【24drs.com】根據線上發表於1月25日臨床胃腸病學和肝病學期刊的Kaplan-Meier分析,憂鬱和焦慮會使某些患者的發炎性腸道疾病(inflammatory bowel disease,IBD)發作和復發頻率加快。
  英國約克大學健康科學系Antonina Mikocka-Walus博士等人表示,應建議在標準IBD照護納入常見的精神障礙篩檢,並於需要時轉介進行心理/精神科治療。
  因此,研究者進行了一篇前瞻研究,使用Swiss IBD Cohort描繪出這兩個生理情況與IBD之間的暫時性傾向。參與的研究對象,在研究開始前至少4個月診斷有IBD,參與期間為2006-2015年。
  在納入研究時和之後每年進行臨床檢查、使用克隆氏症活性指數(Crohn's Disease Activity Index)和修改版Truelove & Witts嚴重度指數(Modified Truelove and Witts Severity Index)評估IBD,患者們也完成有14個問題的醫院焦慮和憂鬱量表(Hospital Anxiety and Depression Scale),以7分作為焦慮/憂鬱症狀的臨界點。
  在開始時,20.2%研究對象的憂鬱症分數超過臨界點、37.5%研究對象的焦慮症分數超過臨界點;兩性之間的憂鬱盛行率約略相當(男性200人[20.6%]vs女性205人[19.8%];P = .635),但是女性的焦慮症比率較高(女性448人[43.2%]vs男性304人[31.3%];P < .001)。
  在開始時,克隆氏症活性指數分數、焦慮或憂鬱之間並無顯著關聯(分別是P = .221與P = .266),修改版Truelove & Witts嚴重度指數分數和焦慮或憂鬱之間也是(分別是P = .167和P = .288)。
  Kaplan-Meier曲線發現,隨著時間,相較於焦慮和IBD復發之間,憂鬱和IBD臨床復發有較強烈之關聯(所有IBD, P = .000001; CD, P = .0007; UC, P = .005)。雖然在整體樣本中有觀察到焦慮和IBD復發之關聯(P = .0014),只有CD的患者也有(P = .031),但是在UC患者則無(P = .066)。
  焦慮和IBD復發的關聯性比憂鬱弱,研究者推測,憂鬱患者的冷漠情況可能會導致不遵守IBD治療, 而焦慮則可能會更容易發作,例如,當一個人找不到廁所時。
  英國Leeds大學Leeds生物醫學暨臨床科學研究中心Alexander C. Ford醫師與英國聖詹姆斯大學醫院Leeds胃腸研究中心David J. Gracie醫師在線上發表於2月9日臨床胃腸病學和肝病學期刊致編輯者的信中寫道,之前的研究只有使用橫斷面研究設計檢視這個議題,意謂著無法建立因果關係,因此,此次的研究發現既新且重要,為腦部與腸道的相互影響提供支持,而這可能會影響IBD的自然史。
  Native link:Depression and Anxiety Can Shorten Time to IBD Flare

Depression and Anxiety Can Shorten Time to IBD Flare

By Ricki Lewis, PhD
Medscape Medical News

Depression and anxiety can precede and shorten the time to recurrence of inflammatory bowel disease (IBD) in some patients, according to a Kaplan-Meier analysis published online January 25 in Clinical Gastroenterology and Hepatology.

"It thus seems prudent to recommend that screening for common mental disorders and referring for psychological/psychiatric treatment should be included in standard IBD care," Antonina Mikocka-Walus, PhD, from the Department of Health Sciences, University of York, United Kingdom, and colleagues write.

Although IBD has long been associated with depression and anxiety, "the relationship of depression and anxiety with disease activity in IBD has been controversial, with no causal link established to date," the study authors report.

In a recent survey of the literature, Dr Mikocka-Walus and colleagues found that 7 of 12 prospective studies positively associated depression and anxiety with IBD flare-ups, while 5 did not. They attribute the inconsistency between the studies to differences in study designs, such as observation period, sample size and selection, and methods of assessing anxiety, depression, and IBD severity.

