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Bellone F, Morace C, Impalà G, Viola A, Gullo AL, Cinquegrani M, Fries W, Sardella A, Scolaro M, Basile G, Squadrito G, Mandraffino G. Quality of Life (QoL) in Patients with Chronic Inflammatory Bowel Diseases: How Much Better with Biological Drugs? J Pers Med 2023; 13:947. [PMID: 37373936 PMCID: PMC10302043 DOI: 10.3390/jpm13060947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/17/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Inflammatory bowel diseases (IBDs), including ulcerative colitis (UC) and Crohn's disease (CD), are chronic and disabling diseases that affect patient health-related quality of life (HRQoL). IBD patients are frequently exposed to high levels of stress and psychological distress. Biological drugs have been proven to reduce inflammation, hospitalization, and most of the complications that characterize IBDs; their potential contribution to patients' HRQoL remains to be explored. AIM To evaluate and compare any change in the HRQoL and markers of inflammation in IBD patients undergoing biological drugs (infliximab or vedolizumab). MATERIAL AND METHODS A prospective observational study was conducted on a cohort of IBD patients, aged >18 years, who were prescribed with infliximab or vedolizumab. Demographic and disease-related data at baseline were collected. Standard hematological and clinical biochemistry parameters, including C-reactive protein (CRP), white blood cells count (WBC), erythrocytes sedimentation rate (ESR), and α1 and α2 globulins were measured after a 12-h fast at baseline (T0), after 6 weeks (T1), and at 14 weeks (T2) of biological treatment. Steroid use, disease activity as measured by the Harvey-Bradshaw index (HBI) and partial Mayo score (pMS) for the CD and UC, respectively, were also recorded at each timepoint. The Short Form 36 Health Survey (SF-36), Functional Assessment of Chronic Illness Therapy (FACIT-F), and Work Productivity and Activity Impairment-General Health Questionnaire (WPAI:GH) were administered to each patient at baseline, T1, and T2 to address the study aims. RESULTS Fifty eligible consecutive patients (52% with CD and 48% with UC) were included in the study. Twenty-two patients received infliximab and twenty-eight received vedolizumab. We noted a significant reduction in the CRP, WBC, α1, and α2 globulins from T0 to T2 (p = 0.046, p = 0.002, p = 0.008, and p = 0.002, respectively). Participants showed a significant decrease in steroid administration during the observation period. A significant reduction in the HBI of CD patients at all three timepoints and a similarly significant decrease in the pMS of UC patients from baseline to T1 were recorded. Statistically significant changes were observed in all questionnaires during follow-up as well as an overall improvement in the HRQoL. The interdependence analysis carried out between the biomarkers and the scores of the individual subscales showed a significant correlation between the variation (Δ) of the CRP, Hb, MCH, and MCV with physical and emotional dimensions of the SF-36 and FACIT-F tools; work productivity loss expressed by some of the WPAI:GH items negatively correlated with the ΔWBC and positively with the ΔMCV, ΔMCH, and Δ α1 globulins. A sub-analysis according to the type of treatment showed that patients receiving infliximab experienced a more pronounced improvement in their HRQoL (according to both SF-36 and FACIT-F) compared with patients receiving vedolizumab. CONCLUSIONS Both infliximab and vedolizumab played an important role in contributing to the improvement of the HRQoL in IBD patients by also reducing inflammation and, consequently, steroid use in patients with an active disease. HRQoL, being one of the treatment goals, should also be assessed when taking charge of IBD patients to assess their clinical response and remission. The specific correlation between the biomarkers of inflammation and life's spheres, as well as their possible role as clinical markers of HRQoL, should be further investigated.
