Psychological problems in gastroenterology outpatients: A South Australian experience. Psychological co-morbidity in IBD, IBS and hepatitis C
Tóm tắt
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. 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). 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. 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.
Tài liệu tham khảo
Mayer EA, Craske M, Naliboff BD: Depression, anxiety, and the gastrointestinal system. J Clin Psychiatry. 2001, 62 (Suppl 8): 28-36. discussion 37.
Kuchler T, Bestmann B, Rappat S, Henne-Bruns D, Wood-Dauphinee S: Impact of psychotherapeutic support for patients with gastrointestinal cancer undergoing surgery: 10-year survival results of a randomized trial. J Clin Oncol. 2007, 25 (19): 2702-2708. 10.1200/JCO.2006.08.2883.
Deter HC, Keller W, von Wietersheim J, Jantschek G, Duchmann R, Zeitz M: Psychological treatment may reduce the need for healthcare in patients with Crohn's disease. Inflamm Bowel Dis. 2007
Mittermaier C, Dejaco C, Waldhoer T, Oefferlbauer-Ernst A, Miehsler W, Beier M, Tillinger W, Gangl A, Moser G: Impact of Depressive Mood on Relapse in Patients With Inflammatory Bowel Disease: A Prospective 18-Month Follow-Up Study. Psychosom Med. 2004, 66 (1): 79-84. 10.1097/01.PSY.0000106907.24881.F2.
Fullwood A, Drossman DA: The relationship of psychiatric illness with gastrointestinal disease. Annu Rev Med. 1995, 46: 483-496. 10.1146/annurev.med.46.1.483.
Crone C, Gabriel GM: Comprehensive review of hepatitis C for psychiatrists: risks, screening, diagnosis, treatment, and interferon-based therapy complications. J Psychiatr Pract. 2003, 9 (2): 93-110. 10.1097/00131746-200303000-00002.
Barratt HS, Kalantzis C, Polymeros D, Forbes A: Functional symptoms in inflammatory bowel disease and their potential influence in misclassification of clinical status. Aliment Pharmacol Ther. 2005, 21 (2): 141-147. 10.1111/j.1365-2036.2005.02314.x.
Holtmann MH, Galle PR, Neurath MF: Treatment of patients with Crohn's disease and concomitant chronic hepatitis C with a chimeric monoclonal antibody to TNF. Am J Gastroenterol. 2003, 98 (2): 504-505. 10.1111/j.1572-0241.2003.07245.x.
Gwee KA, Leong YL, Graham C, McKendrick MW, Collins SM, Walters SJ, Underwood JE, Read NW: The role of psychological and biological factors in postinfective gut dysfunction. Gut. 1999, 44 (3): 400-406.
Barbara G, De Giorgio R, Stanghellini V, Cremon C, Salvioli B, Corinaldesi R: New pathophysiological mechanisms in irritable bowel syndrome. Aliment Pharmacol Ther. 2004, 20 (Suppl 2): 1-9. 10.1111/j.1365-2036.2004.02036.x.
Walker EA, Roy-Byrne PP, Katon WJ, Li L, Amos D, Jiranek G: Psychiatric illness and irritable bowel syndrome: a comparison with inflammatory bowel disease. Am J Psychiatry. 1990, 147 (12): 1656-1661.
Diagnostic and statistical manual of mental disorders [electronic resource] : DSM-IV-TR.
Derogartis LR: SCL-90-R Symptom Checklist-90-R. Administration, Scoring, and Procedures Manual. 1994, Minneapolis: NCS Pearson
Ware JE, Kosinski M, Keller SD: A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996, 34 (3): 220-233. 10.1097/00005650-199603000-00003.
Best WR, Becktel JM, Singleton JW, Kern F: Development of a Crohn's disease activity index. National Cooperative Crohn's Disease Study. Gastroenterology. 1976, 70 (3): 439-444.
Walmsley RS, Ayres RC, Pounder RE, Allan RN: A simple clinical colitis activity index. Gut. 1998, 43 (1): 29-32.
