The relationship of current psychiatric disorder to functional disability and distress in patients with inflammatory bowel disease

Walker, Edward A.; Gelfand, Michael; Gelfand, Ann N.; Creed, Francis; Katon, Wayne

doi:10.1016/0163-8343(96)00036-9

Cited by 135 publications

(93 citation statements)

References 30 publications

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“…The relationship between heightened psychological symptoms and more severe gastrointestinal symptoms was also confirmed. This pattern of relationships has been reported in other illness populations (43,44) but this study is the first to demonstrate such a link in CD. As was suggested by previous researchers (43,44), it is possible that the presence of psychological symptoms, even at subclinical levels, resulted in the increased salience and subsequent reporting of gastrointestinal symptoms.…”

Section: Insert Table 2 Here Study 1 Discussionmentioning

confidence: 74%

“…This pattern of relationships has been reported in other illness populations (43,44) but this study is the first to demonstrate such a link in CD. As was suggested by previous researchers (43,44), it is possible that the presence of psychological symptoms, even at subclinical levels, resulted in the increased salience and subsequent reporting of gastrointestinal symptoms. These results also extend previous findings (24) by demonstrating that in addition to affecting physical and psychological QOL respectively, gastrointestinal and psychological symptoms both have negative impacts, albeit of differing strength, on overall QOL.…”

Section: Insert Table 2 Here Study 1 Discussionmentioning

confidence: 74%

“…For example, Walker and colleagues (44) found that patients suffering from inflammatory bowel disease with depression reported more severe gastrointestinal symptoms than those without depression. It was suggested that the presence of a psychological condition such as depression might serve to exacerbate the perception of physical symptoms (43,44), both of which would then likely have a negative impact on QOL. Similarly, it was found that the majority of patients suffering from gastrointestinal disorders (including CD) presenting for treatment also showed symptoms of depression or elevated state anxiety (45).…”

Section: )mentioning

confidence: 99%

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Reduced quality of life in coeliac disease is more strongly associated with depression than gastrointestinal symptoms

Sainsbury

Mullan

Sharpe

2013

Journal of Psychosomatic Research

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Section: Insert Table 2 Here Study 1 Discussionmentioning

confidence: 74%

Section: Insert Table 2 Here Study 1 Discussionmentioning

confidence: 74%

Section: )mentioning

confidence: 99%

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Reduced quality of life in coeliac disease is more strongly associated with depression than gastrointestinal symptoms

Sainsbury

Mullan

Sharpe

2013

Journal of Psychosomatic Research

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“…Studies in IBD and other chronic medical diseases, which assessed MDD as a separate categorical diagnosis, found prevalence rates of 6-14%. 6,39,40 At baseline, the prevalence of depression in our cohort was higher, which could be explained by the fact that only patients with active CD were included. At re-assessment after treatment, the proportion of patients with MDD was comparable with that previously reported, 6,39 suggesting that if MDD was diagnosed at baseline, but not at re-evaluation, this reflected a psychological reaction to the disease activity in a subgroup of patients.…”

Section: Discussionmentioning

confidence: 91%

The impact of major depressive disorder on the short‐ and long‐term outcome of Crohn's disease treatment with infliximab

Persoons

Vermeire

Demyttenaere

et al. 2005

Aliment Pharmacol Ther

214

161

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Summary Background: Major depressive disorder is the most common psychiatric diagnosis in Crohn's disease. In other chronic diseases, evidence suggests that depression influences the course of the disease. Strong evidence of such a mediating role of major depressive disorder in Crohn's disease has never been found.Aim: To assess the relationship between major depressive disorder and outcome of treatment of luminal Crohn's disease with infliximab.Methods: In this prospective study, 100 consecutive unselected patients underwent assessment of psychosocial, demographical disease‐related biological and clinical parameters at baseline and at 4 weeks after infliximab. Major depressive disorder was diagnosed using the Patient Health Questionnaire. Subsequently, the patients were followed up clinically until the next flare or during 9 months.Results: The Crohn's disease responded in 75% of the patients, and remission was achieved in 60%. The presence of major depressive disorder at baseline predicted a lower remission rate (OR = 0.166, 95% CI = 0.049–0.567, P = 0.004). At follow‐up, 88% of the patients needed retreatment. At univariate regression analysis, major depressive disorder significantly decreased time to retreatment (P = 0.001). Multivariate Cox regression confirmed major depressive disorder as an independent determinant of active disease both at baseline and at re‐evaluation (hazard ratio = 2.271, 95% CI: 1.36–3.79, P = 0.002).Conclusion: Major depressive disorder is a risk factor for failure to achieve remission with infliximab and for earlier retreatment in patients with active luminal Crohn's disease. Assessment and management of major depressive disorder should be part of the clinical approach to patients with Crohn's disease.

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“…In some studies, depression correlated well with disease activity, suggesting that it is secondary to the disability imposed by Crohn disease (2)(3)(4). In other studies, depression was unrelated to disease activity (5) and, in some cases, actually predated the onset of Crohn disease (6).…”

Section: Introductionmentioning

confidence: 99%

Impaired parasympathetic function increases susceptibility to inflammatory bowel disease in a mouse model of depression

Ghia¹,

Blennerhassett²,

Collins³

2008

J. Clin. Invest.

163

156

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Clinical and experimental evidence indicates that intestinal inflammatory conditions can be exacerbated by behavioral conditions such as depression. The recent demonstration of a tonic counterinflammatory influence mediated by the vagus nerve in experimental colitis provides a potential link between behavior and gut inflammation. Here we show that experimental conditions that induced depressive-like behaviors in mice increased susceptibility to intestinal inflammation by interfering with the tonic vagal inhibition of proinflammatory macrophages and that tricyclic antidepressants restored vagal function and reduced intestinal inflammation. These results show that reserpine-induced monoamine depletion and maternal separation, 2 models for depression, produced a vulnerability to colitis by a mechanism involving parasympathetic transmission and the presence of gut macrophages. The tricyclic antidepressant desmethylimipramine protected against this vulnerability by a vagal-dependent mechanism. Together these results illustrate the critical role of the vagus in both the vulnerability to inflammation induced by depressive-like conditions and the protection afforded by tricyclic antidepressants and rationalize a clinical evaluation of both parasympathomimetics and tricyclic antidepressants in treatment of inflammatory bowel disease.

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The relationship of current psychiatric disorder to functional disability and distress in patients with inflammatory bowel disease

Cited by 135 publications

References 30 publications

Reduced quality of life in coeliac disease is more strongly associated with depression than gastrointestinal symptoms

Reduced quality of life in coeliac disease is more strongly associated with depression than gastrointestinal symptoms

The impact of major depressive disorder on the short‐ and long‐term outcome of Crohn's disease treatment with infliximab

Impaired parasympathetic function increases susceptibility to inflammatory bowel disease in a mouse model of depression

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