A stress management programme for inflammatory bowel disease patients. Effect of psychotherapy and relaxation on the psychosocial and somatic course of Crohn's disease: main results of the German Prospective Multicenter Psychotherapy Treatment study on Crohn's Disease. Effect of psychotherapy on the course of Crohn's disease. Results of the German prospective multicenter psychotherapy treatment study on Crohn's disease. German Study Group on Psychosocial Intervention in Crohn's Disease. Effects of a comprehensive lifestyle modification program on quality-of-life in patients with ulcerative colitis: A twelve-month follow-up Stress and exacerbation in ulcerative colitis: a prospective study of patients enrolled in remission Patients’ experiences of an open access follow up arrangement in managing inflammatory bowel disease Evaluation of a psychological treatment for inflammatory bowel disease. The Crohn's and colitis knowledge score: a test for measuring patient knowledge in inflammatory bowel disease A randomised controlled trial to assess the impact of a package comprising a patient-orientated, evidence-based self-help guidebook and patient-centred consultations on disease management and satisfaction in inflammatory bowel disease. Antidepressants and inflammatory bowel disease: a systematic review Reducing psychological distress in patients with inflammatory bowel disease by cognitive-behavioural treatment: exploratory study of effectiveness. Group‐based intervention program in inflammatory bowel disease patients: Effects on quality of life Health‐related Quality of Life Improves in Children and Adolescents with Inflammatory Bowel Disease After Attending a Camp Sponsored by the Crohn's and Colitis Foundation of America Supportive-Expressive Group Psychotherapy for Persons with Inflammatory Bowel Disease Training professionals to engage with and promote self-management. High-utilizing Crohn's disease patients under psychosomatic therapy* A prospective study of the relationship between disease activity and psychologic distress in patients with inflammatory bowel disease. A cluster-randomised controlled trial of a patient-centred guidebook for patients with ulcerative colitis: effect on knowledge, anxiety and quality of life. Crohn's Disease: A Two-Year Prospective Study of the Association Between Psychological Distress and Disease Activity A multiprofessional education programme for patients with inflammatory bowel disease: A randomized controlled trial Cognitive-behavioral therapy for adolescents with inflammatory bowel disease and subsyndromal depression. Effects of Mind-Body Therapy on Quality of Life and Neuroendocrine and Cellular Immune Functions in Patients with Ulcerative Colitis A group-based patient education programme for high-anxiety patients with Crohn disease or ulcerative colitis. Patient education in inflammatory bowel disease does not influence patients knowledge and long-term psychosocial well-being. Relaxation training as a treatment for chronic pain caused by ulcerative colitis A new measure of health status for clinical trials in inflammatory bowel disease. A stress management programme for Crohn's disease. Does Better Disease-Related Education Improve Quality of Life? Impact of Depressive Mood on Relapse in Patients With Inflammatory Bowel Disease: A Prospective 18-Month Follow-Up Study Providing Disease-Related Information Worsens Health-Related Quality of Life in Inflammatory Bowel Disease Improving patient involvement in chronic disease management: the views of patients, GPs and specialists on a guidebook for ulcerative colitis. Psychological treatment may reduce the need for healthcare in patients with Crohn's disease Uncovering the Limits of Patient-Centeredness: Implementing a Self-Management Trial for Chronic Illness [Ambulatory education of patient with Crohn disease/ulcerative colitis]. [The effects of psychotherapy on Crohn's disease patients--results of a randomized multicenter study]. Impact of a nurse-led counselling service on quality of life in patients with inflammatory bowel disease. Randomized Controlled Trial Comparing the Efficacy of a Video and Information Leaflet Versus Information Leaflet Alone on Patient Knowledge About Surveillance and Cancer Risk in Ulcerative Colitis Is self-care a cost-effective use of resources? Evidence from a randomized trial in inflammatory bowel disease Effects of formal education for patients with inflammatory bowel disease: a randomized controlled trial. Quality‐of‐Life Measurement in Patients with Inflammatory Bowel Disease Receiving Social Support Quality of life: a valid and reliable measure of therapeutic efficacy in the treatment of inflammatory bowel disease. Canadian Crohn's Relapse Prevention Trial Study Group. A randomised controlled trial to assess the effectiveness and cost of a patient orientated self management approach to chronic inflammatory bowel disease
This r and omized controlled trial was design ed to determine whether practising stress management techniques would decrease activity and promote psychosocial functioning in inflammatory bowel disease patients . Eighty ambulatory adults received a pre-intervention interview , at which time baseline data about disease activity and psychosocial functioning were collected . They were then r and omly assigned to either the intervention or control group . The intervention group received six classes on stress management which included autogenics , personal planning skills and communication techniques . All 80 subjects were followed up at 4-month intervals for 1 year by interviewers who were blind to group design ation . The data collection instruments , which were used at all assessment points , comprised three question naires : the Crohn 's Disease Activity Index ( CDAI ) and the Inflammatory Bowel Disease ( IBD ) Stress Index . These instruments produced scores which decreased with improvement in physical and psychosocial well-being . At all assessment points , both the CDAI and IBD Stress Index scores dropped significantly ( P less than 0.05 ) from baseline in the treatment group . However , there was no significant change in the scores of the control group throughout the study year . There were no significant changes in medications at any assessment point in either group that could account for changes in the scores . The results of this study indicate that stress management techniques may have therapeutic benefits for IBD patients OBJECTIVE Few studies have been published on the influence of psychotherapy on the physical and psychosocial course of Crohn 's disease ( CD ) . METHODS The present study , a prospect i ve , r and omized multicenter investigation conducted with 108 of 488 consecutive CD patients , was design ed to investigate the influence of short-term psychodynamic therapy and relaxation in addition to a st and ardized glucocorticoid therapy on the somatic course of the disease as well as on patient psychosocial status . Based on the same st and ardized somatic treatment , the psychotherapy and control groups were compared after a 1-year treatment period and a follow-up of another year with regard to somatic course and psychosocial situation . RESULTS A total of 81 ( 75 % ) of 108 r and omized patients completed the psychosocial follow-up . The comparison between the therapy groups after 1 year showed no significant differences in the four main target criteria of psychosocial status ( depression , anxiety , psychosocial-communicative status and health-related quality of life ) . The mean Beck 's Depression Inventory ( BDI ) score at admission was 12.3 in the psychotherapy group and 8.7 in the control group . At the 1-year follow-up , the scores for depression have been 7.8 ( psychotherapy group ) and 7.8 ( control group ) . In the 2-year follow-up , 84 patients were classified into four groups on the basis of somatic course ; 23 % of the control group and 30 % of the psychotherapy group showed episode-free courses , 29 % and 17 % respectively underwent surgery due to failure of immunosuppressive or medical therapy , and a further subranking showed no significant differences between the two groups ( P=.125 ) . At the 1-year follow-up , the scores for depression of patients with an active episode respective remission were 14.6 vs. 5.8 . From the patient 's point of view , at the end of the 2-year follow-up , the overall subjective evaluation of the effectiveness of psychotherapy  was positive . CONCLUSION The patients included showed no psychosocial disturbances of clinical relevance . Although a tendency toward fewer surgical interventions , fewer relapses and reduction of depression was noted , the analysis was unable to demonstrate any benefit from psychosocial intervention on hypothesized parameters of psychosocial status and somatic course . Further studies should be performed to identify patient subgroups that may benefit from psychosocial intervention BACKGROUND Our aim was to study the influence of psychotherapy in addition to a st and ardized corticosteroid treatment on the somatic and psychosocial course of Crohn 's disease . METHODS In a prospect i ve , r and omized multicenter study 108 of 488 patients received either drug treatment  or , in the intervention group , additionally psychotherapy in the first half of the 2-year follow-up period . RESULTS Eighty-four patients ( 77.8 % ) completed the somatic and 81 ( 75 % ) the psychosocial follow-up . Twenty-three per cent of the control group and 30 % of the psychotherapy group showed episode-free courses ; 29 % and 17 % , respectively , underwent surgery due to failure of drug treatment . The main analysis , which was based on subranking by number , duration , and severity of relapses , failed to show significant differences between the two groups ( P = 0.125 ) . The same result was obtained for the psychosocial status after 1 year in the main target criteria depression , anxiety , psychosocio-communicative status , and quality of life . CONCLUSIONS The confirmatory analysis did not prove significantly better courses after additional psychotherapy . There was a tendency towards fewer operations Objective . To analyze the effects of a comprehensive lifestyle modification program on health-related quality -of-life , psychological distress , and clinical parameters in patients with ulcerative colitis ( UC ) 3- and 12 months after completion of the program . Material and methods . Sixty patients with UC in clinical remission or with low disease activity were r and omly assigned to an intervention group or a usual-care control group . Comprehensive lifestyle modification consisted of a structured 60-h training program over a period of 10 weeks which included stress management training , psychoeducational elements , and self-care strategies .  