Rachel Lutz

About a third of inflammatory bowel disease (IBD) patients surveyed were found to meet the clinical threshold to warrant a further diagnosis of post-traumatic stress disorder (PTSD).

Alexandra F. Vanderwerff, PhD, Counseling Psychology, University of Memphis, conducted a study examining the prevalence of PTSD symptoms among IBD patients.

 that her initial hypothesis centered around the idea that remission would serve as a protective factor. She also wrote in the paper that little research had previously been conducted surrounding PTSD and ulcerative colitis (UC) and Crohn’s disease (CD), though previously research has demonstrated that people living with acute conditions can experience symptoms of PTSD.

A random sample of 313 adult patients who self-identified as having either ulcerative colitis (n = 140) or Crohn’s disease (n = 173) were included in the analysis, of whom about three-quarters were female. The participants were instructed to report whether or not they were currently in remission or experiencing a flare-up, as well as their expectations for experiencing a flare-up in the next 2 months.

Ultimately, about a third of participants met the threshold for PTSD symptom endorsement that would warrant a further diagnosis, Vanderwerff found.

These patients’ score was 33 or higher on the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), a 20-item checklist used to help diagnose PTSD. A score of between 31-33 suggests probable PTSD, Vanderwerff explained.

The average score for the entire sample was 26, which is a relatively elevated score. Vanderwerff wrote that these patients experienced clinically significant levels of PTSD and their experience is evidence that the chronic health condition of IBD is associated with significant trauma symptoms that medical personnel should be made aware of.

As for the hypothesis that remission would serve as a protective factor against PTSD: Vanderwerff determined that this was supported for the IBD-related concern and body vigilance.

However, she learned the opposite was true for the clinical severity/PTSD symptomology relationship. When participants noted they were experiencing a flare-up, their IBD-related worries and concerns, and their levels of body vigilance was stronger than levels for individuals currently in remission, the study showed. When participants were in remission, the clinical severity and PTSD symptomology relationship was strengthened.

“My hope is that these findings increase awareness among physicians of the potential psychological needs of their patients, especially during remission when it would be natural and understandable to assume that patients would be at ease,” Vanderwerff said. “I think these findings support the importance of screening for potential distress among IBD patients, the value of integrated psychological services in gastrointestinal and colorectal settings, and to really just be aware of and vigilant for the mental health needs among patients at all stages of the disease.”

Physicians are able to facilitate wellness at all levels when they are vigilant about the mental health needs of their patients.

“By opening that gate, whether through integrated psychological services, or making appropriate referrals, they are setting their patients up for achieving best possible outcome,” Vanderwerff said.

The Relationship between the Impact of Ulcerative Colitis and Crohn’s Disease on Post-traumatic Stress Disorder Symptoms Moderated by Remission Status, Remission Expectations and Post Traumatic Growth

Articles

Inflammatory bowel disease patients were surveyed about their remission or flare-up status, as well as their expectations for a flare-up over the next 2 months. 


A Large Proportion of IBD Patients May Experience a Form of PTSD 

Compared to control cases, there was significant elevation of metabolic parameters in patients treated for 

, and the type of drug used often mattered.

Investigators from Egypt examined patients with schizophrenia compared to healthy controls in order to evaluate the impact of antipsychotics on schizophrenic’s metabolic parameters after a period of 6 months. Between January 2010 and November 2012, the study authors involved 160 patients with schizophrenia and 50 healthy volunteers.

Among patients with schizophrenia, 59 were treated with haloperidol, 48 on clozapine, 45 on risperidone, and 38 on olanzapine. The investigators also noted the patients’ clinical evaluation, duration of illness, type of schizophrenia, detailed drug history, and BMI measures. Additionally, the patients underwent laboratory testing including fasting and post prandial blood glucose levels, total leucocytic count, liver function tests, and lipid profile at baseline and after 6 months.

The investigators determined that treatment with antipsychotics impacted fasting blood glucose levels, but was not significant in altering post prandial blood glucose measurements. They said this meant “that the factor of treatment with antipsychotic is not a contributing factor in the changes in post prandial blood glucose in such model of interaction.” They also noted that the type of drug was not significant in fasting blood glucose, but only weakly significant in post prandial blood glucose.

The lipid profile changes were not significant after 6 months, the investigators said. Changes in the lipid profile are due to other factors, and not the drugs.

Waist circumference and body weight changes were believed to stem from antipsychotic treatment, the study authors found. This was found across all medication types utilized, but patients treated with clozapine and olanzapine showed the most increase in both measures during the study period, while the risperidone-treated group showed the least changes.

For both serum glutamic oxalo-acetic transferase (SGOT) and serum glutamic-pyruvic transferase (SGPT), the study authors said that antipsychotic treatment in liver enzyme changes was significant. So was the type of drug used: the patients treated with olanzapine showed the highest changes, followed by clozapine, while patients treated with haloperidol and risperidone showed the lowest changes. 

The type of drug used was also significant in terms of the liver enzyme changes, the study authors wrote. Patients that used haloperidol showed significant rise in the total leukocyte count, while risperidone and olanzapine showed no significant rise. The investigators said patients treated with clozapine showed no significant decrease in total leukocyte count.

These findings confirm that people with mental illness and schizophrenia in particular are at risk of high morbidity and mortality compared to the general population, the study authors wrote, and lifestyle, disease, and medications are the contributing factors for this risk.

“From the results of this study we can confirm the previous conclusions that metabolic disturbance in patients of schizophrenia is realty and worsens by time,” the study authors concluded. “Antipsychotics treatment may contribute in this effect particularly the novel ones but this effect could be a perpetuating or precipitating.”

