Association between psychological measures with inflammatory anddisease-related markers of inflammatory bowel disease

Abautret-Daly, Áine; Dempsey, Elaine; Riestra, Sabino; Francisco-García, Ruth de; Parra‐Blanco, Adolfo; Rodrigo, Luı́s; Medina, Carlos; Connor, Thomas J.; Harkin, Andrew

doi:10.1080/13651501.2017.1306081

Cited by 29 publications

(32 citation statements)

References 44 publications

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“…The Canadian IBD cohort study suggested that patients had higher lifetime prevalence rates of generalized anxiety disorder (GAD) and major depressive disorder (MDD) than the general population at 13.4% and 27.2% [ 20 ]. This is consistent with similar results which were found in studies initiated in the USA [ 7 ], China [ 21 ], Italy [ 22 ], Ireland [ 23 ], and South Korea [ 24 ]. A systematic review that combined multiple clinical studies showed that IBD had 19.2% and 21.2% anxiety and 21.2% depression, almost twice the rate of the general population, and 66.4% anxious mood and 34.7% depression in IBD patients who were also active.…”

Section: Ibd and Depressionsupporting

confidence: 93%

Tryptophan-kynurenine metabolism: a link between the gut and brain for depression in inflammatory bowel disease

Chen

Bao

et al. 2021

J Neuroinflammation

109

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Inflammatory bowel disease (IBD), which mainly includes ulcerative colitis (UC) and Crohn's disease (CD), is a group of chronic bowel diseases that are characterized by abdominal pain, diarrhea, and bloody stools. IBD is strongly associated with depression, and its patients have a higher incidence of depression than the general population. Depression also adversely affects the quality of life and disease prognosis of patients with IBD. The tryptophan-kynurenine metabolic pathway degrades more than 90% of tryptophan (TRP) throughout the body, with indoleamine 2,3-dioxygenase (IDO), the key metabolic enzyme, being activated in the inflammatory environment. A series of metabolites of the pathway are neurologically active, among which kynerunic acid (KYNA) and quinolinic acid (QUIN) are molecules of great interest in recent studies on the mechanisms of inflammation-induced depression. In this review, the relationship between depression in IBD and the tryptophan-kynurenine metabolic pathway is overviewed in the light of recent publications.

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Section: Ibd and Depressionsupporting

confidence: 93%

Tryptophan-kynurenine metabolism: a link between the gut and brain for depression in inflammatory bowel disease

Chen

Bao

et al. 2021

J Neuroinflammation

109

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“…However, the evidence specifically testing inflammation as a correlate of depressive symptoms in patients with IBD is very limited. In a cross‐sectional study of 11 IBD patients and nine controls, symptomatic IBD patients had the highest depressive and anxiety scores, as well as increased intestinal expression of IL‐6 and IL‐1β and serum IL‐6 . Prospective studies testing the directionality of inflammation and depressive symptoms in IBD are awaited.…”

Section: Inflammation As a Link Between Depression And Ibdmentioning

confidence: 99%

“…Stepped care treatment model according to NICE guidelines [5] Criteria Mild or subthreshold depression For at least 2 weeks (or less if symptoms are severe and of rapid onset), the following 2 core symptoms present Group physical activity programme, group-based peer support or to low-intensity psychologi- of depressive symptoms in patients with IBD is very limited. In a cross-sectional study of 11 IBD patients and nine controls, symptomatic IBD patients had the highest depressive and anxiety scores, as well as increased intestinal expression of IL-6 and IL-1β and serum IL-6 [42]. Prospective studies testing the directionality of inflammation and depressive symptoms in IBD are awaited.…”

Section: Classification Of Diseases 10th Edition (Icd-10)mentioning

confidence: 99%

Depressive symptoms in inflammatory bowel disease: an extraintestinal manifestation of inflammation?

Moulton

Pavlidis

Norton

et al. 2019

Clinical and Experimental Immunology

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Summary Depressive symptoms are reported by more than 20% of people with inflammatory bowel disease (IBD), while sleep difficulties and fatigue are even more common. Co‐morbid depressive symptoms predict a poor IBD course, including increased risk of relapse and surgery, which is inconsistently improved by psychological treatments. Rather than being distinct systems, there is compelling evidence for bidirectional communication between gut and brain, driven by neural, metabolic, endocrine and inflammatory mediators. An emerging concept is that depressive symptoms may be mechanistically linked to excess inflammation and dysregulation of the gut–brain axis. Given the close link between the intestinal microbiota and host immune responses, patients prone to shifts in their intestinal microbiome, including smokers, those with poor diet and early life stress, may be exposed to exaggerated immune responses. Excess inflammation is associated with brain changes (depressive symptoms, fatigue, sleep difficulties) and worsening gastrointestinal symptoms, which are exacerbated by psychological distress. Equally, treatments both for depressive symptoms and IBD provide opportunities to break this cycle by reducing the causes and effects of inflammation. As well as addressing potential risk factors such as smoking and diet, treatments to alter the microbiome may reduce depressive symptoms. Observational evidence suggests that anti‐inflammatory treatments for IBD may improve co‐morbid depressive symptoms correlating with reduction in inflammation. With a growing range of treatments targeting inflammation centrally, peripherally and in the gut, IBD provides a unique model to understand the interplay between brain and gut in the pathogenesis of depressive symptoms, both in IBD and in the whole population.