Quality -of-life , psychological distress , and clinical disease activity were assessed with st and ardized question naires ( Inflammatory Bowel Disease Question naire ( IBDQ ) ; the MOS Short-Form 36 ( SF-36 ) ; the Brief Symptom Inventory ( BSI ) , and the Colitis Activity Index ( CAI ) ) at baseline , and 3 months and 12 months after comprehensive lifestyle modification . Results . Three months after comprehensive lifestyle modification , patients in the intervention group showed significantly greater improvement in the SF-36 scale physical function ( p=0.0175 ) , and a significantly greater reduction in anxiety scores , measured with the BSI ( p=0.0294 ) . Use of relaxation techniques was a significant predictor of improvement in the psychological sum score after 3 months of therapy ( p=0.034 ) . Though 80 % of patients with an initial IBDQ score < 170 in the intervention group showed an improvement of > 16 points after 3 months , no significant effects of the intervention were found on the IBDQ scales , or on clinical disease parameters , including CAI scores , self-assessed disease activity , hospitalizations , or medical consultations . Conclusions . These results are consistent with possible short-term benefits of a comprehensive lifestyle modification program on some aspects of quality -of-life and emotional well-being , but no effects were discernable 12 months after completion of therapy . Comprehensive lifestyle modification had no effect on clinical disease variables . The generalizability of these data is limited because of the inclusion of patients with a relatively low disease activity who were interested in integrative medicine OBJECTIVE : We sought to determine whether psychosocial factors influence the course of ulcerative colitis , hypothesizing that high perceived stress among patients with inactive disease will increase the risk of subsequent exacerbation . METHODS : Sixty-two patients with known ulcerative colitis were enrolled into a prospect i ve cohort study while in clinical remission . Their perceived stress , depressive symptoms , and stressful life events  were followed , along with potential confounders , for up to 45 months ; exacerbation status was monitored for up to 68 months . RESULTS : The 27 patients who experienced an exacerbation were compared with those who remained in remission . Having a score in the upper tertile on the long-term ( past 2 yr ) baseline Perceived Stress Question naire significantly increased the actuarial risk of exacerbation ( hazards ratio = 2.8 , 95 % confidence interval 1.1–7.2 ) . At any given study visit , high long-term stress tripled the risk of exacerbation during the next 8 months ( risk for the three tertiles , 8.3 % , 16.7 % , and 26.2 % , p = 0.02 ) . Shorter sleep time , briefer remission , histological activity , and use of nonsteroidal antiinflammatory drugs , antibiotics , or oral contraceptives also increased the medium- and /or long-term risk of exacerbation , but adjustment for these variables did not eliminate the associations with stress . Exacerbation was not associated with stressful life events , depressive symptoms , short-term ( past month ) perceived stress , smoking , disease extent or duration , or severity of recent course . CONCLUSIONS : Short-term stress does not trigger exacerbation in ulcerative colitis , but long-term perceived stress increases the risk of exacerbation over a period of months to years Background : Improving access is a key policy issue in improving quality of care and extending patient choice and participation . People ’s experience of changing from fixed outpatient appointments to more flexible direct access arrangements for chronic disease has been underexplored . Objectives : To examine patients ’ views on using an open system of access compared with fixed outpatient appointments as part of a guided self-management intervention for inflammatory bowel disease ( IBD ) . Design : Embedded qualitative study undertaken alongside a r and omised controlled trial . Semi-structured interviews were undertaken to obtain an in depth underst and ing of patients ’ experience of the change in access arrangements . Participants : A purposive sample ( n = 30 ) was drawn from the intervention group ( n = 700 ) according to a range of responses to the trial baseline and follow up quantitative measures . Results : 28 interviews were included in the analysis . Compared with the previous system of fixed appointments , preference for the new open access system was based on enhanced personal control in contacting services and the view that it fitted better with everyday routine management and the requirement for urgent medical contact when symptoms fail to respond to medication . Preference for retaining fixed appointments was based on a sense of security from gaining access which did not require the individual to initiate the request for medical help . Conclusions : Open access may fit better with patients ’ self-management of their condition and everyday routines , roles and responsibilities . Ensuring that outpatient organisational arrangements and personnel are responsive to patient initiated requests for appointments is likely to impact on the acceptability of this type of access arrangement . Some people may continue to prefer the fixed appointment system which should be retained if patient choice is to be respected Inflammatory bowel disease ( IBD ) encompasses two related gastrointestinal-tract diseases , ulcerative colitis ( UC ) and Crohn 's Disease ( CD ) . This study , a r and omized controlled trial , compared the effectiveness of a multi-component behavioral treatment package ( n = 11 ) , which included IBD education , progressive muscle relaxation , thermal biofeedback , and training in use of cognitive coping strategies , to the effectiveness of symptom-monitoring ( n = 10 ) as a control condition ; 8 controls subsequently completed treatment . At posttreatment , the treatment group showed mean reductions on 5 symptoms , while the symptom monitoring controls showed mean reductions on all 8 symptoms . On a measure of Total Symptomatic change , the controls showed more improvement than the treated group ; the treated controls at posttreatment , showed increases on all 8 symptoms . However , treated subjects perceived themselves as coping better with IBD , as feeling less IBD-related stress , and as experiencing less depression and anxiety . It is hypothesized that inherent differences may have existed between CD and UC subjects which could have led to the differences seen in treatment responses OBJECTIVE : The aim of this study was to develop a valid and reliable question naire assessing patient knowledge of inflammatory bowel disease ( IBD ) and its treatment — the Crohn 's and Colitis Knowledge ( CCKNOW ) Score . METHODS : A total of 30 multiple choice questions were constructed into a draft question naire . This was piloted on a r and om selection of participants with differing IBD knowledge levels ; junior doctors , nurses , and ward clerks . Factor analysis eliminated questions with poor discriminant ability . The result ing 24-item question naire ( CCKNOW score )  was retested on the three groups , and a Kruskal-Wallis test determined the question naire 's ability to discriminate between the groups . Reliability and readability were tested using Cronbach 's α and the Flesch Kincaid reading score . The vali date d CCKNOW was then tested on patients from the Leicestershire IBD data base . RESULTS : CCKNOW scores differed significantly across the groups of doctors , nurses , and ward clerks ( median 22 , 16 , and five , respectively ) T = 40.35 , p < 0.0001 . The reliability was very good with a Cronbach 's α of 0.95 and the readability was also high . The median score on the CCKNOW  for IBD patients was 10 , with no significant difference between ulcerative colitis and Crohn 's disease . Patients who are members of NACC ( National Association of Crohn 's and Colitis ) achieve statistically significantly higher scores than do nonmembers ( difference in medians 4 , 95 % confidence interval 4–6 , p < 0.0001 ) . CONCLUSIONS : The CCKNOW score provides a valuable index of overall knowledge . It is self-administered and psychometric tests show it to be valid , reliable , and readable . It may be used in the future as a tool to evaluate patient education programs OBJECTIVES To determine if a whole systems approach to self-management improves clinical outcomes and leads to cost-effective use of NHS services . DESIGN Nineteen hospitals were r and omised to 10 control sites and nine intervention sites . Consultants from intervention sites received training in patient-centred care before recruitment and introduced the intervention to eligible patients . Patients at the control sites were recruited and went on to have an ordinary consultation . Qualitative interviews were undertaken to obtain an in-depth underst and ing of patients ' and consultants ' experience of the intervention . SETTING Follow-up outpatient clinics at 19 hospitals in the north-west of Engl and . PARTICIPANTS Seven hundred patients ( 297 at intervention sites and 403 at control sites ) with established ulcerative colitis or Crohn 's disease , aged 16 years and over , and able to write in English .  