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Affiliation(s)
- Federica Bellone
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | - Carmela Morace
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | - Giulia Impalà
- Unit of Anaesthesia and Intensive Care, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy;
| | - Anna Viola
- IBD Unit, Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy; (A.V.)
| | - Alberto Lo Gullo
- Unit of Rheumatology, Department of Medicine, ARNAS Garibaldi Hospital, 95124 Catania, Italy;
| | - Maria Cinquegrani
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | - Walter Fries
- IBD Unit, Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy; (A.V.)
| | - Alberto Sardella
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | - Mariangela Scolaro
- UOC Cardiologia/Utic Ospedale G. Fogliani Milazzo Asp 5, 98123 Messina, Italy
| | - Giorgio Basile
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98122 Messina, Italy;
| | - Giovanni Squadrito
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | - Giuseppe Mandraffino
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
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Bergsten U, Dehlin M, Klingberg E, Landgren AJ, Jacobsson LTH. Gender differences in illness perceptions and disease management in patients with gout, results from a questionnaire study in Western Sweden. BMC Musculoskelet Disord 2023; 24:300. [PMID: 37061681 PMCID: PMC10105391 DOI: 10.1186/s12891-023-06416-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/10/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND Aims were to examine gender differences in patients with gout with regard to a) self-reported gout severity, b) illness perceptions (IP), c) impact on daily activities and Quality of Life (QoL), d) advice from healthcare professionals, e) having changed dietary- or alcohol habits. METHODS Adult patients with gout identified in primary and secondary care in Sweden between 2015 and 2017 (n = 1589) were sent a questionnaire about demographics, gout disease severity, IP (using the Brief Illness Perception Questionnaire, (B-IPQ)) and disease management. T-tests, Chi square tests, ANalysis Of VAriance (ANOVA) and linear regression models were used for gender comparisons. RESULTS Eight hundred sixty-eight patients responded to the questionnaire. Women, n = 177 (20%), experienced more severe gout symptoms (p = 0.011), albeit similar frequencies of flares compared to men. Women experienced modest but significantly worse IP with regard to consequences, identity, concerns and emotional response (p < 0.05) as well as daily activities such as sleeping (p < 0.001) and walking (p = 0.042) and QoL (p = 0.004). Despite this and a higher frequency of obesity in women (38 vs 21%, P < 0.001) and alcohol consumption in men (p < 0.001), obese women had received significantly less advice regarding weight reduction (47 vs 65%, p = 0.041) compared to obese men. On the other hand, women reported having acted on dietary advice to a larger degree. CONCLUSIONS Despite only modestly worse gout severity and perception, women appear to have been given less information regarding self-management than men. These gender differences should be given attention and addressed in clinical care.
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Affiliation(s)
- Ulrika Bergsten
- Region Halland, Research and development department, Halmstad, Sweden
| | - Mats Dehlin
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden.
| | - Eva Klingberg
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden
| | - Anton J Landgren
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden
- Region Västra Götaland, Research and Development Primary Health Care, Södra Bohuslän, Gothenburg, Sweden
| | - Lennart T H Jacobsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden
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Symptom perceptions in functional disorders, major health conditions, and healthy controls: A general population study. CLINICAL PSYCHOLOGY IN EUROPE 2022; 4:e7739. [DOI: 10.32872/cpe.7739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 08/14/2022] [Indexed: 12/24/2022] Open
Abstract
Background
The present study investigated differences in symptom perceptions between individuals with functional disorders (FD), major health conditions, and FDs + major health conditions, respectively, and a group of healthy individuals. Furthermore, it investigated the relevance of FDs among other health-related and psychological correlates of symptom perceptions in the framework of the Common Sense Model of Self-Regulation (CMS).
Method
This cross-sectional study used epidemiological data from the Danish Study of Functional Disorders part two (N = 7,459 participants, 54% female, 51.99 ± 13.4 years). Symptom perceptions were assessed using the Brief Illness Perception Questionnaire (B-IPQ) and compared between the four health condition groups. Multiple regression analyses were performed to examine associations between symptom perceptions, FDs, and other health-related and psychological correlates from the CMS framework.
