Nicole Moulding

Controversies surrounding the comorbidity of depression and anxiety in inflammatory bowel disease patients: A literature review

Abstract Psychological disorders are highly prevalent in patients with inflammatory bowel disease (IBD). Anxiety and depression are known to independently affect quality of life and may additionally impair quality of life in IBD over and above the IBD itself. Some researchers have further proposed that anxiety and depression may influence the clinical course of IBD. However, despite the potential for anxiety and depression to play an important role in the clinical picture of IBD, there is little prospective well‐controlled research in this area. Probably because of this lack of clear data, researchers dispute the actual role of these psychological disorders in IBD, with a number of conflicting opinions expressed. This article reports on a review of the literature in this field. Herein we discuss the five main areas of controversy regarding IBD and the specific psychological comorbidities of depression and anxiety: 1) the relative rate of cooccurrence of these psychological disorders with IBD; 2) the cooccurrence of these psychological disorders with particular phase of IBD; 3) the cooccurrence of these psychological disorders with the specific type of IBD; 4) the rate of these psychological comorbidities compared both to healthy subjects and to other disease states; and 5) the timing of onset of psychological comorbidity with respect to onset of IBD. Methodological weaknesses of the reviewed studies make it impossible to resolve these controversies. However, the results clearly show that anxiety/depression and IBD frequently interact. Given the long‐term illness burden patients with IBD face, further prospective, appropriately controlled studies are needed to adequately answer the question of the precise interplay between anxiety/depression and IBD. (Inflamm Bowel Dis 2007)

Antidepressants and inflammatory bowel disease: a systematic review

BackgroundA number of studies have suggested a link between the patients psyche and the course of inflammatory bowel disease (IBD). Although pharmacotherapy with antidepressants has not been widely explored, some investigators have proposed that treating psychological co-morbidities with antidepressants may help to control disease activity. To date a systematic analysis of the available studies assessing the efficacy of antidepressants for the control of somatic symptoms in IBD patients has not been performed.MethodsWe searched electronic databases, without any language restriction. All relevant papers issued after 1990 were examined.Results12 relevant publications were identified. All of them referred to non-randomised studies. Antidepressants reported in these publications included paroxetine, bupropion, amitriptyline, phenelzine, and mirtazapine. In 10 articles, paroxetine, bupropion, and phenelzine were suggested to be effective for treating both psychological and somatic symptoms in patients suffering from IBD. Amitriptyline was found ineffective for treating somatic symptoms of IBD. Mirtazapine was not recommended for IBD patients.ConclusionAlthough most of reviewed papers suggest a beneficial effect of treatment with antidepressants in patients with IBD, due to the lack of reliable data, it is impossible to judge the efficacy of antidepressants in IBD. Properly designed trials are justified and needed based upon the available uncontrolled data.

The effect of functional gastrointestinal disorders on psychological comorbidity and quality of life in patients with inflammatory bowel disease.

Background  Symptoms of functional gastrointestinal disorders (FGIDs) are common in patients with inflammatory bowel disease (IBD). Psychological comorbidities of anxiety and depression are also highly prevalent in IBD.

Psychological problems in gastroenterology outpatients: A South Australian experience. Psychological co-morbidity in IBD, IBS and hepatitis C

BackgroundIn independent studies, IBD, IBS and HCV have each been associated with a substantially increased risk of psychological problems such as depression and anxiety and impairment of quality of life compared to the general healthy population. However, the relative psychological burden for each of these diagnoses is unknown as it has never been compared contemporaneously at one institution. Current local data are therefore needed to enable an evidence-based allocation of limited clinical psychological resources.MethodsOverall, 139 outpatients (64 IBD, 41 HCV, and 34 IBS) were enrolled in this cross-sectional study. The HADS, SCL90, SF-12 and appropriate disease-specific activity measures were administered. Differences between groups were assesed with ANOVA, the Chi-Square test and the independent samples t-test (two-tailed).ResultsEach of the three groups had significantly lower quality of life than the general population (p < 0.05). Overall, a total of 58 (42%) participants met HADS screening criteria for anxiety and 26 (19%) participants for depression. The HCV group had a significantly higher prevalence of depression than either of the other groups (HCV = 34%, IBS = 15% and IBD = 11%, p = 0.009). In the SCL90, the three disease groups differed on 7 out of 12 subscales. On each of these subscales, the HCV group were most severely affected and differed most from the general population.ConclusionPatients with these common chronic gastrointestinal diseases have significant impairment of quality of life. Anxiety is a greater problem than depression, although patients with HCV in particular, should be regularly monitored and treated for co-morbid depression. Evaluation of specific psychological interventions targeting anxiety is warranted.

