Journal Article Annotations
2023, 3rd Quarter
Annotations by Ashwini Nadkarni, MD
This research team performed a meta-analysis of recently published randomized control trials to analyze the clinical outcomes of CBT treatment in IBD patients. Changes in IBDQ score, treatment duration, follow-up duration, and type of CBT treatment were considered as the primary indicators for assessing QoL in IBD patients. They found 9 eligible RCTS and found that CBT alleviates anxiety and depression in patients with IBD and improves quality of life.
Strength and weaknesses:
This study validates the importance of utilizing CBT to address mood disorders in IBD. However, this particular meta-analysis only took into account 9 studies; RCTs with larger sample sizes and use of more QoL indicators need to be completed to provide sufficient empirical support for CBT as a standard of care treatment for patients with IBD and co-morbid mood disorder.
In this cross-sectional survey, the researcher investigated the association between fatigue and medical and psychiatric symptoms (e.g. anemia, pain, depression, anxiety and quality of life). The prevalence of fatigue in this cohort was 64%. Multivariable analyses revealed fatigue to be correlated with depression, female sex, and younger age but not disease activity, anemia, or pain.
Strength and weaknesses:
The strengths of the study include its broad assessment of possible factors influencing fatigue through a range validated questionnaires as well as clinical and para-clinical data in almost 200 patients with IBD. Limitations included generalizability of the findings to the entire IBD population, given that patients were from an outpatient tertiary care medical center. Also, laboratory values were recorded not numerically but only nominally (increased or not increased). Because laboratory values were recorded up to 4 weeks before or after completion of the questionnaires, therapeutic interventions or flares might have occurred during the period between sample collection and assessment of fatigue. Moreover, most surveyed patients were in remission (52%) or had only mild symptoms (26%). Another key limitation is that the instrument used to assess fatigue, the FAS, is reliable in assessing fatigue but is unidimensional, preventing these findings from being compared to multidimensional fatigue scores from previous IBD studies.
Fatigue is a challenging symptom to treat in patients with IBD and significantly affects quality of life. This study offers C-L psychiatrists emerging data on the need to consider diagnosing and treating depression when they evaluate patients with IBD and impairing fatigue.