Psychiatric manifestations in ulcerative colitis: a North Indian cohort study

Kuldeep Singh; Swati Choudhary

doi:10.18203/2320-6012.ijrms20253972

Authors

Kuldeep Singh Department of Gastroenterology, Apex Hospital, Malviya Nagar, Jaipur, Rajasthan, India
Swati Choudhary Department of Psychiatry, Jaipur National University Institute for Medical Sciences and Research Centre, Jaipur, Rajasthan, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20253972

Keywords:

Ulcerative colitis, Depression, Anxiety, Psychiatric symptoms, North India

Abstract

Background: Ulcerative colitis (UC) is a chronic inflammatory bowel disease that causes results in gastrointestinal and other health issues. Psychiatric problems are being recognized more often but are still often missed, particularly in India. Aim of the study was to examine the demographics, disease characteristics, and psychiatric symptoms of UC patients in North India.

Methods: A prospective observational study of 100 UC patients was carried out from September 2021 to September 2023. Demographics, disease extent, severity, and psychiatric outcomes were recorded, and all patients were assessed for depression and anxiety using PHQ-9 and GAD-7 scores.

Results: The mean age of the study cohort was 38.6±12.4 yrs, with 58% being male. Pancolitis was found in 48% of the patients. Clinically significant depression (PHQ-9 ≥10) and anxiety (GAD-7 ≥10) were seen in 28% and 26%, respectively. Sleep disturbances affected 44% of the patients, and fatigue was reported by 47%. Steroid-related psychiatric events occurred in 3%.

Conclusions: Psychiatric symptoms are common in UC and can negatively impact quality of life. Comprehensive care requires regular screening and a team-based approach.

Metrics

Metrics Loading ...

References

Ungaro R, Mehandru S, Allen PB, Peyrin-Biroulet L, Colombel JF. Ulcerative colitis. Lancet. 2017;389(10080):1756-70. DOI: https://doi.org/10.1016/S0140-6736(16)32126-2

Ordás I, Eckmann L, Talamini M, Baumgart DC, Sandborn WJ. Ulcerative colitis. Lancet. 2012;380(9853):1606-19. DOI: https://doi.org/10.1016/S0140-6736(12)60150-0

Kedia S, Ahuja V. Epidemiology of inflammatory bowel disease in India: The great shift east. Nat Rev Gastroenterol Hepatol. 2022;19(12):739-53.

Ng SC, Shi HY, Hamidi N, Underwood FE, Tang W, Benchimol EI, et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Gastroenterology. 2018;152(3):741-54. DOI: https://doi.org/10.1016/S0016-5085(17)33292-4

Malik TA. Inflammatory bowel disease: Historical perspective, epidemiology, and risk factors. World J Gastroenterol. 2015;21(29):9631-40.

Makharia GK, Ramakrishna BS, Abraham P, Choudhuri G, Misra SP, Ahuja V, et al. Survey of inflammatory bowel diseases in India. Indian J Gastroenterol. 2010;29(4):201-6.

Midha V, Sood A, Avasthi G, Singh A, Sood N, Ahuja V, et al. Spectrum of inflammatory bowel disease in a referral centre in northern India. Indian J Gastroenterol. 2004;23(6):214-8.

Vavricka SR, Schoepfer A, Scharl M, Lakatos PL, Navarini A, Rogler G. Extraintestinal manifestations of inflammatory bowel disease. Inflamm Bowel Dis. 2015;21(8):1982-92. DOI: https://doi.org/10.1097/MIB.0000000000000392

Harbord M, Annese V, Vavricka SR, Allez M, Barreiro-de Acosta M, Boberg KM, et al. The First European evidence-based consensus on extra-intestinal manifestations in inflammatory bowel disease. J Crohns Colitis. 2016;10(3):239-54. DOI: https://doi.org/10.1093/ecco-jcc/jjv213

Mikocka-Walus A, Knowles SR, Keefer L, Graff L. Controversies revisited: a systematic review of the comorbidity of depression and anxiety with inflammatory bowel disease. Inflamm Bowel Dis. 2016;22(3):752-62. DOI: https://doi.org/10.1097/MIB.0000000000000620

Graff LA, Walker JR, Bernstein CN. Depression and anxiety in inflammatory bowel disease: a review of comorbidity and management. Gastroenterology. 2009;136(7):2058-68. DOI: https://doi.org/10.1002/ibd.20873