The investigators therefore conducted a prospective study using the Swiss IBD Cohort to paint a temporal portrait of the associations between the two psychiatric conditions and IBD. Patients participated between 2006 and 2015 and were diagnosed with IBD at least 4 months before the study began.

Clinical exams to assess IBD at enrollment and annually thereafter used the Crohn's Disease Activity Index and the Modified Truelove and Witts Severity Index. Patients took the 14-question Hospital Anxiety and Depression Scale, with a score of 7 being the cutoff for anxiety/depression symptoms.

Of the 2007 patients included in the study, 56% had Crohn disease (CD), and the remainder had ulcerative colitis (UC) or indeterminate colitis. Median age at baseline was 40.5 years, 48.3% were males, and median disease duration was 7.2 years.

At baseline, 20.2% of the participants exceeded the cutoff for the depression score, and 37.5% had an anxiety score above cutoff. The prevalence of depression was about equal between the sexes (200 [20.6%] males vs 205 [19.8%] females; P = .635), but females were more likely to experience anxiety (448 [43.2%] female vs 304 [31.3%] male; P < .001).

At baseline there was no significant association among Crohn's Disease Activity Index score, anxiety, or depression (P = .221 and P = .266, respectively) or between the Modified Truelove and Witts Severity Index score and anxiety or depression (P = .167 and P = .288, respectively).

However, in participants experiencing depression or anxiety, clinical recurrence of IBD occurred sooner than among participants without depression or anxiety. Sex was not a factor.

The Kaplan-Meier curves revealed a stronger association between depression and clinical recurrence of IBD over time (all IBD, P = .000001; CD, P = .0007; UC, P = .005) than between anxiety and recurrence. Although the association between anxiety and IBD recurrence over time was observable in the whole sample (P = .0014), as well as in only the participants with CD (P = .031), this was not so for participants with UC (P = .066).

Depression and anxiety also tracked with specific manifestations of IBD. Depression alone had a statistically significant association with fistula, surgery, and steroid use in patients with CD and with flares in patients with UC and with CD. Anxiety alone was associated with flares in CD and UC and steroid use in UC. Anxiety and depression were both associated with use of biologics in CD.

The association between anxiety and IBD recurrence was weaker than that for depression. The researchers speculate that apathy in patients with depression may cause noncompliance with IBD treatment, whereas anxiety may be more episodic, such as when a person cannot find a bathroom.

The study authors acknowledge that limitations of the study include self-assessment of anxiety and depression and the length of time between follow-ups.

"Previous studies have only examined this issue using a cross-sectional design, meaning that causality cannot be established, so the findings are therefore novel and important, and provide support for the existence of brain-gut interactions, which may affect the natural history of IBD," write David J. Gracie, MD, from the Leeds Gastroenterology Institute, St. James’s University Hospital, United Kingdom, and Alexander C. Ford, MD, from the Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, United Kingdom, in a letter to the editor published online February 9 in Clinical Gastroenterology and Hepatology.

However, they add that the study by Dr Mikocka-Walus and colleagues could not distinguish a pathological connection between depression and anxiety and IBD flares from an increased likelihood of reporting worsening gastrointestinal symptoms among individuals with impaired mood.

Dr Gracie and Dr Ford agree with the study authors in recommending inclusion of psychological/psychiatric screening in standard IBD care. "Whatever the reason for this association, it has important implications for future management strategies in IBD. It suggests that a paradigm shift away from therapies focused solely on reducing the inflammatory burden is needed in a subset of patients," they write.

This study was supported by the Swiss National Science Foundation. The authors and correspondents have disclosed no relevant financial relationships.

Clin Gastroenterol Hepatol. Published online January 25, 2016.

2017/1/12 上午 11:09:38
2016/3/30 下午 04:23:39
2016/1/15 上午 10:03:32

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