Some confusion has occurred in the past decades on the psychosomatic aetiology or pathogenesis of IBD. There is enough evidence that depression or any psychiatric diagnosis is statistically more often associated with Crohn's disease than with diabetes, hyper tension or cardiac diseases  and that emotional distress may cause exacerbation of IBD, as reported at the beginning of this chapter with the sad story of Angela F. Psychiatric illness may precede the onset of Crohn's disease, but no significant data have been reported to strongly support a causative relationship. Patients with ulcerative colitis have no unusual predisposing factors in the onset of their disease when compared with matched controls. Also colectomy is usually followed by a marked improvement in preexisting psychiatric illness. Whereas in European reports there is a tendency to consider psychoneuro-sis among the aetiological factors underlying IBD, most American authors feel that anxiety and depression, despite being frequent in IBD patients, should not be considered aetiopathogenetic factors but just psychological reactions to the disease . However, there is a higher prevalence of psychiatric disorder in patients with Crohn's diseases compared with the normal population, and a small but significant percentage of individuals with Crohn's disease may have a psychiatric disturbance that predates their medical illness .
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