Results
Individuals with FDs (n = 976) and those with FDs + major health conditions (n = 162) reported less favorable symptom perceptions compared to the other two groups, particularly regarding perceived consequences, timeline, and emotional representations (effect size range Cohen’s d = 0.12-0.66). The presence of a FD was significantly associated with all B-IPQ items, even in the context of 16 other relevant health-related and psychological correlates from the CMS framework, whereas symptom presence last year or last week was not.
Conclusion
In the general population, symptom perceptions seem to play a more salient role in FD than in individuals with well-defined physical illness. Symptom perceptions should therefore be targeted in both primary and secondary interventions for FDs.
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Zhao YE, He XF, Zhu XQ. Progress in research of level of psychological resilience and its influencing factors in patients with inflammatory bowel disease. Shijie Huaren Xiaohua Zazhi 2022; 30:823-828. [DOI: 10.11569/wcjd.v30.i18.823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Patients with inflammatory bowel disease (IBD) are often accompanied by varying degrees of anxiety or depression. These negative emotions may increase the frequency and severity of IBD attacks and form a vicious cycle. Psychological resilience is a kind of ability that reflects an individual's ability to maintain a good state in the face of suffering and crisis. A higher level of psychological resilience is helpful for IBD patients to improve their psychological state, and actively adapt to and treat the disease. This article reviews the level of psychological resilience and its influencing factors in IBD patients.
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Affiliation(s)
- Yu-E Zhao
- Nursing Department of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Xi-Fei He
- Nursing Department of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Xiu-Qin Zhu
- Nursing Department of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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Hamama-Raz Y, Nativ S, Hamama L. Post-traumatic Growth in Inflammatory Bowel Disease Patients: The Role of Illness Cognitions and Physical Quality of Life. J Crohns Colitis 2021; 15:1060-1067. [PMID: 33252614 DOI: 10.1093/ecco-jcc/jjaa247] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS The symptoms and complications associated with inflammatory bowel disease [IBD] have been found to be associated significantly with impaired health-related quality of life. Nevertheless, there may also be a positive psychological change such as post-traumatic growth, as was noted among patients with other chronic diseases, but this remains understudied in patients with IBD. In this study, we explored associations between post-traumatic growth and illness cognitions (helplessness, acceptance and perceived benefits). In addition, we evaluated whether physical quality of life in IBD patients mediates the link between illness cognitions and post-traumatic growth. METHODS The study employed a cross-sectional design. Two hundred patients diagnosed with IBD completed questionnaires assessing illness cognitions, physical quality of life and post-traumatic growth. RESULTS There was a negative association between illness cognition of helplessness and post-traumatic growth, and positive associations between illness cognitions of acceptance and illness cognitions of perceived benefits, and post-traumatic growth. In addition, the association between an illness cognition of helplessness and post-traumatic growth was mediated via physical quality of life. Yet, the signs of the direct and the indirect paths of an illness cognition of helplessness on post-traumatic growth were opposite. CONCLUSIONS This study extends the literature on the role of illness cognitions as an important component in facilitating the process of post-traumatic growth among IBD patients. Based on the findings, the management of IBD patients should incorporate more interventions aimed at exploring cognitive aspects of the illness in order to improve physical quality of life and enhance personal growth.
