Mauro Ercolani

New insights into the brain involvement in patients with Crohn's disease: a voxel-based morphometry study.

Background  Crohn’s disease (CD) is a chronic intestinal disorder characterized by overproduction of inflammatory cytokines and recurrent abdominal pain. Recently, brain morphological abnormalities in the pain matrix were found in patients with chronic pain disorders including irritable bowel syndrome. To investigate potential structural brain changes associated with CD, we used magnetic resonance imaging (MRI). Furthermore, we tested whether in patients gray matter (GM) volumes correlated with disease duration.

Fibromyalgic Syndrome: Depression and Abnormal Illness Behavior

This study reports psychological symptoms assessed in 327 patients with fibromyalgia (FS) in a multicenter investigation. Two self-report scales, in their validated Italian translations, were used for screening: the CES-D (the Center of Epidemiologic Studies-Depression) developed at the NIMH for measuring depression and the Illness Behavior Questionnaire (IBQ) developed by Pilowsky and Spence. The cutoff point of 23 in the CES-D scores revealed about 49% of the fibromyalgic patients as depressed. In analyzing patterns of illness behavior patients with FS showed a high score on IBQ scales of disease conviction, psychological versus somatic focusing and denial. CES-D scores showed significant correlations with illness behavior scales. These results and their implications for the treatment of fibromyalgic patients are discussed.

FIVE-YEAR FOLLOW-UP OF COSMETIC RHINOPLASTY

The psychological impact of rhinoplasty for aesthetic reasons on psychological well-being is controversial. The aim of the present study is to assess short- and long-term psychological changes in patients who underwent rhinoplasty. Seventy-nine patients, without traumatic lesions, who presented for cosmetic surgery, completed the MPI scales for Neuroticism and Extroversion and the IPAT scale for Anxiety, 3 months before and 6 months and 5 years after surgery. Results showed a significant decrease of anxiety and neuroticism in both postoperative evaluations and an increase on the Extroversion scale only at the 6-month follow-up. Psychological distress persisted in most patients after the operation.

Short-term outcome of rhinoplasty for medical or cosmetic indication.

Psychological effects of rhinoplastic operations were evaluated in male and female patients who had sought surgical correction because of psychological distress caused by the appearance of the nose or because of a medical referral to correct functional disorders. Seventy-two patients selected by gender and operation motivation were asked to fill out the MPI and the IPAT Anxiety scale 2-3 months before and 8 months after the operation. Results at follow-up highlighted a significant decrease of the mean Neuroticism and Anxiety scores and an increase in Extroversion scores in the group as a whole. The psychological benefits gained by the female patients were greater than those of the males. Patients whose motivation was exclusively aesthetic were, overall, more psychologically distressed than those with a functional motivation.

Adult Attachment and Early Parental Experiences in Patients With Crohn's Disease

Background Crohn’s disease (CD) is a chronic, relapsing and remitting inflammatory bowel disease. The relationship of attachment to the illness is considered to be bidirectional. Objective The authors investigated aspects of this bidirectional relationship. Method A group of 102 patients with CD and 306 healthy subjects filled out the Attachment Style Questionnaire and the Parental Bonding Instrument. Results Patients with CD exhibit a predominantly insecure attachment and perceived their parents’ behaviors as characterized by low maternal care and high paternal overprotection. Discussion The evaluation of attachment style and early parental experiences in patients with CD may shed light on the bidirectional relationship between attachment and illness. These findings may confirm the bidirectional relationship between insecure attachment and chronic illness.

Parental bonding and inflammatory bowel disease.

Background Previous studies have shown a relationship between inflammatory bowel disease (IBD) and psychological stress. Adverse parenting is recognized as an important risk factor for the development of psychiatric disorders in adulthood. Objective The authors sought to further investigate this relationship by clarifying aspects of the bonding relationship in IBD patients and control subjects. Method A group of 307 patients with IBD and a group of 307 healthy subjects filled out the questionnaire Parental Bonding Instrument. Results Patients with IBD perceived their parents’ behaviors as characterized by low care and paternal overprotection; the category Optimal Parenting differs highly in the two samples. Conclusion This study demonstrated an association between inadequate parenting and a chronic physical illness. These findings are consistent with a growing literature that links early parental experience to chronic illness.

