Concerns of patients with inflammatory bowel disease: results from a clinical population.

OBJECTIVE: The impact of chronic illness is influenced not just by physical symptoms but also by psychosocial factors. The aim of this study was to determine the concerns of inflammatory bowel disease (IBD) patients in a clinical sample, if concerns differ between patients from varied clinical and demographic variables, and if concerns influence well-being beyond the influence of physical symptoms. METHODS: Subjects (n = 259) completed a validated measure of concerns specific to IBD and provided demographic and disease-related information. RESULTS: The most intense concerns involved both physical (e.g., energy level) and psychosocial issues (e.g., achieving full potential). There were numerous differences in disease concerns based on ability to work but none based on disease duration. Factor analysis yielded three indices: body image and interpersonal concerns, general physical impact, and disease stigma. Age and education only affected certain concern indices in subgroups of patients. Greater concerns negatively influenced well-being beyond the influence of physical symptoms. CONCLUSION: Psychosocial factors, in addition to physical symptoms, play an important role on the impact of illness in patients with IBD.

Concerns of patients with inflammatory bowel disease: a review of emerging themes.

Idiopathic, chronic inflammatory bowel disease (IBD) refers to two diseases-ulcerative colitis (UC) and Crohn's disease (CD). Despite an abundant literature discussing the pathophysiology and treatment of these diseases, little if any empirical studies have focused on patients' subjective experiences with their diseases. The purpose of this paper was to identify and discuss the concerns of individuals with IBD and to suggest that the integration of concerns in clinical management is necessary for a comprehensive understanding of these chronic and debilitating diseases. In addition, case studies were included to highlight the concerns of people with IBD. Our review of the literature identified eight categories of concerns for individuals with IBD. They included loss of energy, loss of control, body image, isolation and fear, not reaching full potential, feeling dirty, and lack of information from the medical community. In conclusion, we argue that the efficacy of treatment for IBD would be greatly improved if psychosocial issues were to be integrated into treatment protocols.

Health-related concerns of people who receive psychological support for inflammatory bowel disease.

BACKGROUND: People with inflammatory bowel disease (IBD) cope with a number of disease-specific concerns, which may result in referrals for supportive counselling. OBJECTIVE: To determine differences between the health-related concerns of people with IBD who seek counselling or are referred for psychiatric assessment and those who have no recent contact with counselling or psychiatry. METHODS: Forty-five consecutive patients with IBD referred for psychiatric consultation and 31 IBD out-patients who had recent counselling were compared with 190 IBD out-patients at the same hospital with no recent history of counselling. Disease-related concerns, demographic data and perceived symptom severity were assessed with self-report instruments. RESULTS: Counselling patients had greater overall intensity of concern. Counselling patients differed from noncounselling patients on several measures related to illness severity and were more likely to be female. Correcting statistically for illness severity and sex, the counselled patients had significantly higher levels of concern about being a burden, pain and suffering, feeling out of control, financial difficulties, feeling alone, sexual performance, feeling dirty or smelly and being treated as different. CONCLUSIONS: Beyond the intensity of their physical suffering, patients who seek counselling report a pattern of concern in which interpersonal and emotional concerns are prominent compared with those of out-patients who do not seek counselling. Clinicians should be aware of interpersonal concerns, which may increase the need for empathic support. Psychosocial interventions in IBD may be indicated without respect to psychiatric comorbidity.

Lack of synergistic feeding enhancement by systemic clonidine and 8-OH-DPAT.

To expand on recent suggestions that brain alpha 2-adrenergic and serotonergic systems may interact in their controls over feeding, three experiments were conducted to determine if combining clonidine and 8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT) injections subcutaneously might produce exponential feeding enhancements greater than responses elicited by either agent alone. Ad lib fed adult male rats were tested in 2 x 2 drug designs in all studies. In Experiment 1, 30 micrograms/kg clonidine reliably enhanced feeding over a 6-hr test period. However, 250 micrograms/kg 8-OH-DPAT showed no signs of enhancing this response, but instead seemed to impede it as determined by analyses of cumulative intake curves. In Experiment 2, either 10 micrograms/kg clonidine or 250 micrograms/kg 8-OH-DPAT reliably enhanced 6-h interval intakes, but their combination again failed to synergize other than to interact with time in suppressing intake. To determine if feeding synergy might occur if subthreshold doses of each agent were combined, Experiment 3 tested 1 microgram/kg clonidine and 15 micrograms/kg 8-OH-DPAT in 4-h feeding tests. Neither agent alone elicited reliable feeding as planned, but their combination also failed to stimulate feeding. These findings, combined with other recent work, do not support the possibility that previously demonstrated interactions between brain alpha 2-adrenergic and serotonergic systems extend to circumstances wherein enhancements of the former combined with suppressions of the latter might underly robust overeating responses.