INTERVENTIONS Consultants were trained to provide a patient-centred approach to care . Guidebooks on ulcerative colitis and Crohn 's disease were developed with patients prior to the study . Patients prepared a written self-management plan and self-referred to services based on a self-evaluation of their need for advice . MAIN OUTCOME MEASURES Rates of hospital outpatient consultation , quality of life ( QoL ) and acceptability to patients . Health service re source use and assessed cost effectiveness using the EQ-5D . RESULTS After 1 year , the intervention result ed in fewer hospital visits , without change in the number of primary care visits . Patients felt more able to cope with their condition . The intervention produced no reduction in QoL and did not raise anxiety . The intervention group reported fewer symptom relapses ; 74 % of patients in the intervention group indicated a preference to continue the system . Qualitative results showed the guidebook was effective but organisational limitations constrained patient-centred aspects of the intervention for some . Cost-effectiveness analyses favoured self-management over st and ard care . CONCLUSIONS Further use of this method in chronic disease management seems likely to improve overall patient satisfaction and reduce health expenditure without evidence of adverse effect on disease control . Further attention needs to be given to self-referral and access arrangements and a re-distribution of control to patients through increased adherence to patient-centred norms on the part of consultants . Future research is recommended to evaluate the operating systems within secondary and primary care that would allow self-managers to self-refer and to keep them informed of new treatments , also to explore models for training health professionals in self-care methods , to study long-term effects of self-management in chronic disease and to transfer this approach to other chronic conditions Background A number of studies have suggested a link between the patient 's psyche and the course of inflammatory bowel disease ( IBD ) . Although pharmacotherapy with antidepressants has not been widely explored , some investigators have proposed that treating psychological co-morbidities with antidepressants may help to control disease activity . To date a systematic analysis of the available studies assessing the efficacy of antidepressants for the control of somatic symptoms in IBD patients has not been performed . Methods We search ed electronic data bases , without any language restriction . All relevant papers issued after 1990 were examined . Results 12 relevant publications were identified . All of them referred to non-r and omised studies . Antidepressants reported in these publications included paroxetine , bupropion , amitriptyline , phenelzine , and mirtazapine . In 10 articles , paroxetine , bupropion , and phenelzine were suggested to be effective for treating both psychological and somatic symptoms in patients suffering from IBD . Amitriptyline was found ineffective for treating somatic symptoms of IBD . Mirtazapine was not recommended for IBD patients . Conclusion Although most of review ed papers suggest a beneficial effect of treatment with antidepressants in patients with IBD , due to the lack of reliable data , it is impossible to judge the efficacy of antidepressants in IBD . Properly design ed trials are justified and needed based upon the available uncontrolled data BACKGROUND This prospect i ve study aim ed to determine whether cognitive-behavioural group treatment accompanying medical st and ard care is effective in reducing psychological distress in patients with inflammatory bowel disease . METHODS Twenty-eight out patients with Crohn disease or ulcerative colitis completed the treatment programme . Psychological treatment consisting of 12 weekly sessions was conducted in a group setting . Medical and psychometric assessment s were taken at the beginning of the 3-month pretreatment waiting period , at pretreatment , at post-treatment and at the 3 , 6 and 9-month follow-ups . RESULTS During baseline , no change was observed in psychological distress . Disease-related worries and concerns decreased significantly from pretreatment to the follow-ups . The disease groups differed in the decline of concerns between pre- and post-treatment , with a significant reduction of concerns in patients with ulcerative colitis but not Crohn disease . This difference did not occur at the follow-ups , indicating long-term improvement for both disease groups . Depressive coping decreased significantly in women and remained stable at the follow-ups , whereas depressive coping did not change in men . The same gender difference was found for depressive symptoms . CONCLUSIONS The exploratory findings suggest that psychological group treatment for out patients is a feasible and effective approach for the short- and long-term reduction of psychological distress for patients with inflammatory bowel disease . However , the revealed gender differences on coping and depression might indicate the necessity to consider gender-specific aspects of inflammatory bowel disease when design ing and evaluating psychological interventions Background Inflammatory bowel diseases ( IBD ) such as ulcerative colitis ( UC ) and Crohn 's disease ( CD ) have great impact on patients ' health‐related quality of life ( HRQOL ) . The aim of this study was to develop an integrated medical and psychological/psychosocial group‐based intervention program for IBD patients and to evaluate if such a program could influence the patients ' HRQOL and coping abilities . Methods IBD patients in remission or with low disease activity were r and omized to intervention or control groups . The intervention comprised nine weekly sessions , alternating lectures , and group therapy sessions .  The Inflammatory Bowel Disease Question naire ( IBDQ ) and the Sense of Coherence scale ( SOC ) were used to measure HRQOL and coping ability at 0 , 6 , and 12 months . The intervention was evaluated by a  visual analog scale (  VAS ) and written comments  by a content analysis . Results In all , 24 patients were included in the intervention group and 20 in the control group .  The mean IBDQ score showed no statistically significant differences before ( 173.9 ) or after the intervention at month 6 ( 175.7 ) or at month 12 ( 171.8 ) , or when comparing intervention and controls at month 12 . Similarly , there were no statistically significant differences in mean SOC before or after intervention or when comparing groups . The VAS and the content analysis showed that the intervention was well appreciated by the patients . Conclusions The group‐based intervention program was feasible and highly appreciated . There were no statistically significant differences in average IBDQ or SOC over time or in comparison with controls , although a significant increase was seen in patients with short disease duration . ( Inflamm Bowel Dis 2007 Purpose : To describe the reported health‐related quality of life ( HRQOL ) in children and adolescents with inflammatory bowel disease ( IBD ) after attending an IBD summer camp . Methods : A prospect i ve analysis of quality of life was completed at an overnight camp that was exclusively for patients with IBD , which was sponsored by the Crohn 's and Colitis Foundation of America . The IMPACT‐II question naire ( Canada and United States ) and the State‐Trait Anxiety Inventory for Children were administered to the campers at the beginning and at the end of a 1‐week camp to assess HRQOL and anxiety . The IMPACT‐II question naire consists of 35 questions measuring 6 quality ‐of‐life domains ( i.e. , bowel domain , systemic symptoms , emotional functioning , social functioning , body image , and treatment/ interventions ) . The State‐Trait Anxiety Inventory for Children consists of 2 different 20‐item sets of questions . One set assesses state anxiety , and the other , trait anxiety . A repeated‐ measures multivariate analysis of variance was performed to determine the differences between scores attained before and after camp on the IMPACT‐II question naire and in each