WORLD MEDICAL ASSOCIATION DECLARATION OF HELSINKI: Ethical Principles for Medical Research Involving Human Subjects. 1964, Helsinki: World Medical Association
Ladep NG, Obindo TJ, Audu MD, Okeke EN, Malu AO: Depression in patients with irritable bowel syndrome in Jos, Nigeria. World J Gastroenterol. 2006, 12 (48): 7844-7847.
Golden J, Conroy RM, O'Dwyer AM, Golden D, Hardouin JB: Illness-related stigma, mood and adjustment to illness in persons with hepatitis C. Soc Sci Med. 2006, 63 (12): 3188-3198. 10.1016/j.socscimed.2006.08.005.
Cavanaugh SV, Clark DC, Gibbons RD: Diagnosing depression in the hospitalized medically ill. Psychosomatics. 1983, 24: 809-815.
Andrews H, Barczak P, Allan RN: Psychiatric illness in patients with inflammatory bowel disease. Gut. 1987, 28 (12): 1600-1604. 10.1136/gut.28.12.1600.
Cole JA, Rothman KJ, Cabral HJ, Zhang Y, Farraye FA: Migraine, fibromyalgia, and depression among people with IBS: a prevalence study. BMC Gastroenterol. 2006, 6: 26-10.1186/1471-230X-6-26.
Kraus MR, Schafer A, Csef H, Scheurlen M, Faller H: Emotional state, coping styles, and somatic variables in patients with chronic hepatitis C. Psychosomatics. 2000, 41 (5): 377-384. 10.1176/appi.psy.41.5.377.
Rodin G, Craven J, Littlefield C: Depression in the Medically Ill. An Integrated Approach. 1991, New York: Brunner/Mazel, Publishers
Simren M, Axelsson J, Gillberg R, Abrahamsson H, Svedlund J, Bjornsson ES: Quality of Life in Inflammatory Bowel Disease in Remission: The Impact of IBS-LIke Symptoms ans Associated Psychological Factors. Am J Gastroenterol. 2002, 97 (2): 389-396.
Creed F, Guthrie E, Ratcliffe J, Fernandes L, Rigby C, Tomenson B, Read N, Thompson DG: Does psychological treatment help only those patients with severe irritable bowel syndrome who also have a concurrent psychiatric disorder?. Aust N Z J Psychiatry. 2005, 39 (9): 807-815. 10.1111/j.1440-1614.2005.01686.x.
Rodger AJ, Jolley D, Thompson SC, Lanigan A, Crofts N: The impact of diagnosis of hepatitis C virus on quality of life. Hepatology. 1999, 30 (5): 1299-1301. 10.1002/hep.510300504.
De Bie J, Robaeys G, Buntinx F: Hepatitis C, interferon alpha and psychiatric co-morbidity in intravenous drug users (IVDU) : guidelines for clinical practice. Acta Gastroenterol Belg. 2005, 68 (1): 68-80.
Loftis JM, Hauser P: The phenomenology and treatment of interferon-induced depression. J Affect Disord. 2004, 82 (2): 175-190. 10.1016/j.jad.2004.04.002.
Dieperink E, Willenbring M, Ho SB: Neuropsychiatric symptoms associated with hepatitis C and interferon alpha: A review. Am J Psychiatry. 2000, 157 (6): 867-876. 10.1176/appi.ajp.157.6.867.
Forton DM, Allsop JM, Main J, Foster GR, Thomas HC, Taylor-Robinson SD: Evidence for a cerebral effect of the hepatitis C virus. Lancet. 2001, 358 (9275): 38-39. 10.1016/S0140-6736(00)05270-3.
Forton DM, Allsop JM, Cox IJ, Hamilton G, Wesnes K, Thomas HC, Taylor-Robinson SD: A review of cognitive impairment and cerebral metabolite abnormalities in patients with hepatitis C infection. Aids. 2005, 19 (Suppl 3): S53-63. 10.1097/01.aids.0000192071.72948.77.
Avery J, Dal Grande E, Taylor A: Quality of life in South Australia as measured by the SF12 Health Status Questionnaire: Population norms for Trends from 1997 to 2003. Department of Human Services. 2004