Psychiatric co-morbidities in Crohn's disease: an often overlooked aspect

Comorbidades psiquiátricas na doença de Crohn: um aspecto geralmente negligenciado

CORRESPONDENCE

Psychiatric co-morbidities in Crohn's disease: an often overlooked aspect

Comorbidades psiquiátricas na doença de Crohn: um aspecto geralmente negligenciado

Shailendra Kapoor^*

Mechanicsville, VA, USA

Dear Editor,

I read with great interest the recent article by Lima et al., ¹ Crohn's disease may be associated with significant psychiatric illnesses.

An incidence rate of depression as high as 32% has been reported in patients with underlying Crohn's disease.² Higher degrees of depression are observed in patients with a poor quality of life. Younger individuals with underlying Crohn's disease are almost 2.75 times more likely to develop persistent depression.³ Similarly, patients with low economic status tend to develop a more severe degree of depression.⁴ Individuals with extra-intestinal involvement, such as joint involvement, also tend to report higher degrees of depression.

A similar association is observed with the development of anxiety in Crohn's disease patients. Nearly 24% of them develop anxiety.³ In a recent study, Loftus et al. showed that younger patients with underlying Crohn's disease are almost 4.35 times more likely to develop persistent anxiety. ³ Certain therapies, such as infliximab, actually worsen the anxiety. Crohn's disease patients also report high degrees of fatigue, which may be exacerbated by the development of concurrent depression.⁵

Similarly, patients may present with isolated bipolar disorder.⁶ Treatment with steroids especially predisposes Crohn's disease patients to manic episodes. Holroyd et al., in a recent study, reported that nearly 57% of patients with Crohn's disease who developed a manic episode had received recent prednisone therapy.⁷

The above examples clearly highlight the significant psychiatric co-morbidity of Crohn's disease and the need to address these as soon as possible after the diagnosis is made.

• 1. Lima FD, Ribeiro TC, Chebli LA, Pace FH, Chaves LD, Ribeiro MS, et al. Mood swings in patients with Crohn's disease: incidence and associated factors. Rev Assoc Med Bras. 2012;58:481-8.
• 2. Cho OH, Yoo YS, Yang SK. Depression and risk factors in patients with Crohn's disease. J Korean Acad Nurs. 2012;42:207-16.
• 3. Loftus Jr EV, Guerin A, Yu AP, Wu EQ, Yang M, Chao J, et al. Increased risks of developing anxiety and depression in young patients with Crohn's disease. Am J Gastroenterol. 2011;106:1670-7.
• 4. Moradkhani A, Beckman LJ, Tabibian JH. Health-related quality of life in inflammatory bowel disease: psychosocial, clinical, socioeconomic, and demographic predictors. J Crohns Colitis. 2012 [Epub ahead of print]
• 5. Jelsness-Jorgensen LP, Bernklev T, Henriksen M, Torp R, Moum B. Chronic fatigue is associated with increased disease-related worries and concerns in inflammatory bowel disease. World J Gastroenterol. 2012;18:445-52.
• 6. Kalach N, Vicent G, Ginisty D, Barbet P, Cosnes J, Dupont C. Isolated bipolar presentation of Crohn's disease in a child. J Pediatr Gastroenterol Nutr. 2001;32:86-8.
• 7. Holroyd S, DePaulo Jr JR. Bipolar disorder and Crohn's disease. J Clin Psychiatry. 1990;51:407-9.

Publication Dates

• Publication in this collection
  07 May 2013
• Date of issue
  Apr 2013