). The risk of IBS after GE was increased significantly in patients with depression, anxiety, stress or sleep disorders, prior gastrointestinal morbidity, or prolonged use of antibiotics. CONCLUSIONS The risk of IBS in community individuals after having bacterial GE was two fold greater in the general population. Pre-existing psychologic and gastrointestinal comorbidities independently increase this risk of developing IBS.
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Affiliation(s)
- Ana Ruigómez
- Centro Español de Investigación Farmacoepidemiológica, Madrid, Spain
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Sayuk GS, Elwing JE, Lustman PJ, Clouse RE. Predictors of premature antidepressant discontinuation in functional gastrointestinal disorders. Psychosom Med 2007; 69:173-81. [PMID: 17289822 DOI: 10.1097/psy.0b013e318031391d] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To identify factors responsible for premature antidepressant discontinuation that would assist in designing management strategies for patients with functional gastrointestinal disorders. Antidepressants are being used increasingly to manage patients with functional gastrointestinal disorders; poor patient adherence to treatment regimens, particularly in the period shortly after antidepressant initiation, is common and interferes with success. METHODS Clinical records were reviewed from 172 outpatients who attended a university-based practice and who had been prescribed antidepressants to manage their functional gastrointestinal symptoms. Survival analysis methods were used to determine independent predictors of premature antidepressant discontinuation (within 6 months of initiation). Logistic regression analyses were used to see if the same predictors were responsible for side effects or poor treatment response. RESULTS Premature antidepressant discontinuation occurred in 41 (23.8%) subjects. Somatization features (state or trait) and history of depression or an anxiety disorder were the most significant predictors of premature discontinuation (p < or = .01 for each). Advancing age and female sex also were independent predictors (p < .05 for each). Somatization features and psychiatric illness were each linked to poor treatment response, whereas somatization features most consistently were associated with antidepressant side effects. CONCLUSIONS Failure to maintain treatment occurs in nearly a quarter of outpatients given antidepressants for functional gastrointestinal disorders. Somatization features and history of depression or anxiety most significantly interfered with treatment by predicting side effects, poor treatment response, and premature antidepressant discontinuation. Management algorithms should include specific strategies targeted at patients with these risk factors for poor treatment adherence.
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Affiliation(s)
- Gregory S Sayuk
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO 63110, USA
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Maunder RG, Greenberg GR, Hunter JJ, Lancee WJ, Steinhart AH, Silverberg MS. Psychobiological subtypes of ulcerative colitis: pANCA status moderates the relationship between disease activity and psychological distress. Am J Gastroenterol 2006; 101:2546-51. [PMID: 17029612 PMCID: PMC2923655 DOI: 10.1111/j.1572-0241.2006.00798.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Studies of psychological factors in ulcerative colitis (UC) have produced inconsistent findings. This study sought to determine whether perinuclear antineutrophil cytoplasmic antibody (pANCA) demarcates subtypes which differ with respect to psychobiological interactions. METHODS In 148 outpatients with UC, the strength of the relationship between current UC disease activity and psychological distress was assessed. pANCA was determined by ELISA and immunofluorescence, disease activity was determined by symptoms, physical examination, and endoscopy using the St. Mark's index, and depressive symptoms and health anxiety were measured with self-report scales. Pearson correlations between disease activity and depressive symptoms and between disease activity and health anxiety were calculated. RESULTS In 74 pANCA negative subjects, the relationship between disease activity and measures of psychological distress was significant for disease activity-depression (partial correlation = 0.48, p < 0.001) and for disease activity-health anxiety (partial correlation = 0.64, p < 0.001), whereas in 74 pANCA positive subjects, no relationships were found (disease activity-depression: partial correlation = 0.18, p= 0.14; disease activity-health anxiety: partial correlation = 0.20, p= 0.09). The differences in the strength of correlation between pANCA positive and pANCA negative subjects were statistically significant for both disease activity-depression (z = 2.0, p= 0.02) and activity-health anxiety (z = 3.3, p < 0.001). CONCLUSIONS pANCA status demarcates psychobiologically distinct subtypes of UC, such that the absence of pANCA is associated with greater psychobiological interaction. These findings have implications for clinical care and understanding the pathophysiology of intestinal inflammation.
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Wainwright D, Calnan M, O'Neil C, Winterbottom A, Watkins C. When pain in the arm is ‘all in the head’: The management of medically unexplained suffering in primary care. HEALTH RISK & SOCIETY 2006. [DOI: 10.1080/13698570500532512] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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