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Affiliation(s)
| | - Shlomit Nativ
- School of Social Work, Ariel University, Ariel, Israel
| | - Liat Hamama
- Bob Shapell School of Social Work, Tel Aviv University, Israel
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Touma N, Varay C, Baeza-Velasco C. Determinants of quality of life and psychosocial adjustment to pediatric inflammatory bowel disease: A systematic review focused on Crohn's disease. J Psychosom Res 2021; 142:110354. [PMID: 33465493 DOI: 10.1016/j.jpsychores.2020.110354] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/18/2020] [Accepted: 12/30/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Crohn's disease is a chronic and unpredictable inflammatory bowel disease that leads to important psychosocial difficulties especially during sensitive developmental stages such as childhood and adolescence. While risk factors for mood disorders have been identified in the literature, those for quality of life and psychosocial functioning have not. OBJECTIVE This systematic review explored the determinants of quality of life and psychosocial adjustment to pediatric Crohn's disease. METHOD Four international databases were consulted in March 2020: PubMed, PsychInfo, PubPsych and Cochrane Library. A series of keywords were entered in each database to identify the most recent relevant studies. RESULTS One hundred and sixty-eight articles were identified, of which twenty-nine met the inclusion criteria. The majority explored the determinants of quality of life, depression and anxiety, with a few focusing on psychosocial functioning. Consistently with the literature on psychological morbidity, disease activity and parental stress were also strong predictors of quality of life and psychosocial functioning. New evidence showed that abdominal pain, negative illness perceptions and internalizing symptoms were also common predictors of these outcomes. CONCLUSIONS Some risk factors of quality of life, distress and psychosocial functioning are similar, which could indicate that some patients could be at risk of presenting an accumulation of difficulties adjusting to the disease. The identification of these risk factors is fundamental to propose appropriate interventions. Therapeutic education, therapies focused on pain management or on the parent-child relationship can be considered to allow a better adjustment or prevent difficulties.
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Affiliation(s)
- Nathalie Touma
- University of Paris, Laboratory of Psychopathology and Health Process (LPPS), 71 Av Edouard Vaillant, F-92100 Boulogne-Billancourt, France.
| | - Caroline Varay
- University of Paris, Laboratory of Psychopathology and Health Process (LPPS), 71 Av Edouard Vaillant, F-92100 Boulogne-Billancourt, France
| | - Carolina Baeza-Velasco
- University of Paris, Laboratory of Psychopathology and Health Process (LPPS), 71 Av Edouard Vaillant, F-92100 Boulogne-Billancourt, France; Department of Psychiatric Emergency and Post-Emergency, Montpellier University Hospital Center, 371 Av du Doyen Gaston Giraud, 34090 Montpellier, France
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Eindor- Abarbanel A, Naftali T, Ruhimovich N, Bar-Gil Shitrit A, Sklerovsky-Benjaminov F, Konikoff F, Matalon S, Shirin H, Milgrom Y, Ziv-Baran T, Broide E. Important relation between self-efficacy, sense of coherence, illness perceptions, depression and anxiety in patients with inflammatory bowel disease. Frontline Gastroenterol 2020; 12:601-607. [PMID: 34917318 PMCID: PMC8640387 DOI: 10.1136/flgastro-2020-101412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 06/03/2020] [Accepted: 07/19/2020] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Anxiety and depression are common disturbances in patients with inflammatory bowel diseases (IBD), and were found to impact the disease course. Illness perceptions (IPs), self-efficacy (SE) and sense of coherence (SOC) are important psychological functions, used by the individual to cope with his chronic disease. AIMS to investigate the association of IP, SE and SOC on anxiety and depression among patients with IBD. PATIENTS AND METHODS Patients filled questionnaires including: demographic, socioeconomic and clinical features. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale. IP, SE and SOC were assessed using the Brief Illness perception Questionnaire, IBD-SE and SOC scales. RESULTS The study sample consisted of 299 patients with IBD, median age 34.15, 63% females, 70.9% had Crohn's disease, filled the questionnaires. In the multivariate analysis, lower results in IP, SE and SOC were found to be associated with significantly increase anxiety (OR 8.35, p<0.001; OR 4.18, p=0.001; OR 4.67, p<0.001, respectively) and depression (OR 15.8, p=0.001; OR 10.99, p=0.029; OR 6.12, p=0.014. CONCLUSIONS Anxiety and depression are associated with IP, SE and SOC in patients with IBD. Clinicians should be aware of this impact, recognise their patients' psychological abilities to cope with the disease and improve those abilities, when needed, in order to achieve a better coping with the disease and to prevent the development of anxiety and depression.
