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Anxiety and Depression in Patients with Inflammatory Bowel Diseases: The First Step toward Proper Management

机译：炎症性肠病患者的焦虑和抑郁症：迈向适当管理的第一步

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Inflammatory bowel diseases (IBDs) are known to cause chronic intestinal inflammation and deteriorate patient quality of life in various ways. 1 , 2 IBDs have unique features that cannot be easily managed, and most patients have exacerbated disease courses and complications over time. 2 The long-lasting, fluctuating, and often severe disease courses of IBDs can cause various psychiatric problems. Ulcerative colitis (UC) is often accompanied by unpredictably frequent bowel movements and bloody stools, which can cause fear of not having immediate access to a toilet. 1 This is regarded to be the underlying mechanism of anxiety and depression in patients, especially for those with uncontrolled UC. Therefore, patients with significant IBDs have been confirmed to develop anxiety and depression in various cohort studies. Moreover, many studies have also shown that when poorly controlled, patient anxiety and depression can lead to frequent recurrence of IBDs, 3 increased hospitalization rates, 4 and reduced treatment compliance. 5 Despite the high incidence of anxiety and depression along with poor quality of life in patients with IBDs, screening and treatment for psychiatric complications have been often underestimated. In addition to improving the disease activity in patients with IBDs, the demand for observation and improvement of the overall patient quality of life has been a long-standing problem. As patients reported outcomes have become important indexes of IBDs, 6 several published cohort studies have focused on psychiatric problems and assessed patients using the Hospital Anxiety and Depression Scale (HADS), Short-Form 12 (SF-12), and Inflammatory Bowel Disease Quality-of-Life Questionnaire (IBDQ). However, the study by Moon et al . 7 appears to be the first to comprehensively quantify psychiatric problems using the HADS, Work Productivity and Activity Impairment (WPAI), SF-12, and IBDQ, simultaneously. In this study, severe loss of work productivity and social activity was reported at 46.2% and 53.5%. The prevalence of comorbid psychiatric illnesses, defined as a HADS score ≥8, among the patients was 33.7% for anxiety and 41.8% for depression respectively. In addition, significant mood disorders requiring psychological interventions, defined by a HADS score ≥11, were identified in 16.7% (anxiety) and 20.6% (depression) of patients. Furthermore, work activity impairment was significantly higher in patients with severe disease activity than in those with moderate disease activity (all p&0.05). These data clearly identified recent unmet psychosocial needs among newly diagnosed patients with UC in Korea. South Korea is currently experiencing a steep increase in the incidence of IBDs compared with Western countries. The first systematic nationwide cohort study of UC was launched in 2014 in South Korea. This ongoing prospective cohort study only includes patients with newly diagnosed moderate-to-severe UC and is called the moderate-to-severe ulcerative colitis in Korea (MOSAIK) cohort study (Clinicaltrials.gov, NCT02229344). 