of its domains . Paired sample t tests were performed on state and trait anxiety before and after camp . Results : A total of 125 individuals consented to participate , but 61 patients ( 50 girls and 11 boys ; age range , 9 to 16 y ) completed the IMPACT‐II question naire in full . Of those 61 patients , 47 had Crohn 's disease and 14 had ulcerative colitis . There was statistically significant improvement between the mean ( ±SD ) precamp total score ( 172.95 ± 36.61 ) and the mean postcamp total score ( 178.71 ± 40.97 ; P = 0.035 ) , bowel symptoms scores ( P = 0.036 ) , social functioning scores ( P = 0.022 ) , and treatment interventions scores ( P = 0.012 ) . No difference was found between anxiety scores before and after camp on either the state or trait anxiety inventories ( n = 55 ; P > 0.05 ) . Conclusions : Overall , HRQOL improved in children after attending IBD summer camp . This exploratory study suggests that contributing factors for these improvements may be an increase in social functioning , a better acceptance of IBD symptoms , and less distress regarding treatment interventions , suggesting that a camp that is specifically design ed for children with IBD may normalize the chronic illness experience . However , future research using a multimodal measurement approach is warranted to support these conclusions Objective : Supportive-expressive ( SE ) group psychotherapy is design ed to be applicable to medically ill population s. In this open trial , SE therapy was adapted for use in treating inflammatory bowel disease ( IBD ) . Method : Thirty subjects with Crohn 's disease ( CD ) or ulcerative colitis ( UC ) were enrolled in 4 psychotherapy groups . Each group met weekly for 20 weeks to discuss emotional and interpersonal issues associated with illness . Physical and psychological variables were measured at the onset and at the finish of the group sessions . Results : There was no mean group change in quality of life ( QL ) , anxiety , or depression over the course of treatment , although there was a mean group reduction in maladaptive coping . Conclusion : Although the trial was uncontrolled and the sample size small , which limits interpretation , the results are consistent with an ineffective intervention . Because a null result would be consistent with previously reported psychotherapeutic trials in cases of IBD , and because SE therapy has been effective in treating other medically ill population s , we discuss characteristics of IBD that may account for a relative resistance to psychotherapeutic support . Objectif : La thérapie de soutien par l'expression ( SE ) en groupe peut s'appliquer à des population s souffrant de maladies somatiques . Dans cet essai ouvert , la thérapie de SE a été adaptée au traitement de la maladie intestinale inflammatoire ( MII ) . Méthode : Trente sujets souffrant de la maladie de Crohn ( MC ) ou de colite ulcéreuse ( CU ) se sont inscrits dans 4 groupes de psychothérapie . Chaque groupe s'est réuni chaque semaine pendant 20 semaines pour discuter des questions émotionnelles et interpersonnelles liées à la maladie . Les variables physiques et psychologiques ont été mesurées au début et à la fin des séances de groupe . Résultats : Il n'y avait pas de moyenne dans le groupe concernant le changement de qualité de vie ( QV ) , d'anxiété ou de dépression en cours de traitement , mais il y avait une réduction moyenne des mécanismes d'adaptation mésadaptés . Conclusion : Même s'il s'agit d'un essai non contrôlé et d'un petit échantillon , ce qui limite l'interprétation , les résultats sont conformes à une intervention inefficace . Étant donné qu'un résultat nul serait conforme aux essais psychothérapeutiques déjà rapportés dans des cas de MII , et que la thérapie de SE a traité efficacement d'autres population s souffrant de maladies somatiques , nous présentons les caractéristiques de la MII auxquelles on peut attribuer une résistance relative au soutien thérapeutique We have set out to investigate an approach to improve patients '  ability to self-manage chronic illness .  For effective health care in chronic disease , we believe patients need to work in partnership with their doctor ; patient-centred consultations are one way to achieve this . This report describes our experience of training specialists in gastroenterology to consult in a patient-centred style as part of a complex self-management intervention in a r and omized controlled trial ( RCT ) involving 700 patients with established inflammatory bowel disease ( IBD ) attending outpatient clinics . The training session aim ed to provide specialists from nine r and omly selected intervention sites with the basic skills to carry out the intervention . The training lasted 2 hours , and included background on the research and intervention , a demonstration video , role-play , and video-feedback training . The main findings of the RCT are presented ( service use , enablement and satisfaction ) , and discussed in the light of the views of consultants and patients on the experience of putting the training into practice . The findings of our study confirm and highlight the value of training in patient-centred communication and its potential for promoting self-management effects ; the training proved effective in enabling consultants in gastroenterology to establish guided self-management in patients with IBD Objective Few studies have been published on health care utilization in Crohn 's disease and the influence of psychological treatment on high utilizers . Methods The present sub study of a prospect i ve multi center investigation conducted in 87 of 488 consecutive Crohn 's disease ( CD ) patients was design ed to investigate the influence of the course of Crohn 's disease on health care utilization ( hospital days ( HD ) and sick leave days ( SLD ) collected by German insurance companies ) and to examine the conditions of high-utilizing patients . Predictors of health care utilization should be selected . Based on a st and ardized somatic treatment , high health care utilizing patients of the psychotherapy and control groups should be compared before and after a one-year treatment . Results Multivariate regression analysis identified disease activity at r and omization as an important predictor of the clinical course ( r2 = 0.28 , p < 0.01 ) . Health care utilization correlated with duration of disease ( p < 0.04 ) , but the model was not significant ( r2 = 0.15 , p = 0.09 ) . The patients ' level of anxiety , depression and lack of control at r and omization predicted their health-related quality of life at the end of the study ( r2 = 0.51 , p < 0.00001 ) . Interestingly , steroid intake and depression ( t1 ) predicted the combined outcome measure ( clinical course , HRQL , health care utilization ) of Crohn 's disease at the end of the study ( r2 = 0.22 , p < 0.001).Among high utilizers , a significantly greater drop in HD ( p < 0.03 ) and in mean in SLD were found in the treatment compared to the control group . Conclusion The course of Crohn 's disease is influenced by psychological as well as somatic factors ; especially depression seems important here . A significant drop of health care utilization demonstrates the benefit of psychological treatment in the subgroup of high-utilizing CD patients . Further studies are needed to replicate the findings of the clinical outcome in this CD subgroup BACKGROUND The evaluation of  psychologic states  is very useful in the management of inflammatory bowel disease ( IBD ) patients , particularly when related to disease activity ( DA ) . Our aim was to prospect ively evaluate the relationship between psychologic distress and DA . METHODS DA and psychologic distress were evaluated in 104 IBD out patients by means of clinical criteria and the  Hospital Anxiety and Depression Scale ( HADS ) at base line and after 6 months . Patients were grouped in unchanged , improved , and worsened DA from base line to follow-up . RESULTS Repeated- measures ANOVA showed a significant group-by-time interaction for HADS anxiety ( F = 89.6 , P = 0.0001 ) and depression ( F = 3.67 , P = 0.03 ) subscales . CONCLUSIONS Over time changes in DA significantly affect psychologic distress and are closely related to corresponding increases and decreases in anxiety and depression in IBD patients . Our findings therefore suggest that the assessment of psychologic distress , particularly anxiety , should be included in the clinical management of IBD patients A r and omised controlled trial was undertaken to evaluate the impact of a patient-centred , evidence -based guidebook on knowledge , anxiety and quality of life ( QoL ) in patients with ulcerative colitis . The information in the book was developed closely with patients and focused on their identified needs . All 240 subjects in the study were on long-term follow-up for ulcerative colitis and were effectively responsible for the day-to-day management of their condition in the community . Outcomes were measured at 1 month and 9 months . Patients attended outpatient clinics at six hospitals : three hospitals were r and omised to be control sites ; and three were intervention sites where patients were given a  copy  of the guidebook .  