Psychosocial issues

Limited data is available regarding psychosocial issues

ECCO Statement 12A (2010)

Psychological disturbances seem to be a consequence of the illness rather than the cause or specific to Crohn's disease. The degree of psychological distress correlates with the disease severity and predicts health related quality of life. Its influence upon the course of disease remains controversial [EL1b, 2b and 3b, RG B].

It is uncertain whether psychosocial issues predispose a patient to disease onset

ECCO Statement 12B (2010)

An association between psychological factors and the aetiology of Crohn's disease is unproven [EL3b, 4, RG D] and the role of psychological factors on the disease course is controversial [EL1b, 2b, RG B].

Psychosocial issues possibly effect course of Crohn's Disease

Studies suggest depression and anxiety predispose to adverse course of Crohn’s Disease.

ECCO Statement 12B (2010)

An association between psychological factors and the aetiology of Crohn's disease is unproven [EL3b, 4, RG D] and the role of psychological factors on the disease course is controversial [EL1b, 2b, RG B].

ECCO Statement 12C (2010)

It remains unclear whether acute life events trigger relapses [EL1b,2b, RG B] Most patients consider stress to have an influence on their illness [EL2c,3, RG C].

Data is available from the following studies:

Doctor / patient relationship is important

  • A good doctor–patient relationship is helpful psychologically and should take psychosocial factors into account in diagnosis and therapy.
  • The IBDQ and the RFIPC are questionnaires that can detect psychological distress.
  • Refer patients for psychological support if indicated, and provide contact details for patient associations.

ECCO Statement 12D (2010)

The psychosocial consequences and health-related quality of life of patients should be taken into account in clinical practice at regular visits. Individual information and explanation about the disease should be provided through a personal interview. The course of the disease can be improved by combining self-management and patient-centred consultations [EL1b,3b, RG B].

ECCO Statement 12E (2010)

Physicians should assess the patient's psychosocial status and demand for additional psychological care and recommend psychotherapy if indicated. Integrated psychosomatic care should be provided in IBD centres [EL2b, RG B].

ECCO Statement 12F (2010)

Patients should be informed of the existence of patient associations [EL 5, RG D].

ECCO Statement 12G (2010)

Psychotherapeutic interventions are indicated for psychological disorders, such as depression, anxiety, reduced quality of life with psychological distress, as well as maladaptive coping with the illness [EL1b,2b,3b, RG B].

ECCO Statement 12H (2010)

The choice of psychotherapeutic method depends on the psychological disturbance and should best be made by specialists (Psychotherapist, Specialist for Psychosomatic Medicine, Psychiatrist). Psycho-pharmaceuticals should be prescribed for defined indications [EL5, RG D].

 

Psychosocial considerations in ulcerative colitis

  • Psychological factors do not appear to effect the onset of UC, but may impact the course of UC.
  • Active but not inactive UC (similar to other chronic somatic disease) predisposes to psychological distress.
  • The psychosocial aspects of disease should be discussed with patients and psychological support provided if needed. This is required in up to 1/3 of patients, particularly in the young, those with anxiety or little social support. Consider the Rating Form of IBD Patient Concerns (RFIPC).
  • Some patients benefit from psychotherapeutic interventions
ECCO Statement 10A (UC 2012)

There is no conclusive evidence for anxiety, depression and psychosocial stress contributing to risk for UC onset [EL2c, RG D]

ECCO Statement 10B (UC 2012)

Psychological factors may have an impact on the course of UC. Perceived psychological stress [EL2a, RG B] and depression [EL2a, RG B] are risk factors for relapse of the disease. Depression is associated with low health-related quality of life [EL3a, RG B]. Anxiety is associated with non adherence with treatment [EL4, RG C]

ECCO Statement 10C (UC 2012)

Psychological distress and mental disorder are more common in patients with active ulcerative colitis than in population-based controls, but not in patients in remission [EL3a, RG B]

ECCO Statement 10D (UC 2012)

Clinicians should particularly assess depression among their patients with active disease and those with abdominal pain in remission [EL 2b, RG B]

ECCO Statement 10E (UC 2012)

The psychosocial consequences and health-related quality of life of patients should be taken into account in clinical practice at regular visits. Individual information and explanation about the disease should be provided through a personal interview [EL3b, RG B]. Patients' disease control can be improved by combining self-management and patient-centred consultations [EL1b, RG B]

ECCO Statement 10F (UC 2012)

Physicians should screen patients for anxiety, depression and need for additional psychological care and recommend psychotherapy if indicated [EL 2b, RG B]. Patients should be informed of the existence of patient associations [EL 5, RG D]

ECCO Statement 10G (UC 2012)

Psychotherapeutic interventions are indicated for psychological disorders and low quality of life associated with ulcerative colitis [EL 1b, RG B]

ECCO Statement 10H (UC 2012)

The choice of psychotherapeutic method depends on the psychological disturbance and should best be made by specialists (Psychotherapist, Specialist for Psychosomatic Medicine, Psychiatrist). Psychopharmaceuticals should be prescribed for defined indications [EL 5, RG D]

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