Ingrid Banovic

Crohn's disease and fatigue: Constancy and co-variations of activity of the disease, depression, anxiety and subjective quality of life

Fatigue in Crohns disease (CD) is considered as a consequence of the disease and its treatment. If research showed the impact of the activity of the disease on vitality, patients can express fatigue even if the disease is inactive. Sleep disturbances are now considered in inflammatory bowel disease (IBD) and they could be involved in fatigue. It is well-known that depression and anxiety occur in IBD: They involve sleep disturbances and asthenia. But neither factors have been assessed simultaneously from a longitudinal perspective. Fifty-two patients participated in this study. Fatigue (MFI), depression (HAD-D), anxiety (HAD-A), sleep disturbances (ISI, IQPS), subjective quality of life (Mos-SF36) and activity of the disease (CDAI) were assessed twice with a one-year interval. Results showed constancy in fatigue and the mental health state. Moreover, if depression, anxiety, quality of life, and fatigue followed the same course of activity of the disease only during one visit, CDAI did not correlate with these dimensions between visits. CDAI only prognosticated insomnia. These results suggest that fatigue and poor quality of life may be primarily linked to depression in a secondary context of CD.

Diagnostic profiles determined by the C.A.R.T procedure: IBD patients and fatigue

Fatigue is common in IBD. It remains a complex phenomenon with primary factors related to the disease and secondary factors (depression, anxiety, sleep disturbances, pain) whose respective importance and organization are difficult to determine. By using the C.A.R.T. procedure, the diagnostic variables of 108 IBD-related fatigue patients were determined globally, according to their sex and the clinical activity of their disease. Results underline the diversity of diagnostic profiles in which psychological variables have significant influence. It is important to consider fatigue according to profiles that best illustrate its complexity and allow for identifying better potentially remediable factors.

Personality and fatigue perception in a sample of IBD outpatients in remission: A preliminary study

BACKGROUND AND AIMS Fatigue is considered as a feature of IBD. Nevertheless, medical variables would partly explain this complex phenomenon. Psychological variables would be especially connected to fatigue for patients in remission. Moreover, personality is known to be linked to the fatigue of patients with CFS. This preliminary study aimed to determine if personality dimensions are linked to the perception of fatigue in IBD. METHODS 81 IBD outpatients in remission completed the MFI (fatigue); ISI, EES (sleep disturbances); TCI-R (personality); HADS (depression and anxiety). Medical data were collected (ferritin, C-reactive protein, number of flare-ups, number of hospitalizations, duration of the disease and surgical sequelae). RESULTS With the exception of surgical sequelae, none of the medical variables was linked to fatigue perception. Anxiety and sleep disturbances were the most continuously connected to fatigue perception. Significant relationships were observed between personality categorization on Persistence, Self-Directness and the level of fatigue. CONCLUSION In order to improve vitality in IBD patients in remission, identification and treatment of psychological aspects should become a dimension of disease management. Fatigue should not be considered only as a direct feature of IBD.

Perception of improved state of health and subjective quality of life in Crohn's disease patients treated with Infliximab

UNLABELLED BACKGROUND AND AIMS AND METHOD: Although Infliximab is a very potent therapy of refractory Crohns disease, its administration requires iterative infusions in hospital and there are concerns regarding its long-term safety. The aim of this study was to assess in a sample of 51 patients suffering from CD the impact of type of treatment (intravenous Infliximab versus conventional therapy without Infliximab) on the evaluation of the state of health (CGI) and the quality of life (MOS-SF36). Secondary variables were also assessed: the impact of depression (MADRS), the impact of activity of the disease (Harvey-Bradshaw Index). RESULTS Overall, the assessments made using the CGI and the SF-36 revealed that the two types of treatment did not differ on the assessment of state of health and quality of life. A downward influence of depression and activity of the disease was observed. CONCLUSION Patients considered more efficacy of Infliximab than its potential side effects. It seems important to assess and to consider depression in order to improve medical care setting of Crohns disease.

The causal representation of outpatients with Crohn’s disease: is there a link between psychological distress and clinical disease activity?

Objectives: Because of the fluctuating and occasional character of Crohn’s disease (CD), patients have to cope with a changeable condition of health. Personal perceived control is known to be an important element of adaptation to their medical condition. The objectives of this work are to determine if perceived personal control is predictive of the clinical activity of the disease and of psychological distress (depression, anxiety). Methods: The Hospital Anxiety Depression Scale (HADS), the causal dimension scale and the Clinical Global Impression (CGI; assessing perceived severity) were administered to 160 patients affected by Crohn’s disease. Indicators of inflammation (CRP), disease duration and clinical activity of the disease were also asessed. Results: Globally, CD patients perceive their disease as being personally neither controllable nor uncontrollable. Whereas psychological distress is significantly higher when the disease is active, the relationship between the variables appears complex. The feeling of personal control is explained by the clinical activity of the disease (p=.0001) and by the perception that CD is unstable (p<.00001) and globally impacts the life of patients (p=.001). Nevertheless perception of personal control does not explain the clinical activity of the disease. Finally, psychological distress is explained by the perception that the medical team is unable to control the disease (p=.00001) and by the global consequences of the disease on life (p<.005). Conclusions: Psychological treatments should take these dimensions into account so as to improve the well-being and medical conditions of patients.

Impact du rythme de travail (5 quarts de 8h par semaine vs 3 quarts de 12h par semaine) sur la santé perçue des soignants et les demandes psychologiques au travail.

Resume Cet article restitue une recherche sur les horaires de travail du personnel soignant d’un hopital francais, et notamment l’impact de deux rythmes (3 quarts de 12h vs 5 quarts de 8h 4 ) sur la sante et les demandes psychologiques au travail percues par les soignants. A partir de 255 questionnaires, cette recherche indique que les soignants en 12h et ceux en 8h ont globalement la meme perception de leur sante et des demandes psychologiques au travail. Quelques differences existent: les soignants en 12h se percoivent comme moins fatigues et moins epuises emotionnellement que les soignants en 8h. Nous discutons ces resultats par i) le temps de repos plus important en 12h ; ii) de meilleures relations avec les collegues liees a la concertation et au vote mis en place lorsqu’un service envisage de travailler en 12h et iii) le caractere volontaire des soignants qui acceptent / choisissent de travailler en 12h.