The results showed that patients receiving the guidebook demonstrated significantly better knowledge of their ulcerative colitis at 1 month , which persisted at 9 months , than patients in the control group . Anxiety and QoL scores were unchanged throughout . The present authors conclude that appropriate information is an essential prerequisite to greater patient involvement in chronic disease management . Patient-centred information increases knowledge without increasing anxiety and should be made available to patients through an appropriate health provider Our objective was to explore the relationship between psychological distress and subsequent Crohn 's disease ( CD ) activity . Eighteen CD patients were followed prospect ively for 2 years at 8- to 12-week intervals . Disease activity was assessed using the Crohn 's Disease Activity Index ( CDAI ) . Psychological distress was assessed using the following self-administered question naires : Beck Depression Inventory ( BDI ) , Beck Anxiety Inventory ( BAI ) , Beck Hopelessness Scale ( BHS ) ,  and multiple Holmes Recent Life Changes ( RLC ) Question  naires . The effects of psychological distress on current and subsequent CDAI ( approximately 8–12 weeks later ) were assessed using generalized estimating equations ( GEE ) . The mean CDAI score during follow-up was 138 ± 86 , with a median of 121 ( range , 0 to 394 ) . BDI scores ( possible range of 0 to 63 ) were independently associated with CDAI scores simultaneously ( β = 5.64 , P=0.004 ) and 8–12 weeks later ( β = 6.08 , P=0.004 ) . Higher levels of anxiety , hopelessness , and recent life changes were also suggestive of higher CDAI scores , however , their effects were generally of lesser magnitude and not independent of the influence of depressive symptoms . Levels of depressive symptoms are positively associated with future changes in CDAI . Routine psychological assessment may help to identify patients at higher risk for exacerbation Objective . Health-related quality of life is impaired in patients with inflammatory bowel disease and improved disease-related information can improve this situation . The aims of this study were to create an education programme that could be readily applicable at the clinic and would be suitable for newly diagnosed patients with inflammatory bowel disease , and to investigate whether the programme could improve their health-related quality of life . Material and methods . Ninety-three patients with inflammatory bowel disease in remission were included and r and omized to an intervention group or a control group . The intervention group attended a multiprofessional education programme while the control group received regular information . Four question naires were used for measuring health-related quality of life . Both groups completed the question naires at baseline and after 6 months . The intervention group also completed the question naires after 1 month . Results . No significant differences were found when comparing the two groups at 6 months . However , the multiprofessional education programme was highly appreciated by the patients . Conclusions . In the present study no improvement could be seen in health-related quality of life in patients with inflammatory bowel disease after participating in an education programme in comparison with the control group . This might be due to the fact that the question naires were not sensitive enough or that some patients were not in clinical remission . The patients ’ enthusiasm for the multiprofessional education programme has led to its being part of the regular care at the clinic OBJECTIVE To examine the feasibility and efficacy of a manual-based cognitive-behavioral therapy ( CBT ) in reducing depressive symptomatology in adolescents with inflammatory bowel disease ( IBD ) . Primary and Secondary Control Enhancement Therapy-Physical Illness ( PASCET-PI ) modified for youths with IBD was compared to treatment as usual ( TAU ) , plus an information sheet about depression , without therapist contact using assessable patient analysis . METHOD Following assessment , participants 11 to 17 years old with IBD and mild to moderate subsyndromal depression were r and omly assigned to PASCET-PI ( n = 22 ) or comparison treatment ( n = 19 ) . Primary outcome measures at baseline ( T1 ) and 12 to 14 weeks posttreatment ( T2 ) were Children 's Depression Inventory ( child/parent report ) , Schedule for Affective Disorders and Schizophrenia for School-Age Children ( K-SADS ) , Children 's Global Assessment Scale , and Perceived Control Scale for Children . RESULTS The PASCET-PI group showed significantly greater improvement in Children 's Depression Inventory ( child/parent report ) , Children 's Global Assessment Scale , and Perceived Control Scale for Children posttreatment than the comparison group . CONCLUSIONS Screening and treatment of depressive symptoms in pediatric setting s is feasible . PASCET-PI may be an efficacious intervention for subsyndromal depression in adolescents with IBD , although comparison with a more active treatment is necessary to attribute the improvement to PASCET-PI . CLINICAL TRIAL REGISTRATION INFORMATION URL : http:// clinical trials.gov . Unique identifier : NCT00446238 Background : The aim of this study was to investigate the effects of mind-body therapy on neuroendocrine and cellular immune measures , health-related quality of life and disease activity in patients with ulcerative colitis ( UC ) in remission . Methods : Thirty UC patients in remission or with low disease activity were r and omly assigned to an intervention group ( n = 15 ) or a usual-care waiting control group ( n = 15 ) . Intervention consisted of a structured 60-hour training program over 10 weeks which included stress management training , moderate exercise , Mediterranean diet , behavioral techniques and self-care strategies . Quality of life , perceived stress and disease activity were assessed with st and ardized question naires ( IBDQ , SF-36 , PSS , CAI ) . In addition , the distribution of circulating lymphocytes and lymphocyte subsets as well as the β-adrenergic modulation of TNF-α production in vitro were analyzed . Urine catecholamines and plasma cortisol , prolactin and growth hormone were measured pre- and postinterventionally , and were compared with a healthy control group ( n = 10 ) . Results : In response to therapy , patients in the intervention group showed significantly greater improvement in the SF-36 scale Mental Health and the Psychological Health Sum score compared with changes observed in the usual-care waiting control group . Patients in the intervention group showed significantly greater improvement on the IBDQ scale Bowel Symptoms compared with the control group . However , no significant group differences in circulating lymphocyte subsets or endocrine parameters were observed in response to therapy . In addition , no significant effects of intervention on either the basal levels of TNF-α or the suppressive action of the β-adrenergic agonist isoproterenol on TNF-α production were observed . Conclusion : Mind-body therapy may improve quality of life in patients with UC in remission , while no effects of therapy on clinical or physiological parameters were found , which may at least in part be related to selective patient recruitment BACKGROUND The inflammatory bowel diseases ( IBD ) ulcerative colitis ( UC ) and Crohn disease ( CD ) affect a person 's health-related quality of life ( HRQOL ) . IBD patients report high levels of anxiety , which correlates with the degree of perceived dissatisfaction with the information on disease-related themes provided in routine health care . The aim of this study was to evaluate changes in anxiety after participation in a group-based educational intervention for IBD patients screened for high anxiety . METHODS The programme consisted of 8 sessions , and 49 patients participated .  Anxiety was assessed using the Hospital Anxiety and Depression ( HAD ) Scale at baseline and 6 months after intervention . HRQOL was assessed with the Inflammatory Bowel Disease Question naire ( IBDQ ) and the SF-36 health survey . Participant satisfaction with education was measured using a study -specific question naire . RESULTS No significant change on the HAD anxiety score was found at the 6-month follow-up for those who participated in the education programme despite the fact that the participants reported they had gained better knowledge of disease-related items . Furthermore , there were no significant changes over time regarding bowel symptoms , systemic symptoms , emotional functioning and social functioning of the IBDQ or generic HRQOL ( SF-36 ) . CONCLUSIONS IBD patients with a high anxiety level  reported improved satisfaction with information about disease-related items , but did not indicate any benefits in terms of reduced anxiety or improved HRQOL after participating in the education programme , not at least in the short-term perspective . In this selected group of patients , psychosocial problems other than disease-related concerns were found that warrant other approaches BACKGROUND AND AIMS Patient education is accepted in many disciplines as a valid component of disease management in chronic diseases . The aim of this prospect i ve study was to analyze the effects of an education program in patients with inflammatory bowel disease . METHODS 145 patients with inflammatory bowel disease were prospect ively included : 73 were  educated in four sessions  , 72 were  educated after the one year evaluation period ( control group ) . The following topics