Psychosocial Aspects of Crohn's Disease
Section snippets
Human Studies
Social disorganization and major changes in a person's lifestyle correlate with medical disorders and subsequent illness or injury.13 Although several studies link social stress in humans to chronic diseases, only a few have evaluated IBD, and many are anecdotal, retrospective, or uncontrolled studies. Even the few well-designed studies of IBD give mixed results: in a 6-month prospective study, Duffy et al44 studied the relationship of monthly major life events with symptoms and disease
Stress Effects on Gut Function
Psychological and emotional stressors may affect the GI motor, sensory, and secretory function directly or indirectly through the richly innervated nerve plexuses existing between the enteric nervous system, the spinal and autonomic connections, and the CNS (i.e., the “brain–gut axis”).84, 85 Stress effects on intestinal motility have been reported in laboratory animals and in humans. Immobilization stress and conditioned fear cause significant changes in intestinal myoelectric activity in
PSYCHOSOCIAL CONCOMITANTS AND CONSEQUENCES OF INFLAMMATORY BOWEL DISEASE
In addition to the influencing role of psychosocial factors on the pathogenesis or exacerbation of Crohn's disease, once the disease develops, psychosocial concomitants must be understood and considered to understand the clinical expression of the illness and to provide proper care.
As with any chronic and painful illness, Crohn's disease may have emotional and psychological consequences. The spectrum of the psychological disorders that may be associated with Crohn's disease is beyond the scope
NEED FOR AN INTEGRATED MODEL OF ILLNESS AND DISEASE
Disease activity and severity are insufficient to explain the variability in the patient's symptoms or behavior (i.e., the illness).50 Other domains of the patient's health, such as psychological factors and environmental modulators, have to be included and considered to allow for a more comprehensive assessment of the patient's health status (or illness).
The biopsychosocial model29, 30, 47 permits a broader and more practical framework to deal with the complexity of the patient's illness. It
Assessment and Evaluation of Psychosocial Factors
The assessment of a patient's psychosocial well-being is an essential part of diagnosis and patient care. The data collection requires the willingness to address the biologic and psychosocial aspects of the illness.31 Physicians should create a trusting clinical environment so that the patients will feel comfortable disclosing their thoughts and feelings. Nevertheless, some patients (e.g., patients with alexithymia) have difficulty in expressing their feelings or relating them to their illness.
SUMMARY
Patients and clinicians have always recognized the importance of psychosocial factors as consequences of IBD and as predeterminants for symptom exacerbation.92 Over the past decade, improvements in psychosocial assessment and clinical research design methodology, coupled with new data in brain–gut physiology and psychoneuroimmunology, have led investigators and clinicians to accept a broader approach to illness and disease (i.e., the biopsychosocial model). Based on this understanding and the
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Cited by (50)
Differential immune responses and microbiota profiles in children with autism spectrum disorders and co-morbid gastrointestinal symptoms
2018, Brain, Behavior, and ImmunityCitation Excerpt :Anxiety, depression, epilepsy, severe progressive neuropathy, gait ataxia, and limb ataxia are also seen in adult patients with celiac disease (Hallert and Derefeldt, 1982, Hadjivassiliou et al., 2002, Bushara, 2005, Fasano and Catassi, 2005, Genuis and Bouchard, 2010). In individuals with diseases/syndromes such as irritable bowel syndrome (IBS), ulcerative colitis and Crohn’s disease, psychiatric symptoms have also been reported (Ringel and Drossman, 2001, Ringel and Drossman, 2002). Studies focused on assessing the underlying pathology of GI dysfunction in children with ASD have demonstrated low α-1-antitrypsin concentrations suggestive of intestinal protein loss (Walker-Smith and Andrews, 1972), increased intestinal permeability as measured by a lactulose:mannitol test (D'Eufemia et al., 1996, de Magistris et al., 2010) and the presence of a diffuse inflammation of the intestinal tract found after endoscopy or colonoscopy as part of clinical work up for GI symptoms (reviewed in (Buie et al., 2010)).
Mood swings in patients with Crohn's disease: Incidence and associated factors
2012, Revista da Associacao Medica BrasileiraEffects of Stress on Intestinal Mucosal Functions
2012, Physiology of the Gastrointestinal Tract, Two Volume SetA bio-behavioral study of chronic idiopathic colitis in the rhesus macaque (Macaca mulatta)
2012, Applied Animal Behaviour ScienceCitation Excerpt :Greene et al. (1994) report a significant influence of daily stress on the characteristic waxing and waning of inflammatory bowel disease. Ringel and Drossman (2001) report a similar result for Crohn's disease patients and highlight the important relationship between psychosocial stress, disease pathogenesis and response to treatment. However, past research has not considered cortisol concentration in nonhuman primates and results have not been conclusive for human patients.
Effects of Stress on Intestinal Mucosal Functions
2012, Physiology of the Gastrointestinal TractIntestinal barrier function: Molecular regulation and disease pathogenesis
2009, Journal of Allergy and Clinical ImmunologyCitation Excerpt :Studies have demonstrated that stress-induced permeability and ion secretion changes are attenuated in mast cell–deficient animals or after mast cell depletion or stabilization.199-201 Psychologic stress has been shown to influence the clinical course of chronic intestinal disorders, including IBD and irritable bowel syndrome.255-257 Long-term stress has been associated with an increased risk and number of relapses in patients with ulcerative colitis.255
Address reprint requests to Yehuda Ringel, MD, Division of Digestive Diseases, 774 Burnett-Womack Building CB7080, University of North Carolina, Chapel Hill, NC 27599–7080