INSPIRE study: does stress management improve the course of inflammatory bowel disease and disease-specific quality of life in distressed patients with ulcerative colitis or Crohn's disease? A randomized controlled trial.

BACKGROUND: The use of stress management psychotherapy is hypothesized to produce greater improvement in disease course and disease-specific quality of life (IBDQ) compared to usual medical care alone in patients with ulcerative colitis (UC) or Crohn's disease (CD) showing high levels of stress (based on the Perceived Stress Questionnaire [PSQ]). METHODS: Fifty-eight patients with UC and 56 patients with CD who had experienced continuous disease activity or had relapsed over the previous 18 months, with an activity index for UC or CD ≥ 4, a PSQ ≥ 60, and without serious psychiatric disorders or other serious medical conditions were randomized to receive either treatment as usual (TAU) or TAU plus stress management psychotherapy. Psychotherapy consisted of three group sessions (psychoeducation, problem-solving, relaxation) and 6-9 individual sessions based on cognitive behavior therapy-related methods with 1-3 booster sessions at 6 and 12 months follow-up. Gastroenterologists blinded to intervention group assessed disease activity and course at baseline and at 3, 6, 12, and 18 months. Patients completed the IBDQ at baseline, 6, 12, and 18 months. RESULTS: The intervention did not improve disease or reduce relapse; however, it increased the IBDQ score (P = 0.009, mean differences 16.3 [SD 6.1]). On analysis of UC and CD separately, improvement of IBDQ was only found in the UC group. CONCLUSIONS: Stress management psychotherapy does not appear to improve disease course or reduce relapse in patients with IBD. It might improve quality of life, particularly in patients with UC.

The INSPIRE study: do personality traits predict general quality of life (Short form-36) in distressed patients with ulcerative colitis and Crohn's disease?

OBJECTIVE: To assess the role of personality as a predictor of Short form-36 (SF-36) in distressed patients (perceived stress questionnaire, PSQ) with ulcerative colitis (UC) and Crohn's disease (CD). MATERIAL AND METHODS: Fifty-four patients with CD and 55 with UC (age 18-60 years) who had relapsed in the previous 18 months, i.e. with an activity index (AI) for UC or CD> or =4, PSQ> or =60, and without severe mental or other major medical conditions, completed the Buss-Perry Aggression Questionnaire (BPA), the Neuroticism and Lie scales of the Eysenck Personality Questionnaire (EPQ-N and -L), the Multidimensional Health Locus of Control Scale (LOC) (Internal (I), Powerful Other (PO), Chance (C)), the Toronto Alexithymia Scale (TAS) and the SF-36. RESULTS: Multiple linear regression analyses controlling for gender, age and clinical disease activity (AI) in separate analyses for UC and CD showed that the mental and vitality subscales were predicted by neuroticism in both UC and CD. The highest explained variance was 43.8% on the "mental" subscale in UC. The social function subscale was related to alexithymia only in UC, while the role limitation and pain subscales were related to personality in CD only. The physical function subscale related differently to personality in UC and CD. CONCLUSIONS: While mental and vitality subscales were predicted by neuroticism in both UC and CD, other subscales had different relationships to personality, suggesting different psychobiological interactions in UC and CD.

The INSPIRE study: are different personality traits related to disease-specific quality of life (IBDQ) in distressed patients with ulcerative colitis and Crohn's disease?

BACKGROUND: To explore the relationship between personality and disease-specific quality of life [Inflammatory Bowel Disease Questionnaire (IBDQ)] in distressed [Perceived Stress Questionnaire (PSQ)] patients with ulcerative colitis (UC) and Crohn's disease (CD). METHODS: Included in the study were 56 patients with UC and 54 patients with CD ranging in age from 18 to 60 years with a relapse in the previous 18 months, a UC or CD activity index 4, a PSQ 60, and without serious mental or other serious medical condition. The patients completed the Buss-Perry Aggression Questionnaire, the Neuroticism and Lie (social conformity/desirability) scales of the Eysenck Personality Questionnaire, the Multidimensional Health Locus of Control (LOC) Scale [Internal (I), Powerful Other (PO), Chance (C)], the Toronto Alexithymia Scale, and the IBDQ. RESULTS: In linear regression controlling for sex, education (years), and clinical disease activity (AI) in separate analyses of UC and CD patients, higher IBDQ score was related to less social conformity in CD and less neuroticism in UC; higher emotional function score was related to less neuroticism in both CD and UC and less PO-LOC in UC. Higher social function score was related to less social conformity in CD and lower I-LOC and PO-LOC in UC. Bowel function and systemic symptoms were unrelated to personality in either UC or CD. CONCLUSIONS: Although the emotional function subscale was related to neuroticism in both UC and CD, the social function subscale and total IBDQ were related to different personality traits in UC and CD. Personality traits should be taken into account when using IBDQ in studies.

[The goals of nursing in inpatient psychosomatic medicine - an empirical approach]. / Pflegeziele in der psychosomatischen Akutbehandlung - Eine empirische Annäherung.

Nursing plays an essential part in the acute psychosomatic inpatient treatment. The goals, which the nurses aim at while taking care of their patients, have, however seldom been investigated. This first systematic inquiry into the goals, which care at the clinic for psychosomatic medicine bears in mind, was carried out on a sample of 84 patients. These goals were evaluated and compared with different common outcome measures. Carers, first of all, aim at goals referring to the symptom, such as improving the patients' eating habits. Apart from that they mainly focus on goals not directly connected to the patients' physical condition, such as helping to improve the patients' self esteem. In some cases the nurses' estimate concerning the success of the treatment corresponds to that of the patients' to a greater extent than to that of the patients' personal therapist. Nursing in inpatient psychosomatic medicine extends much further than the demands of care normally imply. The knowledge concerning the patients' mental condition, which the nurses have according to this inquiry, ought to be used within the treatment.

[The Luebeck Interview for Psychosocial Screening (LIPS)--a validation study with patients suffering from coronary artery disease]. / Das Lübecker Interview zum psychosozialen Screening (LIPS)--Eine Validierungsstudie bei Patienten mit koronarer Herzkrankheit.

Identifying patients in cardiology who are able to benefit from more detailed psychosocial diagnostics or interventions is still problematic in every day hospital care. Existing psychosocial screening instruments--either self-evaluation questionnaires and evaluation interviews carried out by doctors--are discussed. A new screening instrument for evaluating patients in cardiology is presented: The Luebeck Interview for Psychosocial Screening (LIPS). With help of LIPS patients are evaluated by their doctor through a short semistructured interview referring to the patients' psychosocial situation. Test statistical data of the instrument gained through 194 patients are presented. For a subgroup of 80 patients the validity for predicting their quality of life six weeks after discharge form hospital by psychosocial assessment in hospital is presented. Data on reliability and validity of LIPS appear to range from acceptable to good. Predicting quality of life by self-report inventories reaches a better fit than a prediction by LIPS as an evaluation from the doctor's perspective. The errors of the prediction by both methods are highly correlated. Further research on LIPS combined with a structured clinical Interview for mental disorders seems to be desirable.