Do Stressful Events and Depressive Mood Exacerbate IBD

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The answer is: yes, according to many authors, but there is not a full agreement. North et al. carried out a prospective study on a consecutive sample of 32

patients with IBD who had at least one relapse in a 2-year period after entry into the study. A mean of 2.2 exacerbations was seen per subject during the study period. Mood changed concurrently with exacerbations of IBD, but no evidence indicated that stressful life events or depressed mood precipitated exacerbations in this study group [3]. Interestingly, in another investigation carried out on a larger series of 107 IBD patients and 60 controls, patients reported a lower amount of life-event stress than controls but listed more feelings of being under pressure [4]. Greene et al. found that psychosocial stress contributes to the clinical course of IBD [5] and, more recently, Mittermaier et al. reported that psychological factors such as a depressive mood associated with anxiety and impaired quality of life may exert a negative influence on the course of IBD. Therefore, assessment and management of psychological distress should be included in clinical treatment of patients with IBD [6].

According to my experience, very few patients easily accept being examined and managed by a psychotherapist; therefore, both surgeons and gastroen-terologists should be prepared to assess the psychological pattern of their patients by means of appropriate tests, among them the Draw-the-Family test, which may well provide evidence of and objectively score latent psychodynamic disorders, mainly related to family life. This test may be useful in case of IBD patients and may be separately shown to the psychologist afterwards to obtain more useful comments on the personality and mood of the examined subject [7]. An indirect evaluation of psychological reactions of the IBD patient may be carried out by means of the so-called Balint group, i.e. periodical meetings among the clinicians and nurses in charge of the patient. In this case, staff report to a psychiatrist patient reactions to treatment and transfer to the psychiatrist their own emotional distress felt with the patients on some occasions. We used this method with satisfactory results when dealing with cancer and IBD stoma patients [8].

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