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Affiliation(s)
- Adi Eindor- Abarbanel
- The Kamila Gonczarowski Institute of Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center affiliated to Sackler School of Medicine Tel Aviv University, Zriffin, Israel
| | - Timna Naftali
- Department of Gastroenterology and Hepatology, Meir Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Kfar Saba, Israel
| | - Nahum Ruhimovich
- Department of Gastroenterology and Hepatology, Meir Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Kfar Saba, Israel
| | | | - Fabiana Sklerovsky-Benjaminov
- Department of Gastroenterology and Hepatology, Meir Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Kfar Saba, Israel
| | - Fred Konikoff
- Department of Gastroenterology and Hepatology, Meir Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Kfar Saba, Israel
| | - Shay Matalon
- The Kamila Gonczarowski Institute of Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center affiliated to Sackler School of Medicine Tel Aviv University, Zriffin, Israel
| | - Haim Shirin
- The Kamila Gonczarowski Institute of Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center affiliated to Sackler School of Medicine Tel Aviv University, Zriffin, Israel
| | - Yael Milgrom
- Digestive diseases institute, Shaare Zedek Medical Center, Jerusalem, Jerusalem, Israel
| | - Tomer Ziv-Baran
- Department of Epidemiology and Preventive Medicine, School of Public, Tel Aviv, Israel
| | - Efrat Broide
- The Kamila Gonczarowski Institute of Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center affiliated to Sackler School of Medicine Tel Aviv University, Zriffin, Israel
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Polak EJ, O'Callaghan F, Oaten M. Perceptions of IBD within patient and community samples: a systematic review. Psychol Health 2019; 35:425-448. [PMID: 31538517 DOI: 10.1080/08870446.2019.1662014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective: Inflammatory bowel disease (IBD) is a chronic, gastrointestinal condition that involves a range of debilitating bowel symptoms. Adjustment to living with IBD can be negatively impacted by maladaptive cognitive and behavioural factors (e.g. negative illness representations and repressing emotions). Patient samples also report negative reactions from the general public and such perceptions can further negatively impact people living with IBD. Therefore, we aimed to systematically review literature investigating the illness perceptions, perceived stigmatisation, and negative emotional reactions toward IBD within patient and community samples. We also aimed to review how these factors impact those living with IBD (i.e. adjustment, psychological health). Design: A range of databases (e.g. Psych INFO, PubMed) were searched over two years. One reviewer individually screened titles and abstracts using the specified inclusion criteria, and this process was repeated by a second reviewer. Subsequently, the full text articles were screened and data were extracted for the 82 articles that satisfied the inclusion criteria. Following data extraction, a narrative synthesis was conducted.Results: The review of 82 studies suggested that negative illness perceptions are linked to poorer psychosocial outcomes, that patient samples frequently anticipate stigmatisation, fear relating to bowel accidents was the most common emotion reported, and that the general public direct little enacted stigma towards IBD.Conclusion: For people living with IBD: (i) poorer psychological adjustment was reported by those who held more negative perceptions and reactions toward their illness; and (ii) their concerns regarding public perceptions of IBD warrants further empirical attention. Results emphasise the importance of targeting perceptions, and facilitating education and adaptive responding during treatment.