8 The ongoing study aims to capture all eligible patients with newly diagnosed UC in referred centers. The first patient consented to participate in the study in August 2014, and as of March 2017, the study has enrolled 355 patients. The study will release a report on major findings in February 2023. The MOSAIK cohort study has unique strengths in terms of the comprehensive outcome of IBD care and intervention to improve quality of life because no studies have collected the HADS, WPAI, SF-12, and IBDQ simultaneously. The present study strongly proposes a need for point-of-care screening and timely interventions for psychosocial distress among patients with newly diagnosed UC, particularly those with moderate-to-severe UC. Unfortunately, no specific study plan has been proposed for providing timely intervention and care. Prospective studies are rarely conducted to investigate whether adequate psychiatric interventions may be helpful in patients experiencing anxiety or depression. Moreover, it is important to recognize that gastroenterologists are not always experts in all manifestations of IBDs. Therefore, it is important to conduct a prospective study that includes experts who can effectively manage patients’ psychiatric problems. However, the disease flare and exacerbation of psychiatric symptoms has been proved to be proportional in similar studies. Therefore, proper control over disease activity could also improve the psychiatric symptoms in patients with IBD. Unfortunately, no study has shown how effective control of psychiatric symptoms can independently alleviate IBD outcomes. In particular, with the recent introduction of new biologics, future challenges should be explored to determine whether adequate psychiatric intervention can independently improve patient outcomes, especially on the impact on hospitalization, recurrence rate, and treatment compliance.
机译：已知炎症性肠病（IBD）以各种方式引起慢性肠炎症并使患者生活质量恶化。 1,2 IBD具有独特的特征，不能轻易管理，大多数患者随着时间的推移，大多数患者患有恶化的疾病课程和并发症。 2持久，波动，往往严重的IBD疾病课程会导致各种精神病问题。溃疡性结肠炎（UC）通常伴随着不可预测的频繁的排便和血腥粪便，这可能导致担心没有立即进入厕所。 1这被认为是患者焦虑和抑郁症的潜在机制，特别是对于具有不受控制的UC的人。因此，已确认患有重要IBD的患者在各种裁群研究中产生焦虑和抑郁症。此外，许多研究还表明，当控制不良，患者焦虑和抑郁症可能导致IBD的频繁复发，3个增加的住院费率，4率和治疗顺应性减少。 5尽管焦虑和抑郁发病率高，但患有IBDS患者的生活质量差，筛查和治疗往往被低估了。除了改善IBD患者的疾病活动外，对整体患者生活质量的观察和改善的需求是一个长期存在的问题。由于患者报告的结果已成为IBD的重要指标，6名出版的队列研究重点关注精神病问题，并评估使用医院焦虑和抑郁症（患者），短型12（SF-12）和炎症性肠病质量的患者 - 生活问卷（IBDQ）。但是，由月球等研究。 7似乎是第一个全面量化使用曾经，工作效率和活动障碍（WPAI），SF-12和IBDQ的精神病问题。在这项研究中，报告了46.2％和53.5％的严重失去工作生产率和社会活动。定义为同型精神病疾病的患病率≥8，患者中的患者分别为33.7％，抑郁症为41.8％。此外，在16.7％（焦虑）和20.6％（抑郁）患者的16.7％（焦虑）和20.6％（抑郁）患者中确定了需要心理干预的重要情绪障碍。此外，严重疾病活动的患者的工作活动障碍显着高于中等疾病活动的患者（所有P <0.05）。这些数据在新诊断的UC患者中清楚地确定了最近的未满足的心理社会需求。与西方国家相比，韩国目前正在经历IBD的发病率急剧增加。 UC的第一个系统全国范围的队列研究于2014年在韩国推出。这种正在进行的前瞻性队列研究仅包括新诊断的中度至严重的UC患者，并且被称为韩国中度至严重的溃疡性结肠炎（MOSAIK）队列研究（Clinicaltrials.gov，NCT02229344）。 8正在进行的研究旨在捕获所有符合条件的患有新诊断的UC的符合条件的患者。第一位患者同意在2014年8月参加该研究，截至2017年3月，该研究已注册355名患者。该研究将在2023年2月发布关于主要调查结果的报告。莫萨克队列研究在IBD护理和干预的全面结果方面具有独特的优势，以提高生活质量，因为没有学习收集曾经，WPAI，SF-12，和IBDQ同时。本研究强烈建议需要对新诊断的UC的患者患者的心理社会窘迫，特别是那些具有中度至严重的UC的患者的心理社会窘迫。不幸的是，没有提出具体的学习计划来提供及时的干预和护理。前瞻性研究很少进行调查是否有足够的精神疗效患者可能有助于焦虑或抑郁的患者。此外，重要的是要认识到，胃肠学主在IBD的所有表现中并不总是专家。因此，重要的是进行一项潜在的研究，包括能够有效地管理患者精神病问题的专家。然而，在类似的研究中被证明，精神症状的疾病爆发和恶化的症状是成比例的。因此，对疾病活动的适当控制也可以改善IBD患者的精神病症状。不幸的是，没有研究表明对精神症状有效的控制如何独立缓解IBD结果。特别是，随着最近引入新生物学的引入，应探索未来的挑战，以确定是否可以独立改善患者结果，特别是对住院治疗，复发率和治疗顺应性的影响。

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    《Gut and Liver》 |2020年第4期|共2页
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    Jung Won Lee;

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