The study, “Study of Biological Parameters of Schizophrenics During 6 Months of Different Anti Psychotics Treatment,” was published online in the 

The lipid profile changes were not significant after 6 months, while the changes in the lipid profile are due to other factors and not the drugs.

Metabolic Changes in Patients Treated with Antipsychotics for Schizophrenia 

Patients receiving care for HIV may be able to facilitate hepatitis C virus (HCV) co-infection treatment, according to a 

Investigators from around the U.S. constructed their own HIV treatment cascades with the intent to characterize the treatment and understand the barriers among men and women who are at risk for or who have HIV. These treatment cascades were developed using data from The Women’s Interagency HIV Study, which evaluated nearly 2500 women over 6 visits between 2015-2018, and the Multicenter AIDS Cohort Study, which examined about 2200 men during 1 visit between 2015-2018.

The study authors wrote that people with HIV more frequently have HCV co-infection compared to other groups, and furthermore, experience accelerated liver-related mortality. They explained that direct-acting antivirals (DAAs) can yield high sustained virologic response (SVR) rates; however, they described the uptake as suboptimal.

The study participants included 323 women and 93 men who were eligible for cascade treatment, meaning they were HCV RNA-positive or reported DAAs. The participants were surveyed and self-reported barriers in clinical terms, (like CD4 levels), patient barriers (such as missed visits), systemic barriers (such as appointment access), and financial and insurance barriers.

Most of the participants had HIV, with women at 77% and men at 70%. The investigators also noted that 69% and 63% of the women and men were Black, respectively, and found that the HIV-positive women were more likely to attain cascade outcomes when compared to HIV-negative women (39% vs. 23% initiated, respectively; and 21% vs. 12% SVR, respectively). Similar rates were found among the men they analyzed.

Black men and patients who were substance abuse users were treated less often, the study authors reported. They also found that women initiating treatment reported fewer patient barriers compared to women who did not initiate treatment (14% vs. 33%, respectively).

Clinical barriers were prevalent, at about 53%, among men who were not treated.

“HIV care may facilitate HCV treatment linkage and barrier navigation,” the study authors concluded. “HIV-negative individuals, Black men, and substance users may need additional support.”

As many as two-thirds of adults who should receive HIV testing have not received the testing at all, according to a study presented during the International AIDS Society AIDS 2020 Virtual Sessions and 

®. A third of survey responders lived in areas with a high HIV burden, while three-quarters had visited a primary care provider in the past year of their survey response – but not tested. The most commonly preferred testing method was through a routine visit to their health care provider (53%), according to the study, followed by self-testing for HIV (18%) and access via an urgent or walk-in clinic (12%).

A study presented at the American College of Gastroenterology 2020 conference also found that federally qualified health center are beneficial for patients who need to receive the full suite of HCV treatment, also 

HIV care may help enable better treatment for HCV infectious.

HIV Treatment can Facilitate Hepatitis C Care in Some Cases 

) infection decreased in both proportion and number among hospital inpatients during the novel coronavirus disease 2019 (COVID-19) pandemic peak months compared to the pre-COVID era, while 

infection among outpatient visits remained stable, according to a poster presented at the American College of Gastroenterology (ACG) 2020 conference.

Investigators from the University of Virginia Health System wrote that 

infections are common, although from 2011 to 2017 there was a noted decline in the spread of the disease. However, many health care systems have noted a dramatic shift in 

 infections and infection control throughout the COVID-19 pandemic.

Because of this shift, the investigators conducted a retrospective study at a single center to determine if the changes in the hospital census and infection control during the pandemic affected rates of 

infection. They also surveyed 13 primary care providers regarding empiric 

 infection prescribing habits, in an effort to determine if empiric treatment was offered in lieu of testing during COVID-19.

The study authors collected inpatient admissions and outpatient visits between November 2019 and May 2020 and included all patients who had a PCR test for 

infection. They also noted the PCR result and the setting from which it was taken. Then, they compared 

 infection rates pre-COVID-19 (November-February 2020) and during COVID (March-May).

There was a decrease in the number of inpatient admissions in the post-COVID-19 period compared to the pre-COVID period, according to the investigators. 

In November, December, January, and February respectively, there were 2159, 2233, 2314, and 2088 inpatient admissions compared to 1786, 1421, and 1876, respectively, in March, April, and May. 

From this group of inpatient admissions, the number of positive 

infection tests decreased in the post-COVID-19 period (when the mean was 10) compared to the pre-COVID-19 period (when the mean was 19). Additionally, the proportion of positive 

infection tests over monthly admissions decreased in the post-COVID-19 period compared to the previous period, the study authors said. When they controlled their analysis for age and gender, the study authors determined that the odds of testing positive for 

Among the outpatient visits, the number of positive 

infection tests per month was unchanged pre-COVID-19 compared to post-COVID-19. The mean remained at about 8 during that time. The numbers of positive 

infection tests remained relatively similar throughout the pre- and post-COVID-19 months.

As for the primary care physicians, only 1 of the 13 respondents empirically prescribed antibiotics for 

infection during COVID-19, the study authors discovered.

infection downtrend may include decrease in elective procedures/ admissions that pose risk for 

infection or heightened awareness of infection control best-practices due to COVID-19,” the study authors wrote. “Further research is necessary to evaluate 

infection trends as hospital census fluctuates and to assess outcomes of COVID-19 infection control policy changes on 

infection and other healthcare infections.”

C. diff infections have decreased during the ongoing pandemic.