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Affiliation(s)
- Elia-Jade Polak
- School of Applied Psychology, Griffith University, Gold Coast, QLD, Australia
| | - Frances O'Callaghan
- School of Applied Psychology, Griffith University, Gold Coast, QLD, Australia
| | - Megan Oaten
- School of Applied Psychology, Griffith University, Gold Coast, QLD, Australia
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Pittet VEH, Maillard MH, Simonson T, Fournier N, Rogler G, Michetti P. Differences in Outcomes Reported by Patients With Inflammatory Bowel Diseases vs Their Health Care Professionals. Clin Gastroenterol Hepatol 2019; 17:2050-2059.e1. [PMID: 30471455 DOI: 10.1016/j.cgh.2018.11.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 10/04/2018] [Accepted: 11/13/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Inflammatory bowel disease (IBD) scoring systems combine patient-reported data with physicians' observations to determine patient outcomes, but these systems are believed to have limitations. We used real-world data from a large IBD cohort in Switzerland to compare results between patients and healthcare professionals from scoring systems for Crohn's disease (CD) and ulcerative colitis (UC). METHODS We collected data from the Swiss IBD cohort, beginning in 2006, using 2453 reports for 1385 patients (52% female, 58% with CD). During office visits, physicians asked patients about signs and symptoms and recorded their answers (health care professional-reported outcomes). On a later date, patients received a questionnaire at home (independently of the medical visit), complete it, and sent it back to the data center. Patients also completed the short form 36 and IBD quality of life (QoL) questionnaires. We calculated Cohen's kappa (κ) statistics to assess the level of agreement in scores between patients and health care professionals (Δt between reports collected less than 2 months apart). We used Spearman correlation coefficients (ρ) to compare general well-being (GWB) and QoL scores determined by patients vs health care professionals. Our primary aim was to investigate the overall and individual level of agreement on signs and symptoms reported by health care professionals vs patients. RESULTS The best level of agreement (although moderate) was observed for number of stools last week in patients with CD (κ = 0.47), and nocturnal diarrhea in patients with UC (κ = 0.52). Agreement was low on level of abdominal pain (κ = 0.31 for patients with CD and κ = 0.37 for patients with UC) and GWB (κ = 0.23 for patients with CD and κ = 0.26 for patients with UC). Patients reported less severe abdominal pain and worse GWB (CD) or better GWB (UC) than that determined by health care professionals. Patient self-rated GWB correlated with IBD quality of life (ρ = 0.68 for patients with CD and ρ = 0.70 for patients with UC) and SF-36 physical scores (ρ = 0.55 for patients with CD and ρ = 0.60 for patients with UC); there was no correlation between health care professional-rated GWB and QoL. CONCLUSIONS In a comparison of patient vs health care provider-reported outcomes in a Swiss IBD cohort, we found that health care professionals seem to misinterpret patients' complaints. Patients self-rated GWB correlated with QoL scores, indicating that reporting GWB in a single question is possible and relevant, but can vary based on how the data are collected.
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Affiliation(s)
- Valérie E H Pittet
- Institute of Social & Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland.
| | - Michel H Maillard
- Division of Gastroenterology & Hepatology, Lausanne University Hospital, Lausanne, Switzerland; Crohn and Colitis Center, Gastroentérologie Beaulieu SA, Lausanne, Switzerland
| | - Thomas Simonson
- Institute of Social & Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Nicolas Fournier
- Institute of Social & Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Gerhard Rogler
- Department of Gastroenterology & Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Pierre Michetti
- Division of Gastroenterology & Hepatology, Lausanne University Hospital, Lausanne, Switzerland; Crohn and Colitis Center, Gastroentérologie Beaulieu SA, Lausanne, Switzerland
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Nyuyki KD, Cluny NL, Swain MG, Sharkey KA, Pittman QJ. Altered Brain Excitability and Increased Anxiety in Mice With Experimental Colitis: Consideration of Hyperalgesia and Sex Differences. Front Behav Neurosci 2018; 12:58. [PMID: 29670513 PMCID: PMC5893896 DOI: 10.3389/fnbeh.2018.00058] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/13/2018] [Indexed: 12/28/2022] Open
Abstract
Crohn’s disease (CD) and ulcerative colitis (UC) are incurable lifelong inflammatory bowel diseases (IBD) with a rising worldwide incidence. IBD is characterized by diarrhea, rectal bleeding, severe cramping and weight loss. However, there is a growing evidence that IBD is also associated with anxiety- and depression-related disorders, which further increase the societal burden of these diseases. Given the limited knowledge of central nervous system (CNS) changes in IBD, we investigated CNS-related comorbidities in a mouse model of experimental colitis induced by dextran sulfate sodium (DSS) administration in drinking water for 5 days. In male and female C57BL6J mice, DSS treatment caused increased brain excitability, revealed by a decrease in seizure onset times after intraperitoneal administration of kainic acid. Moreover, both sexes showed increased anxiety-related behavior in the elevated plus-maze (EPM) and open field (OF) paradigms. We assessed somatic pain levels, because they may influence behavioral responses. Only male mice were hyperalgesic when tested with calibrated von Frey hairs and on the hotplate for mechanical and thermal pain sensitivity respectively. Administration of diazepam (DZP; ip, 1 mg/kg) 30 min before EPM rescued the anxious phenotype and improved locomotion, even though it significantly increased thermal sensitivity in both sexes. This indicates that the altered behavioral response is unlikely attributable to an interference with movement due to somatic pain in females. We show that experimental colitis increases CNS excitability in response to administration of kainic acid, and increases anxiety-related behavior as revealed using the EPM and OF tests.