Effects of intracisternal vs. intrahypothalamic 5,7-DHT on feeding elicited by hypothalamic infusion of NE.

A variety of evidence has led to suggestions that brain serotonin (5-HT) and norepinephrine (NE) interact within the medial hypothalamus to control food intake. To test the possibility that chronic decrements in 5-HT might enhance NE-induced feeding, adult male rats were prepared with permanently indwelling cannulae aimed at the paraventricular nucleus (PVN), then received either intracisternal (IC) or PVN injections of the 5-HT neurotoxin, 5,7-dihydroxytryptamine (5,7-DHT) vs. its vehicle, 1% ascorbic acid. Over a 4-week period, IC-5,7-DHT rats showed no signs of enhanced daily feeding or drinking. However, in 40-min intake tests, feeding but not drinking was enhanced by injecting 20 nmol NE into the PVN commencing 2 weeks after neurotoxin treatment. Terminal monoamine assays confirmed that IC-5,7-DHT produced large (80-90%) depletions of brain regional 5-HT. A functional index of 5-HT terminal damage was also implied by the impaired short-term feeding responses IC-5,7-DHT rats showed to the systemic administration of the 5-HT1A agonist, 8-hydroxy-2-(di-n-propylamino) tetralin (8-OH-DPAT) when tested between 3 and 4 weeks after IC treatment. Over a comparable 4-week period, PVN-5,7-DHT rats also showed no tendencies to overeat or overdrink on a daily basis. However, in contrast to IC-5,7-DHT rats, they also showed no differences in their feeding or drinking responses to NE injections into the PVN. This was so despite reliable depletions of 5-HT in the hypothalamus (-28%) and hippocampus (-71%). These results support earlier work showing that neither widespread nor localized hypothalamic damage to brain 5-HT neurons produce chronic overeating. However, the data suggest that phasic enhancements of PVN NE activity may trigger enhanced feeding when there is widespread damage to brain 5-HT neurons, although the PVN does not appear to be the brain site mediating this effect.

Effects of systemic 8-OH-DPAT on the feeding induced by hypothalamic NE infusion.

Past research suggests that activating brain serotonin (5-hydroxytryptamine or 5-HT) systems can inhibit feeding induced by activating brain norepinephrine (NE) systems. To explore this interaction more fully, we tested the capacity of the endogenous 5-HT release inhibitor, 8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT), to enhance feeding stimulated by infusing NE into the medial hypothalamus. All experiments were conducted using ad lib-fed adult male rats with indwelling cannulae aimed at the paraventricular nucleus (PVN). In the first study, proven PVN-NE responders were tested for 40-min food intake after receiving 20 nanomoles (nmol) 1-NE or saline in the PVN following subcutaneous (SC) pretreatment with 250 micrograms/kg 8-OH-DPAT or saline. Both drugs produced equivalent, reliable increments in feeding compared to PVN-saline. However, no additivity or synergy was seen when they were combined. Short-term water intake was unaffected by these treatments as was subsequent food or water intake over the next 22 hr. In a second study, additional proven PVN-NE responders were tested under two comparable conditions when 1) the 8-OH-DPAT dose was left at 250 micrograms/kg but the NE dose was lowered to 10 nmol, and 2) the 8-OH-DPAT dose was lowered to 120 micrograms/kg and the NE dose was increased to 40 nmol. In the first case, no reliable feeding was seen in response to either agent alone or combined. In the second case, NE alone enhanced feeding but 8-OH-DPAT did not. The combination of both produced the same enhanced feeding as seen with NE alone.(ABSTRACT TRUNCATED AT 250 WORDS)