Neuendorf R, Harding A, Stello N, Hanes D, Wahbeh H. Depression and anxiety in patients with inflammatory bowel disease: A systematic review. J Psychosom Res. 2016;87:70-80. DOI: https://doi.org/10.1016/j.jpsychores.2016.06.001

Bernstein CN. The brain-gut axis and stress in inflammatory bowel disease. Gastroenterol Clin North Am. 2017;46(4):839-46. DOI: https://doi.org/10.1016/j.gtc.2017.08.006

Kelly JR, Kennedy PJ, Cryan JF, Dinan TG, Clarke G, Hyland NP. Breaking down the barriers: the gut microbiome, intestinal permeability and stress-related psychiatric disorders. Front Cell Neurosci. 2015;9:392. DOI: https://doi.org/10.3389/fncel.2015.00392

Knowles SR, Graff LA, Wilding H, Hewitt C, Keefer L, Mikocka-Walus A. Quality of life in inflammatory bowel disease: a systematic review and meta-analyses—part II. Inflamm Bowel Dis. 2018;24(5):966-76. DOI: https://doi.org/10.1093/ibd/izy015

Gracie DJ, Hamlin PJ, Ford AC. The influence of psychiatric comorbidity on disease outcome in inflammatory bowel disease: a systematic review and meta-analysis. Am J Gastroenterol. 2019;114(8):1107-1118.

Marrie RA, Walld R, Bolton JM, Sareen J, Walker JR, Patten SB, et al. Increased incidence of psychiatric disorders in immune-mediated inflammatory disease. Inflamm Bowel Dis. 2017;23(9):1415-21. DOI: https://doi.org/10.1016/j.jpsychores.2017.07.015

Mikocka-Walus A, Pittet V, Rossel JB, von Känel R; Swiss IBD Cohort Study Group. Symptoms of depression and anxiety are independently associated with clinical recurrence of IBD. Aliment Pharmacol Ther. 2016;44(5):508-16.

Bager P, Befrits R, Wikman O, Lindgren S, Moum B, Hjortswang H, et al. Fatigue in out-patients with inflammatory bowel disease is common and multifactorial. J Crohns Colitis. 2011;6(6):655-62.

Warrington TP, Bostwick JM. Psychiatric adverse effects of corticosteroids. Mayo Clin Proc. 2006;81(10):1361-7. DOI: https://doi.org/10.4065/81.10.1361

Knowles SR, Mikocka-Walus A. Psychological aspects of inflammatory bowel disease: a biopsychosocial approach. Inflamm Bowel Dis. 2014;20(7):1427-35. DOI: https://doi.org/10.4324/9781315815374

Bernstein CN, Hitchon CA, Walld R, Bolton JM, Sareen J, Walker JR, et al. Increased burden of psychiatric disorders in inflammatory bowel disease. Am J Gastroenterol. 2019;114(2):375-82. DOI: https://doi.org/10.1093/ibd/izy235

Byrne G, Rosenfeld G, Leung Y, Qian H, Raudzus J, Nunez C, et al. Prevalence of anxiety and depression in patients with inflammatory bowel disease. Can J Gastroenterol Hepatol. 2017;2017:6496727. DOI: https://doi.org/10.1155/2017/6496727

Zhang CK, Hewett J, Hemming J, Grant T, Zhao H, Abrams JA, et al. The influence of depression on quality of life in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2013;19(8):1732-9. DOI: https://doi.org/10.1097/MIB.0b013e318281f395

Maunder R, Levenstein S. The role of stress in the development and clinical course of inflammatory bowel disease: epidemiological evidence. Curr Mol Med. 2008;8(4):247-52. DOI: https://doi.org/10.2174/156652408784533832

Häuser W, Janke KH, Klump B, Hinz A. Anxiety and depression in patients with inflammatory bowel disease: comparisons with chronic liver disease patients and the general population. Inflamm Bowel Dis. 2011;17(2):621-32. DOI: https://doi.org/10.1002/ibd.21346

Mikocka-Walus A, Andrews JM, Rampton D, Goodhand J, van der Woude CJ, Bernstein CN. Depression, anxiety, and self-harm in inflammatory bowel disease: a systematic review. J Psychosom Res. 2020;134:110132.