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Affiliation(s)
- Kewir D Nyuyki
- Hotchkiss Brain Institute, Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nina L Cluny
- Hotchkiss Brain Institute, Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mark G Swain
- Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Calgary Liver Unit, Division of Gastroenterology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Keith A Sharkey
- Hotchkiss Brain Institute, Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Quentin J Pittman
- Hotchkiss Brain Institute, Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Zhang M, Zhang T, Hong L, Zhang C, Zhou J, Fan R, Wang L, Wang Z, Xu B, Zhong J. Improvement of psychological status after infliximab treatment in patients with newly diagnosed Crohn's disease. Patient Prefer Adherence 2018; 12:879-885. [PMID: 29872273 PMCID: PMC5973631 DOI: 10.2147/ppa.s156883] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Patients with newly diagnosed Crohn's disease (CD) are associated with impaired physical and psychological well-being. These psychological characteristics are dynamic with the course of disease and could be influenced by medical treatment. Infliximab is effective and widely used in moderate-to-severe CD patients. The aim of this study was to evaluate the improvement of psychological status after infliximab treatment in patients with newly diagnosed CD. METHODS Newly diagnosed moderate-to-severe CD patients were prospectively enrolled in our study. Infliximab 5 mg/kg was administered at weeks 0, 2, 6, 14, 22, and 30. Outcomes including disease severity, illness perceptions, coping strategies, anxiety, depression, and quality of life (QoL) were measured at baseline, week 14, and week 30. RESULTS Eighty-two patients completed our study. The rates of clinical remission at weeks 14 and 30 were 59/82 (72.0%) and 58/82 (70.7%), respectively. Patients who achieved clinical remission at weeks 14 and 30 significantly improved in illness perceptions (P<0.001 and <0.001), maladaptive coping (P=0.005 and 0.004), anxiety (P<0.001 and <0.001), depression (P=0.004 and 0.004), and QoL (P<0.001 and <0.001). However, emotion-focused coping and problem-focused coping remained unchanged. For infliximab nonresponders, no significant changes were seen in illness perceptions, coping strategies, anxiety, depression, or QoL at week 14 or 30. CONCLUSION Effective infliximab treatment not only led to clinical remission in patients with newly diagnosed moderate-to-severe CD but also improved their psychological status including illness perceptions, maladaptive coping, anxiety, depression, and QoL.
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Affiliation(s)
- Maochen Zhang
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Tianyu Zhang
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Liwen Hong
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Chen Zhang
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Jie Zhou
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Rong Fan
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Lei Wang
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Zhengting Wang
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Bin Xu
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Correspondence: Jie Zhong; Bin Xu, Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No 197, Ruijiner Road, Shanghai 200025, People’s Republic of China, Tel +86 21 6437 0045 (ext 600907), Email ;
| | - Jie Zhong
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Correspondence: Jie Zhong; Bin Xu, Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No 197, Ruijiner Road, Shanghai 200025, People’s Republic of China, Tel +86 21 6437 0045 (ext 600907), Email ;
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