Psychosocial Adjustment

Given the close relationship between gut and brain, gastrointestinal disease may convey a special risk for psychiatric disorder, or vice versa. Youth with IBD are at greater risk of having depressive and anxiety symptoms and disorders than are healthy children (Burke et al. 1989; Engstrom 1992; Szigethy et al. 2004a, 2004b), but only a subset have psychiatric disorders of clinical significance, with depressive disorders being noted in 10%-20% of children and adolescents with IBD (Burke et al. 1989; Szigethy et al. 2004a). Although the depressive symptoms associated with IBD may be a consequence of cyto-kine-mediated inflammation and/or medications used to manage IBD, depressive symptoms and disorders can occur during periods in which IBD appears to be in remission, and the degree to which co-morbid psychiatric disorder may be influenced by drugs used in the treatment of IBD such as cortico-steroids is unclear (Szigethy et al. 2004a). Similarly, abdominal pain is common in patients with IBD who appear to be in remission, without evidence of active gut pathology (Farrokhyar et al. 2006). Review of existing studies suggests that the rates of internalizing disorders observed in association with IBD typically do not exceed those documented with other chronic physical disorders and may be a bit lower than the high rates noted in pediatric FGIDs (Mackner and Crandall 2007).

A related but different question is to what degree a psychiatric disorder such as depression can impact the course, prognosis, and even pathophysiology of the disease process in IBD. Stressful life events may appear to exacerbate the disease process, but re search in children has been limited. Theoretically, depression may impact physical health by influencing patient and family adherence to prescribed treatment regimens and the requirements of a healthy lifestyle and could also have a direct physiological impact on the disease process itself, perhaps via immune mechanisms. Consequently, aggressive management of depressive disorders in patients who are physically ill might be found to benefit physical health status, and considerable interest has been shown in whether treatment of depression or anxiety in patients with IBD might positively impact the course of the disease.

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