Journal Article Annotations
2021, 4th Quarter
Annotations by Ashwini Nadkarni, MD
Patients with Crohn’s disease (CD) had a higher Sensory Sensitivity compared to UC patients. (High Sensory Sensitivity means having a low threshold for different stimuli, including sensitivity to subtle sounds, smells, and signs of the recurrence of the active phase of the disease). For patients with CD, only the severity of depressive symptoms predicted activity of the disease.
Strength and weaknesses:
The sample was small, non-random, and originated from a single center. In addition, there was a difference in mean age between the UC and CD groups. These factors diminish generalizability of the findings. A study with a prospective, multi-center design with a larger number of IBD patients would offer greater value in determining the predictive role of temperament and chronotype in disease activity.
This study explored the differences between patients with UC and CD regarding chronotype (personal disposition toward a certain circadian pattern of functioning), temperament and depression, and determined the role of such psychological factors as predictors of disease activity. This is one of the first studies investigating temperament among adult patients with IBDs. A notable finding of the study was that the severity of depressive symptoms predicted activity of disease for Crohn’s patients. Thus, the study’s findings validate the importance of C-L psychiatrists aggressively treating depression as a means to improve IBD outcomes.
This study assessed the impact of Covid-19 on a variety of indicators for illness including those related to self-care and stress management for IBD patients. The results indicate that for patients with pre-existing depression and anxiety, IBD symptoms, disease management patterns, stress levels and sleep patterns worsened.
Strengths and weaknesses
Generalizability is a concern in this study since it was limited to English-speaking patients seen at tertiary-care centers. Additionally, there was limited variation in participant racial and ethnic identity. Survey research methodologies also have inherent nonresponses, recency, and recall bias. Strengths were a large sample size and a questionnaire designed through collaboration between gastroenterology and psychology experts.
Covid-19 has uniquely impacted patient with co-morbid psychiatric disorders and IBD. These patients are likely to require increased psychiatric outreach and follow up.
Integrated care programs which incorporate resilience training demonstrate reductions in unplanned hospitalizations, opioid use, and corticosteroid use for their patients. Such programs incorporate a multi-disciplinary team of gastroenterology, nursing, behavioural health, and nutritional specialists and reinforce positive health psychology with care personalized on therapeutic targets of disease acceptance, optimism/hope and future orientation, self-confidence, social support, and self-regulatory skills.
Strength and weaknesses:
The study did not randomize participants or make a comparison to non-randomized controls; thus, the study did not necessarily prove that such a model of care is in fact superior to usual care. Additionally, generalizability was limited given patients were from a large, urban academic center with biases toward lower resilience and higher health care usage. Finally, the study took place before the beginning of the pandemic.
When IBD patients with high hospitalization utilization and more frequent usage of opioids are evaluated by C-L psychiatrists, resiliency programs such as the one referenced in this article serve as a model for optimal care both in the inpatient setting as well as for longitudinal, ambulatory care planning.