Psychological treatment may reduce the need for healthcare in patients with Crohnʼs disease

Deter, Hans‐Christian; Keller, Wolfram; Wietersheim, Jörn von; Jantschek, G.; Duchmann, Rainer; Zeitz, Martin

doi:10.1002/ibd.20068

Cited by 127 publications

(32 citation statements)

References 40 publications

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“…However, in a follow-up study of this cohort, they found in multivariate analysis that steroid intake and depression predicted worse disease outcomes. In the high utilizers of health care, a signifi cant drop in healthcare utilization was noted in those treated vs. not for their depression ( 118 ).…”

Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Farraye

Melmed

Lichtenstein

et al. 2017

American Journal of Gastroenterology

391

421

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Recent data suggest that infl ammatory bowel disease (IBD) patients do not receive preventive services at the same rate as general medical patients. Patients with IBD often consider their gastroenterologist to be the primary provider of care. To improve the care delivered to IBD patients, health maintenance issues need to be co-managed by both the gastroenterologist and primary care team. Gastroenterologists need to explicitly inform the primary care provider of the unique needs of the IBD patient, especially those on immunomodulators and biologics or being considered for such therapy. In particular, documentation of up to date vaccinations are crucial as IBD patients are often treated with long-term immune-suppressive therapies and may be at increased risk for infections, many of which are preventable with vaccinations. Health maintenance issues addressed in this guideline include identifi cation, safety and appropriate timing of vaccinations, screening for osteoporosis, cervical cancer, melanoma and non-melanoma skin cancer as well as identifi cation of depression and anxiety and smoking cessation. To accomplish these health maintenance goals, coordination between the primary care provider, gastroenterology team and other specialists is necessary. of evidence, we entered data from the papers of highest evidence into the GRADE program (accessible at http://www.gradepro.org ). Th e recommendation statements from this guideline are shown in Table 1 . Summary statements, when listed, are designed to be descriptive in nature without associated evidence-based ratings. VACCINATIONSRecent data suggest that IBD patients do not receive preventive services at the same rate as general medical patients ( 2 ). Members of the gastroenterology team are oft en the only clinicians that a patient with IBD will see. As such, it is incumbent upon gastroenterologists to take a proactive role in the health care needs of their IBD patients ( 3-5 ). It is crucial to clarify with the patient the limits of the specialist's responsibilities and delegate routine health care issues to the primary care clinician. It is equally important to educate the primary care clinician to the unique health maintenance needs of the IBD patient, especially those on immunomodulators and biologic agents. Although it appears that both primary care clinicians and gastroenterologists are hesitant to take ownership of vaccinations ( 6-8 ), it is reasonable ( 9 ) that vaccination recommendations be the responsibility of the treating gastroenterologist, but the actual delivery/administration of these vaccines may be a shared responsibility ( 10-13 ). Communicating specifi c recommendations to the primary care team in a concise fashion are needed. Consider empowering the patient by giving written recommendations to bring to their primary care physician. Clinicians sharing an electronic medical record should use this platform to send recommendations to the referring clinician.Patients with IBD are oft en treated with long-term immunesuppressive therapies and may t...

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Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Farraye

Melmed

Lichtenstein

et al. 2017

American Journal of Gastroenterology

391

421

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“…[44,58]. Many of the above studies have found long lasting effects from brief therapeutic interventions which may contribute to reduced health care utilization and costs and decreased productivity loss in managing IBD, for example reduction of outpatient attendances, sick-leave and hospital days [6,20,31,47,51,55,58]. Yet, some have found only a short term benefit with a diminished positive effect of therapy over time [57,60].…”

Section: Discussionmentioning

confidence: 99%

“…Forty CD patients who underwent 20 hours of psychodynamic psychotherapy without the use of a manual, and 10 relaxation treatment sessions over a 1 year period, showed a significant higher decrease in hospital and sick-leave days compared to 24 controls [51]. No significant effects on psychological indices were found, but the treatment group reported few psychological symptoms at baseline; patients who wanted psychological treatment or who had psychiatric co morbidity were excluded.…”

Section: Psychodynamic Therapymentioning

confidence: 95%

"Role of Psychosocial Factors on the Course of Inflammatory Bowel Disease and Associated Psychotherapeutic Approaches. A Fresh Perspective and Review"

Banan¹

2015

GHOA

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In this review article we seek to provide a fresh prospective on the role of psychosocial factors such as stress, anxiety, and depression, in the course of Inflammatory Bowel Diseases (IBD). IBD patients suffer from depression and anxiety at higher rates than the general population. Psychological stressors adversely affect the course of IBD through activation and possible dysfunction of the Brain-Gut-Axis. The mechanisms by which psychological factors increase mucosal inflammation, disrupt the intestinal barrier, and thereby worsen IBD symptoms are not well understood. This is a new and upcoming area of research that needs more attention because of its importance in managing and treating patients with IBD while also reducing costs associated with these disorders. Therefore, in this article we also seek to explore treatment options that target these psychological factors. Interventions include both pharmacological and nonpharmacological psychotherapeutic approaches. Whereas some of these therapies improve IBD symptoms, many also improve depression, anxiety, stress symptoms, fatigue, relapse rate, and Quality of Life (QOL) in both adults and children with IBD. These psychological factors are important determinants of health related quality of life (HRQOL) and therefore are important symptoms to treat alongside the IBD symptoms.

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“…Thus, our results, in conjunction with prior studies in the literature, suggest a potential need for routine screening for psychiatric co-morbidity in IBD patients. In addition, there is continued need for research on interventions addressing depression and anxiety in IBD patients as the literature so far has been limited and conflicting 22,48,49 . Such interventions may improve mood and health-related quality of life as well as natural history of disease and IBD-related healthcare costs.…”

Section: Discussionmentioning

confidence: 99%