were presented : pathogenesis , diagnostic procedures , course of disease , medical and surgical treatment , nutrition , social problems and support , stress management , and coping with the disease . RESULTS The repeated measurement two-way analysis of variances showed no effects of the patient education program on disease-related knowledge , depression and quality of life . CONCLUSION This patient education program was not able to increase disease-related knowledge or psychosocial variables in patients with IBD . However , most of the patients were very satisfied with the education program , since as judged by their own assessment it helped them to act responsibly for themselves and their disease & NA ; Relaxation training was found to be highly successful in ameliorating pain in a population that has not been studied before — individuals with ulcerative colitis . Twenty subjects with chronic pain due to ulcerative colitis received 6 weekly training sessions of 75 min duration in the technique of progressive relaxation , and another 20 subjects with the same condition constituted an attention control group . There were no significant differences between experimental and control subjects before treatment but , immediately after treatment and also at the 6‐week follow‐up , experimental and control subjects differed significantly on 6 of 7 measures . By comparison with control subjects , experimental subjects : ( 1 ) used significantly fewer words on the McGill Pain Question naire to describe their pain ( P < 0.001 ) ; ( 2 ) rated their pain , on a scale of 1–10 , as less intense ( P < 0.02 ) ; ( 3 ) said that their pain was less frequent ( P < 0.04 ) ; ( 4 ) rated their pain relief , on a scale of 1–10 , as greater ( P < 0.001 ) ; ( 5 ) reported , on the Zung Pain and Distress Scale , less distress due to pain ( P < 0.001 ) . After treatment but not before there were significantly fewer experimental than control subjects taking anti‐inflammatory drugs ( P < 0.03 ) We have developed a measure of subjective health status ( quality of life ) for patients with inflammatory bowel disease ( IBD ) . Ninety-seven patients with IBD described problems they had experienced as a result of the disease ; the 32 most frequent and important items were included in the Inflammatory Bowel Disease Question naire ( IBDQ ) . Sixty-one IBD patients were evaluated twice . One month separated the evaluations , at which disease activity indices , the IBDQ , and a number of other question naires were administered . Reproducibility studies in 19 stable patients showed improvement in scores , but also a small within-person st and ard deviation . Responsiveness studies revealed large changes in scores in patients who had improved or deteriorated and suggested that the IBDQ was more responsive than a general health status measure . Responsiveness appeared greater in patients with ulcerative colitis than in those with Crohn 's disease . Predicted and observed correlations between changes in IBDQ score and changes in other measures were similar . We conclude that although further testing is required , particularly in examining the relation between changes in the IBDQ and changes in the activity of Crohn 's disease , the IBDQ shows promise as a measure of health status for clinical trials in IBD The present study was design ed to assess the effectiveness of techniques of behavioural assessment and treatment of Crohn 's disease ( CD ) . On the assumption that stress events have a pronounced influence on the life of Crohn 's patients , we proposed stress management treatment . This is intended to control stress and improve patients ' personal and social competence .  Forty-five patients with Crohn 's disease were r and omly assigned to one of three treatment groups , two experimental groups : stress management and self-directed stress management , and a control group : conventional medical treatment . The subjects underwent eight individual sessions which were specific to each condition . All subjects completed symptom monitoring diaries . The subjects who received training in stress management experienced a significant post-treatment reduction of tiredness ( P < 0.1 ) , constipation ( P < 0.1 ) , abdominal pain ( P < 0.5 ) and distended abdomen ( P < 0.5 ) . The subjects who received training in self-directed stress management experienced a significant reduction in tiredness ( P < 0.1 ) and abdominal pain ( P < 0.5 ) . No significant changes were observed in symptomatology in the conventional medical treatment group . Similar results were obtained in the 12 month follow-up The importance of health-related quality of life ( HRQOL ) assessment in patients with chronic disorders such as inflammatory bowel disease ( IBD ) is now acknowledged by research ers . Of the many factors that may influence HRQOL , patient knowledge of the condition and disease-related information provision have hitherto not been studied . In all , 250 patients with inactive IBD ( UC = 128 , CD = 122 ) were r and omly chosen from our IBD clinic .  Two sets of question naires [ initially a st and ard question naire to assess level of disease-related information by a patient information score ( PIS ) , followed by a HRQOL question naire ] were sent to each patient . In the PIS , a score of 7 or more indicated satisfactory disease-related knowledge and in the HRQOL , a score less than 51 suggested a normal QOL , and a score above 60 significantly impaired QOL . A total of 168 patients ( 66 % ) returned both the question naires ( UC = 91 , CD = 77 ) . The mean QOL in patients with UC and CD was 62.2 ± 8.3 and 63.9 ± 9.5 respectively , ( P = NS ) . 99 patients ( 59 % ) had significantly impaired QOL ( mean score 65 ± 7.6 ) with only 12 patients ( 8 % ) , 6 in each group , having a normal QOL . Mean PIS score for the patients was 7.04 ± 0.1 ; 53 % of the UC patients and 75 % of the CD patients ( P = 0.006 ) were considered well informed ( ie , PIS scores of 7 or more ) . The mean PIS for UC patients was 6.5 ± 0.4 vs 7.5 ± 0.2 for the CD group ( P = 0.001 ) . There was , however , no correlation seen between the QOL and PIS scores , both for UC and CD patients ( R = 0.3 ) . In conclusion , most patients with IBD have impaired QOL , despite of having inactive disease . The level of disease-related knowledge appears to be better in patients with CD , although that does not seem to affect QOL Objective There is evidence of an interaction between psychological factors and activity of inflammatory bowel disease ( IBD ) . We examined the influence of depressive mood and associated anxiety on the course of IBD over a period of 18 months in a cohort of patients after an episode of active disease . Methods In this prospect i ve , longitudinal , observational study , 60 patients ( 37 women and 23 men ) with clinical ly inactive IBD ( Crohn disease , n = 47 , 78 % ; ulcerative colitis , n = 13 , 22 % ) were enrolled after a flare of disease .  Psychological status , health-related quality of life ( HRQOL ) , and disease activity were evaluated at baseline and then every 3 months for a period of 18 months by means of clinical and biological parameters , the Beck Depression Inventory ( BDI ) , the Spielberger State-Trait Anxiety Inventory , the Inflammatory Bowel Disease Question naire , the Perceived Stress Question naire , and the Rating Form of Inflammatory Bowel Disease Patients Concerns .  Results At baseline , depression ( BDI ≥13 points ) was found in 17 of 60 ( 28 % ) patients . Thirty-two patients ( 59 % ) experienced at least one relapse during the 18 months of follow-up . Regression analysis showed a significant correlation between BDI scores at baseline and the total number of relapses after 12 ( p < .01 ) and 18 months ( p < .01 ) of follow-up . Furthermore , depression scores at baseline correlated with the time until the first recurrence of the disease ( p < .05 ) . Anxiety and low HRQOL were also related with more frequent relapses during follow-up ( p < .05 and p < .01 , respectively ) . Conclusions Psychological factors such as a depressive mood associated with anxiety and impaired HRQOL 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 Background Patients with inflammatory bowel disease ( IBD ) have identified a need for more information about their disease . Purpose To assess the effect of an educational intervention on health-related quality of life ( HRQOL ) in patients with IBD . Methods Consecutive ambulatory IBD patients were r and omized to receive four IBD-specific educational booklets or usual care . Subjects completed two disease-specific HRQOL question naires — the Inflammatory Bowel Disease Question naire ( IBDQ ) ( range 1—poor to 7—excellent ) and the Quality Index in Crohn 's and Colitis ( QuICC ) ( range 1—excellent to 5—poor ) at entry and after 2 weeks . The mean change in HRQOL scores at follow-up was compared between the education and control groups . Results 59 subjects participated , with a mean age of 40.0 ± 11.9 years . 34 were given educational booklets and 25 received st and ard care .  