Psychological comorbidity and complexity of gastrointestinal symptoms in clinically diagnosed irritable bowel syndrome patients

Background and Aim:  The prevalence of psychological disorders is high in patients with irritable bowel syndrome (IBS) but their role in symptom reporting is uncertain. It is thus interesting whether the number of functional gastrointestinal disorders (FGID) determines the load of psychological comorbidity. The Rome III criteria have not been used to evaluate such a relationship as yet. Moreover, not many studies have examined the sensitivity of the Rome III criteria in detecting IBS. Our aims were therefore: (i) to determine whether those IBS participants with more FGID had a tendency to greater psychological comorbidity than those with fewer FGID; and (ii) to assess the performance of the Rome III criteria in detecting IBS versus the diagnosis of the gastroenterologist.

Intelligent Design: Student Perceptions of Teaching and Learning in Large Social Work Classes.

Research into the effects of large classes demonstrates that students are disadvantaged in terms of higher order learning because interactions between teachers and students occur at lower cognitive levels. This has significance for social work education, with its emphasis on the development of critical thinking and problem solving, both higher order cognitive skills. This paper reports on quantitative and qualitative research that explored social work students’ perceptions of different teaching and learning strategies in a large mental health course designed with reference to principles of student‐centred learning and constructive alignment. Findings revealed that well‐integrated design, relevance to the real world and teacher enthusiasm were seen as most useful by students, rather than particular learning strategies per se. Higher satisfaction ratings and grades were also associated with this student‐centred course compared with an earlier traditional lecture‐style course. The paper concludes that design based on the interplay between diverse learning activities, including lecture input, strengthened the student‐centred orientation of learning and recommends further research that compares learning outcomes associated with these contrasting approaches to professional education.

Growing up in domestic violence: what does maternal protectiveness mean?

There is limited understanding at the current time about the nature of relationships between women and their children in contexts of domestic violence. This is particularly the case in relation to maternal protectiveness, which tends to be seen in simplistic terms of whether women stay in violence or leave to protect their children. This article reports on a qualitative research study that explores mother–child relationships in the context of domestic violence. We conducted semi-structured interviews with 14 women and two men who were raised in contexts of domestic violence. Thematic analysis revealed complexities between the former children’s perceptions of their own needs and their mothers’ vulnerabilities in the context of violence, as well as shifting understandings over time that involved development of deeper insights into the impact of violence on their mothers and themselves. The nuances of maternal protectiveness identified through this analysis can help social workers appreciate the multiple factors that impact on children’s relationships with their mothers in contexts of violence. The findings therefore have practice implications for social work with women who mother in domestic violence as well as children and adults who grow up in these environments.

Beyond Balancing Competing Needs: Embedding Involuntary Treatment Within a Recovery Approach to Mental Health Social Work

Abstract The recovery model of mental illness has become increasingly influential over the past two decades and while the synergies with social work are strong, there has been no examination of how social workers manage working within a recovery framework with involuntary clients in risk management-oriented settings. In this paper we report on a qualitative study with 10 mental health social workers exploring how such tensions are managed in everyday practice. While the social workers identified numerous dilemmas, they drew on a combination of recovery principles and social work values and practice approaches in an effort to move client agency closer to the centre of multidisciplinary interventions. We conclude that while the implementation of a recovery approach in the Australian mental health system has been at best uneven, its official embrace lends social workers a sense of legitimacy in advocating for client rights in the complicating context of involuntary community treatment.

Psychogastroenterology: a call for psychological input in Australian gastroenterology clinics

Gastroenterologists should be able to refer patients directly to psychologists with full Medicare reimbursement. Psychological comorbidities are frequently seen in patients with gastrointestinal conditions. However, time pressure and lack of expertise in non‐medical therapies of psychological problems prevent gastroenterologists from initiating psychological treatment although such treatment may improve patients’ outcomes and reduce health‐care utilization. Psychologists are needed as part of the multidisciplinary team in gastroenterology clinics in Australia to take the leading role in the psychological management of those patients by contributing to screening, faster diagnosis and treatment of depression and anxiety disorders in particular.

“Love your body, move your body, feed your body”: Discourses of self-care and social marketing in a body image health promotion program

Over the past decade, a number of health promotion programs have been developed in western countries to address body image dissatisfaction and associated eating disorders among women and girls. There has, however, been little critical examination of the application of health promotion theory and practice in this area. This paper reports on an interview study with health promotion workers responsible for managing and implementing the most extensive, long-running body image health promotion program in Australia. The study explores the ways in which health promotion workers envision body image as a site for preventive intervention, and specifically attends to the power dynamics of subject constructions and the opportunities for community empowerment and involvement. The study reveals a dominant discourse of individualised self-care as a solution to body image dissatisfaction, and a simultaneous reliance on marketing frameworks and practices. The paper explores the dilemmas associated with the application of these approaches in this area, particularly the way they reproduce contradictions in the social body which are implicated in producing the pursuit of thinness itself, and the tendency of marketing discourse to dissipate the possibilities for resistance. The paper also considers other approaches to health promotion for their potential to overcome some of the dilemmas associated with the marketing of self-care.