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“…The close relation between anxious-depressive symptoms and IBD is presently explained in the emerging theories of “gut-brain axis” dysfunction ( 51 , 52 ). The presence of an alteration of the immune system in pro-inflammatory sense involves an alteration of the micro-anatomy and the gut microbiota ( 53 ), promoting the development of a neuro-inflammation, with a modification of synaptic plasticity and neuronal functioning ( 54 , 55 ). Overall, findings seem to confirm data emerging from a recent meta-analysis showing correlation between depressive symptoms and the negative progression of the disease, particularly in CD patients, who are more likely to suffer from depression compared with UC patients ( 56 ).…”

Section: Discussionmentioning

confidence: 99%

Alexithymia and Psychopathology in Patients Suffering From Inflammatory Bowel Disease: Arising Differences and Correlations to Tailoring Therapeutic Strategies

et al. 2018

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Comorbidity with anxiety or depression is common in patients with Inflammatory Bowel Disease (IBD) as Crohn Disease (CD) and Ulcerative Colitis (UC). Data suggest that the cognitive construct of alexithymia has high prevalence in people suffering from anxiety and mood disorders and even in people with IBD. Most studies have investigated mainly anxiety and depression, considering IBD population as a homogeneous group of patients. Little evidence shows the impact of alexithymia on the course of IBD. We evaluated a broad spectrum of psychopathological symptoms and alexithymia levels in a group of outpatients affected by IBD in clinical remission, comparing CD and UC and investigating the relationship with clinical and socio-demographic variables. One hundred and seventy IBD outpatients were screened by using the Hospital Anxiety Depression Scale (HADS), the Self-report Symptom Inventory-90-Revised (SCL-90-R) and the Toronto Alexithymia Scale (TAS-20). A high prevalence of anxious and depressive symptoms (42.35 and 25.8% respectively) together with alexithymia (31.76%) was confirmed. CD patients experienced high levels of depression (HADS Depression 35.2% p = 0.034; SCL-90-R mean 1.39 p < 0.001), somatisation (SCL-90-R mean 1.04 p < 0.001), obsessive-compulsive symptoms (SCL-90-R mean 1.2 p < 0.001), and global severity (SCL-90-R mean 1.15 p < 0.001). There is no statistical difference in the prevalence of alexithymia in both subpopulations. The levels of alexithymia are correlated to the levels of anxiety (HADS Anxiety rs = 0.516 p < 0.001), depression (HADS Depression rs = 0.556 p < 0.001; SCL-90-R rs = 0.274 p = 0.001), somatisation (SCL-90-R rs = 0.229 p = 0.005), obsessive-compulsive symptoms (SCL-90-R rs = 0.362 p < 0.001), and global severity (SCL-90-R rs = 0.265 p = 0.001). Furthermore, alexithymia is associated with a delay of diagnosis of IBD, poly-therapies and greater IBD extension. Older age, female gender, greater IBD extension, surgery, and delay of diagnosis seem to be related to a high prevalence of psychopathological symptoms such as anxiety, depression, somatisation, and obsessive-compulsive symptoms. Psychopathological symptoms and high levels of alexithymia are frequent in IBD patients and seem to be related to a high risk of poor clinical outcome. CD patients could be considered at higher risk of mental comorbidity. A more comprehensive psychiatric assessment, including alexithymia, and an integrated treatment of underlying conditions, must be taken into account in order to improve the global prognosis of the disease.

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Association between psychological measures with inflammatory anddisease-related markers of inflammatory bowel disease

Cited by 29 publications

References 44 publications

Tryptophan-kynurenine metabolism: a link between the gut and brain for depression in inflammatory bowel disease

Tryptophan-kynurenine metabolism: a link between the gut and brain for depression in inflammatory bowel disease

Depressive symptoms in inflammatory bowel disease: an extraintestinal manifestation of inflammation?

Alexithymia and Psychopathology in Patients Suffering From Inflammatory Bowel Disease: Arising Differences and Correlations to Tailoring Therapeutic Strategies

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