6 patients ( 10 % ) did not complete the study . Mean IBDQ scores became significantly worse in the education group with a change of −0.17 ± 0.49 compared with controls at + 0.28 ± 0.62 ( p = 0.006 ) . This could be explained by worsened disease activity in the education group . There was no significant change in the QuICC scores ( p = 0.61 ) . Education group patients who had not received prior educational material had improved mean IBDQ scores of + 0.24 ± 0.47 compared with education patients who had received educational material prior to this study , with a score change of −0.25 ± 0.46 ( p = 0.09 ) . Conclusions The addition of educational booklets to IBD patients in a tertiary center does not improve , and may worsen , short-term HRQOL . Education of newly diagnosed or less informed patients should be studied further Patient information , shared care and decision-making are recognised as beneficial to chronic disease management . As part of an RCT , opinions of ulcerative colitis patients and their doctors were sought on a guidebook design ed to support self-care and mediate doctor/patient interaction during consultations . Semi-structured interviews were conducted with 6 specialists and 16 GPs . Patients ' views were obtained from written responses to a postal question naire ( 136 replies ) . Inclusion of lay knowledge and clarification of treatment decision processes increased patients ' perception of involvement in disease management through increased identification and awareness of others ' self-management experiences . Doctors focused on the importance of improving patients ' compliance and use of services . However , the guidebook was seldom used as it had been intended during consultations . Patients felt constrained by time limits and consultants did not actively encourage guidebook use . Based on the findings , we suggest an approach utilising the guidebook to improve patient participation in disease management Background Few published studies examine the influence of psychological treatment on health care utilization in Crohn 's disease . Methods The present sub study of a prospect i ve , r and omized , multicenter trial conducted in 69 of 488 consecutive Crohn 's disease ( CD ) patients was design ed to investigate the way in which healthcare utilization is influenced by psychotherapy and relaxation in addition to st and ardized glucocorticoid therapy . Before and after a 1‐year period of st and ardized somatic treatment the psychotherapy and control groups were compared with regard to hospital and sick‐leave days . Predictors of healthcare utilization were analyzed . Results The comparison between groups before and after psychological treatment showed a significantly higher decrease of mean hospital days ( P < 0.03 ) and sick‐leave days in the treatment group compared with the controls . When a covariate analysis was applied to compare the data at r and omization , the difference in hospital days remained statistically a trend ( P < 0.1 ) . Multivariate regression analysis detected a significant gender and depression effect for hospital days ( cor r2 = 0.114 ) and a significant gender and age effect for sick‐leave days ( cor r2 = 0.112 ) . Conclusion A significant drop in healthcare utilization  after psychological treatment demonstrates a clear benefit of this additional therapy . This is important , since the study failed to demonstrate significant changes in the psychosocial status or somatic course of study patients . Clinical and psychological factors influencing these outcomes are discussed . ( Inflamm Bowel Dis 2007 Research evaluating  self-management  of chronic conditions points to the effectiveness of interventions ’ changing the health behavior of individuals . However , we know little about how self-management is negotiated within health services . The authors design ed a qualitative investigation to illuminate the quantitative findings of a r and omized controlled trial ( RCT ) of a  self-management program for people with inflammatory bowel disease . They conducted in-depth interviews with physicians and patients , and qualitative analysis illuminated the nature of doctor-patient encounters and possible reasons for lack of change in patient satisfaction with the consultation . The findings suggest that factors inhibiting effective patient-centered consultations include failure of physicians to incorporate expressed need relevant to people ’s self-management activities fully , interpretation of selfmanagement as compliance with medical instructions , and the organization of out patients ’ clinics . Giving attention to these barriers might maximize the opportunities for patient selfmanagement of chronic illness based on a therapeutic alliance with health care professionals BACKGROUND Patient education has been accepted widely over the past years as a valid component of disease management in patients with chronic diseases . The aim of our study was to evaluate the effects of patient education in patients with inflammatory bowel disease . Participation in a patient education program should increase the patient 's disease-related knowledge and positively influence the patient 's quality of life , depression , beliefs of internal control and social activity . METHODS We studied 36 patients with Crohn 's disease and ulcerative colitis : 18 were educated in four sessions , 18 were not educated ( control-group ) . The following topics were presented : diagnosis , causes and course of disease ; medication and surgery ; nutrition and social benefits and stress management and coping with the disease . RESULTS The effects of the program were evaluated before , immediately and three months after the intervention using question naires . Participants in the program showed a significant increase in knowledge after three months compared with the non- participants . There were positive , although not significant effects on psychosocial variables . CONCLUSION Patient education is a valuable means to increase knowledge of disease and treatment in patient 's with Crohn 's disease and ulcerative colitis . Effects on psychosocial variables need to be examined on a long term basis in larger patient groups In a prospect i ve multicenter study of Crohn disease patients , the influence of psychotherapy on the course of the disease and on psychosocial variables ( anxiety , depression , life satisfaction and data of the PSKB ) was studied . Psychodynamic oriented psychotherapy was provided in addition to a st and ardized medical treatment and took place during the first year of the two-year observation period . 108 of 488 patients were recruited and r and omly assigned to the psychotherapy and the control group .  84 patients completed the somatic and 81 the psychosocial follow up . 23 % of the control group and 30 % of the psychotherapy group showed episode-free courses , 29 % and 17 % respectively underwent surgery ( worst outcome group ) . The ranking and comparisons of the disease course showed no significant difference ( p = 0.125 ) between psychotherapy and control group . The psychosocial variables also showed no differences between these groups . Subjectively , the patients report favourable effects to psychotherapy AIM Health related quality of life is impaired in patients suffering from inflammatory bowel disease . Although counselling directed towards physical and psychological morbidity is assumed to improve health related quality of life , this has never been demonstrated . METHODS Physical and psychological well-being were assessed using question naires administered to 100 out- patients in the United Kingdom suffering from inflammatory bowel disease , 50 subjects not suffering from inflammatory bowel disease and a disease control group comprising 28 patients with psoriatic arthritis . A specific nurse led counselling package was given to half the inflammatory bowel disease group and health related quality of life was assessed at baseline , 6 and 12 months . RESULTS Inflammatory bowel disease and psoriatic arthritic patients had a range of physical disease activity , although none were severely ill during the course of the study . Medical therapy was similar in both groups throughout the duration of the trial . The mean Short Form 36 ( SF-36 ) scores for mental health were low in inflammatory bowel disease patients ; 62.9 + /- 9.1 ( SD ) in ulcerative colitis , 60 + /- 9.8 ( SD ) in Crohn 's disease , compared with 72.4 + /- 7.2 ( SD ) in healthy controls ( P < 0.05 ) . Mean SF-36 scores for social function were also reduced in Crohn 's disease patients ; 68.4 + /- 10.1 ( SD ) in Crohn 's disease , compared with 87 + /- 10.1 ( SD ) in healthy controls ( P < 0.05 ) . As expected , the mean SF-36 scores in psoriatic arthritic patients were significantly low 61.9 + /- 1.5 ( SD ) compared with 82.4 + /- 14 ( SD ) in healthy controls ( P < 0.05 ) . Crohn 's disease patients were significantly more anxious than the other groups , mean HAD score was 10 + /- 3.7 ( SD ) in Crohn 's disease patients and 6.86 + /- 3.5 ( SD ) in healthy volunteers ( P < 0.05 ) , although mean HAD scores for depression were similar in all groups . Maladaptive coping mechanisms were present in a significant proportion of Crohn 's disease patients . At follow-up all aspects of psychological morbidity returned to the normal range in the Crohn 's disease patients without significant change in the mean physical disease index . CONCLUSION Health related quality of life can be improved over 6 months by provision of a nurse led counselling service but the effects are not sustained for 12 months Background and Aims Knowledge of colorectal cancer risk in patients with ulcerative colitis is inadequate . The authors aim ed to improve knowledge in a sample of