Brain functional changes in patients with ulcerative colitis: A functional magnetic resonance imaging study on emotional processing

Background: Ulcerative colitis (UC) is associated with psychological stress and poor emotional functioning. The neural emotional processing involves the complex integration of several cortical and subcortical brain structures. The amygdala plays a fundamental role in the neural processing of emotional stimuli and is a core structure of the brain–gut axis (BGA) that represents the anatomo‐functional substrate for the bidirectional influences between emotions and gastrointestinal functions. The aim of this study was to investigate the brain emotional processing in UC patients compared to healthy people. Methods: Ten UC patients in remission and 10 matched healthy controls underwent a functional magnetic resonance imaging (fMRI) scan while performing a task involving emotional visual stimuli. A set of negative, positive, and neutral pictures were used to study brain‐related emotional responses. Results: A significantly reduced blood oxygen level‐dependent (BOLD) signal in UC patients relative to controls was found in the amygdala, thalamic regions, and cerebellar areas (P < 0.05 corrected for multiple comparisons). The group‐related differences were detected in the brain activity in response to positive emotional stimuli. Conclusions: UC is associated with an emotional dysfunction characterized by decreased sensitivity to emotions with a positive content. The previous intestinal inflammatory activity in UC patients might have contributed to determine the functional changes of the amygdala that we found. On the other hand, the dysfunction of the amygdala may influence the course of the disease. (Inflamm Bowel Dis 2010;)

Illness behavior, affective disturbance and intestinal transit time in idiopathic constipation

Patients with constipation differ not only from healthy subjects but can also be categorized into two groups: slow transit constipation (STC) and normal transit constipation (NTC) using measures of total intestinal transit time (TITT). We investigated the role of illness behavior and affective state in 45 NTC and 29 STC patients as compared with 20 healthy subjects. All subjects completed the Illness Behavior Questionnaire (IBQ), the Symptom Questionnaire (SQ), and the CES-D to assess illness behavior, psychological distress, and depression. The constipated patients reported more psychological distress than healthy subjects. Within the constipated group, the NTC subjects had significantly higher scores on the IBQ dimensions of hypochondriasis and disease affirmation. Our results suggest that even among constipated patients psychological distress is prominent and that measures of illness behavior help to discriminate among different pathophysiological groups.

Benign Joint Hypermobility Syndrome: Psychological Features and Psychopathological Symptoms in a Sample Pain-Free at Evaluation

30 subjects with BJHS (Hypermobile) (M age = 32.3 yr., SD = 10.4) and two control groups, 25 healthy subjects (Healthy) (M age = 33.9 yr., SD = 93) and 30 fibromyalgic patients (Fibromyalgic) (M age = 32.2 yr., SD = 9.4), were given the Symptom Checklist-90-R, the Illness Behavior Questionnaire, the Female Functional Symptoms Frequency (FFF) and the Male Functional Symptoms Frequency (MFF), derived from the DSM-III–R, evaluating functional somatic disturbances and their intensity, and the Symptom Questionnaire. The mean scores for the Hypermobile group showed significant psychological distress and increased frequency and intensity of somatic symptoms. Scores on Anxiety and Somatic Symptoms, General Hypochondriasis, Disease Conviction, Affective Disturbance, Denial, and Irritability were significantly higher in the Hypermobile than in the Healthy group. Elevated scores were found for the Fibromyalgic group on the Illness Behavior Questionnaire subscales for Psychological vs Somatic Focus, Disease Affirmation, and Discriminating Factors when compared with the Hypermobile group. Considerable emotional symptoms were detected which should not be underestimated by physicians when establishing an integrated biopsychosocial therapy.

Stressful Events and Psychological Symptoms in Patients with Functional Urinary Disorders

The relationship between micturition, stressful events, and psychological symptoms was studied in 58 female patients with functional micturition disorders (urethral syndrome) and 21 control patients. All received three questionnaires (Symptom Questionnaire, Illness Behavior Questionnaire, and the Biographic Questionnaire). Analysis highlighted the appearance of the urethral syndrome in highly stressful situations and the increase in the patients anxiety, depression, dysphoria, hostility, and irritability. A tendency to complain of other psychophysiologic symptoms was also noted.