Understanding and managing psychological disorders in patients with inflammatory bowel disease: a practical guide

Abstract

Mood disturbances such as anxiety and depression are common in patients with inflammatory bowel disease (IBD), and impact negatively on their quality of life and disease course. An integrated multidisciplinary IBD team, which includes access to psychology and psychiatry opinion, makes possible the prompt recognition and management of psychological disturbance in patients with IBD. Based on our experience and existing literature, including systematic reviews of the effectiveness of available treatment modalities, a stepwise approach to the maintenance and restoration of psychological well-being is recommended, evolving upwards from lifestyle advice, through behavioural therapies to pharmacotherapy.

Keywords: inflammatory bowel disease; psychological stress.

Figure 1

This figure serves as a guide for the steps than can be taken in the psychological care of IBD patients by all members of the MDT. HADS or other psychometric scores can be used in adult patients (over 18) to alert clinicians that patients need help, but scores alone are not diagnostic of mood disorders and the decision to treat always depends on physician judgement and patient preference. § Some patients with mild to moderate depression may benefit from pharmacological together with psychological treatment; the decision will depend on symptom load. ¥ Patients with a passive death wish could be referred for routine or urgent psychiatric evaluation. For patients with current suicidal ideas or active suicidal intent an emergency (same day) referral must be made. ACT, acceptance and commitment therapy; A&E, accident and emergency department; CBT, cognitive behavioural therapy; GP, general practitioner; HADS, hospital anxiety and depression scale; IAPT, improving access to psychological therapies; IBD, inflammatory bowel disease; PHQ-9, patient health questionnaire 9.