patients and determine whether this was best achieved by a simple information leaflet or by watching a video and reading a leaflet . Material s and Methods Patients ( n = 124 ) were recruited into a r and omized controlled trial conducted from the gastroenterology outpatient departments of two Leicester hospitals . Participants completed a question naire prior to receiving the leaflet or viewing the video , immediately afterward , and 1 month later . Results One hundred fifteen question naires were returned ( response rate = 93 % ) . Both videos and leaflets  increased knowledge with mean percentage improvements in scores of 71 % ( 95 % CI = 40.2–100 ) and 49 % ( 95 % CI = 32.1–66 ) , respectively . However , the difference between the two interventions was not statistically significant ( Difference = 22 % , 95 % CI = −56.3–13.2 , p = 0.2 ) . After 1 month , knowledge levels decreased in both groups to 55 % ( 95 % CI = 33.2–75.8 ; video plus leaflet ) and 36 % ( 95 % CI = 23.7–48.6 ; leaflet alone ) . Conclusions Leaflets and videos have an important role in reinforcing information provided by clinicians . However , there appears to be no immediate or prolonged advantage of a video over and above that of a simple information leaflet . The cost implication s of producing a video , such as extra staff time , need to be weighed against the minor benefit that this medium has to offer Objectives : To determine if a whole-system approach to self-management in inflammatory bowel disease ( IBD ) , using a guidebook developed with patients and physicians trained in patient-centred care , leads to cost-effective use of health system re sources . Methods : Cost-effectiveness analysis over a one-year time horizon comparing the whole systems self-management approach to treatment with usual treatment .  Nineteen hospitals in the northwest Engl and were r and omized to the intervention or to be controls ; 651 patients ( 285 at intervention sites and 366 at control sites ) with established IBD were included . The economic evaluation related differential health service costs , from a UK NHS perspective , to differences in quality -adjusted life years ( QALYs ) based on patients ' responses to the EQ-5D . Results : The intervention was associated with a mean reduction in costs of £ 148 per patient and a small mean reduction in QALYs of 0.00022 per patient compared with the control group . This result ed in an incremental cost per QALY gained of £ 676,417 for treatment as usual and a probability of around 63 % that the whole-system approach to self-management is cost-effective , assuming a willingness to pay up to £ 30,000 for an additional QALY . Conclusions : Although there is uncertainty associated with these estimates , more widespread use of this method in chronic disease management seems likely to reduce health care costs without evidence of adverse effect on patient outcomes BACKGROUND Patients with inflammatory bowel disease ( IBD ) suffer physical dysfunction and impaired quality of life ( QOL ) , and need frequent health care . They often lack knowledge about their disease and desire more education . Educational interventions for other chronic diseases have demonstrated reduced health care use and increased knowledge , medication adherence and QOL . METHOD Sixty-nine participants were r and omly assigned to formal IBD education and st and ard of care ( pamphlets and ad hoc physician education ) or st and ard of care alone . Assessment of IBD knowledge and QOL occurred at baseline , immediately posteducation and eight weeks posteducation . Participants documented medication adherence and health care use in diaries . Patient satisfaction was assessed at the end of the study . RESULTS The education group had higher knowledge scores ( P=0.000 ) , perceived knowledge ratings ( P=0.01 ) and patient satisfaction ( P=0.001 ) . There was a lower rate of medication nonadherence and health care use for the education group , but the differences were not significant . QOL indices did not change . Significant correlations were found for increased health care use in patients with poorer medication adherence ( P=0.01 ) and lower perceived health ( P=0.05 ) . CONCLUSION Formal IBD patient education improves knowledge , perceived knowledge and patient satisfaction . Further study of long-term effects may better demonstrate potential benefits for QOL , medication adherence and health care use Background : Crohn 's disease and ulcerative colitis , referred to as inflammatory bowel diseases , affect mainly young adults and have an elevated morbidity and a negative effect on quality of life . This study aim ed to compare the health‐related quality of life between 2 r and omized groups of patients with inflammatory bowel disease : ( 1 ) the supported group ( SG ) , patients receiving social support for an 18‐month period , and ( 2 ) the control group ( CG ) , patients receiving no social support  Methods : Health‐related quality of life was assessed at 4 moments with the Portuguese versions of the Medical Outcomes Study Short Form 36 and the Inflammatory Bowel Disease Question naire ( IBDQ ) , both vali date d in Brazil . Results : In the SG , using analysis of variance for repeated measures complemented by the Bonferroni test positive variations were observed ( 1 ) in the Social Aspects domain , between the first and third evaluations ( P = 0.044 ) , and ( 2 ) in the Emotional Aspects domain , between the first and second and the third and fourth evaluations ( P = 0.029 ) . Conclusions : In the sample studied , social support , measured by use of the Inflammatory Bowel Disease Question naire , had a positive impact on the social and emotional aspects of quality of life BACKGROUND / AIMS Quality of life ( QOL ) , a subjective index of health perception and function , embraces physical , social , and emotional performance but has not had a prominent role in clinical trials of inflammatory bowel disease ( IBD ) . To test the robustness of the Inflammatory Bowel Disease Question naire ( IBDQ ) , a disease-specific QOL index , this study assessed its validity , reliability , and responsiveness during a multicenter trial . METHODS Three hundred five patients with stable Crohn 's disease received cyclosporin or placebo for 18 months . IBDQ and dimensional scores ( bowel , social , systemic , and emotional ) were correlated with disease activity ( Crohn 's disease activity index [ CDAI ] and Harvey-Bradshaw index ) . Concordance of IBDQ scores was tested in 280 stable subjects . Linear regression evaluated change in IBDQ scores over time . RESULTS IBDQ scores correlated highly with CDAI ( r = -0.67 ; P < 0.0001 ) . The reliability coefficient for IBDQ score was 0.70 vs. 0.66 for CDAI and 0.55 for Harvey-Bradshaw index . Regression line slopes of IBDQ scores were significantly different in patients who deteriorated from those who remained stable ( [ b ] < 0.15 ; P < 0.0001 ) . QOL scores were lower in patients who required surgery . CONCLUSIONS The IBDQ is a valid reliable assessment tool that reflects important changes in the health status of patients with IBD . The IBDQ is a robust measure of therapeutic efficacy and should be used in future clinical trials in IBD Objectives : We developed a patient centred approach to chronic disease self management by providing information design ed to promote patient choice . We then conducted a r and omised controlled trial of the approach in inflammatory bowel disease ( IBD ) to assess whether it could alter clinical outcome and affect health service use . Design : A multicentre cluster r and omised controlled trial . Setting : The trial was conducted in the outpatient departments of 19 hospitals with r and omisation by treatment centre , 10 control sites , and nine intervention sites . For patients at intervention sites , an individual self management plan was negotiated and written information provided . Participants : A total of 700 patients with established inflammatory bowel disease were recruited . Main outcome measures : Main outcome measures recorded at one year were : quality of life , health service re source use , and patient satisfaction . Secondary outcomes included measures of enablement — confidence to cope with the condition . Results : One year following the intervention , self managing patients had made fewer hospital visits ( difference −1.04 ( 95 % confidence interval ( CI ) −1.43 to −0.65 ) ; p<0.001 ) without increase in the number of primary care visits , and quality of life was maintained without evidence of anxiety about the programme . The two groups were similar with respect to satisfaction with consultations . Immediately after the initial consultation , those who had undergone self management training reported greater confidence in being able to cope with their condition ( difference 0.90 ( 95 % CI 0.12–1.68 ) ; p<0.03 ) . Conclusions : Adoption of this approach for the management of chronic disease such as IBD in the NHS and other managed health care organisations would considerably reduce health provision costs and benefit disease control
BACKGROUND The effect of psychological interventions in inflammatory bowel diseases ( IBD ) is controversial .
OBJECTIVES To assess the effects of psychological interventions ( psychotherapy , patient education , relaxation techniques ) on health related quality of life , coping , emotional state and disease activity in IBD .