This document discusses inflammatory bowel disease (IBD) and the relationship between psychological distress and symptom severity in IBD patients. It finds that IBD patients experience significant psychological symptoms like anxiety and depression that are correlated with worse physical symptoms. Current treatments primarily focus on medication but have adverse side effects and do not address psychological issues. The document proposes developing a new intervention for IBD patients that treats psychological distress in order to decrease symptom severity and improve quality of life.
The Interface of Loneliness, Hospitalization and Illness | Crimson PublishersCrimsonpublishersPPrs
This article reviews the experience of loneliness and how it is influenced, and influences, the ill person and the hospitalized individual. Social ties enhance the immune system and help individuals cope with stress and illness. Loneliness has physical, emotional, and cognitive negative effects. Loneliness, which can involve both excruciating physical and mental suffering, is an ancient nemesis. Loneliness is implicated in numerous somatic, psychosomatic, and psychiatric diseases [1]. It is a mundane yet arcane human affliction that is often hazardous to health and hostile to happiness [2]. In this article, I review the experience of loneliness as it affects us when we are not doing well, such as when we are ill or hospitalized.
This document discusses chronic illness management. It defines a chronic illness as a condition lasting 3 months or longer that can be unpredictable. Common chronic illnesses include heart disease, cancer, diabetes and arthritis. Risk factors include behaviors like smoking, poor diet and lack of exercise, as well as genetic predisposition. Chronic diseases account for most American deaths each year. Health psychology examines the biological, psychological and social factors related to illness and health. Clinical health psychologists help patients manage chronic conditions through cognitive and behavioral therapies.
Quality of life and comorbid anxiety disorder in persons with schizophrenia, ...iosrphr_editor
BACKGROUND: Quality of life is considered in clinical psychiatry as an intermediate and distal outcome in the management of major mental disorders. Anxiety disorder is the commonest mental disorder which can be identified easily and can be treated easily. Treating co-morbid Anxiety disorders has multiple benefits of improving quality of life, reducing distress to the patient and family, and performance of the patient. AIM: To assess the quality of life and comorbid anxiety disorder in persons with schizophrenia, schizoaffective and bipolar affective disorder under remission.
An overview of depression and its pharmacotherapypharmaindexing
This document provides an overview of depression and its pharmacotherapy. It defines depression as a common and serious mental health disorder. Left untreated, depression can lead to complications like suicidal thoughts and negatively impact quality of life. The document classifies depression, discusses its prevalence, risk factors, and health impacts. It causes symptoms like sadness, loss of interest, and changes in appetite and sleep. Pharmacotherapy options for depression include antidepressants, often used for mild to moderate cases. Psychotherapy combined with antidepressants can increase treatment success rates compared to medication alone.
This document provides information and advice for coping with chronic illness. It discusses the importance of acceptance, maintaining a positive attitude, taking control through education and active participation in treatment, building support networks, managing stress, addressing potential depression or anxiety, quitting smoking if applicable, and finding appropriate resources and support groups.
Factors associated with the presence of diabetic ketoacidosis at diagnosis of...松波動物病院メディカルセンター
This systematic review identified 46 studies from 31 countries involving over 24,000 children with new onset type 1 diabetes. The studies compared various factors to determine which were associated with the presence of diabetic ketoacidosis (DKA) at diagnosis. Younger age, diagnostic errors, ethnic minority status, lack of health insurance, lower body mass index, preceding infections, and delayed treatment were associated with increased risk of DKA. Having a family member with diabetes, higher parental education, and living in an area with a higher background rate of type 1 diabetes were protective factors against DKA. Many children presented with DKA despite being seen by a doctor before diagnosis, suggesting potential opportunities for earlier diagnosis and treatment.
This document proposes a study of the social and behavioral factors influencing diabetic retinopathy among Mexican Americans in Starr County, Texas. The study would use focus groups to examine how emotional distress from vision loss due to diabetic retinopathy may lead to a cycle worsening the condition. Researchers hypothesize that lack of knowledge about diabetic retinopathy and its relationship to vision loss contributes to visual deterioration. The study aims to apply concepts from social cognitive theory to understand how internal and external factors interact regarding diabetic retinopathy among the target population.
The Interface of Loneliness, Hospitalization and Illness | Crimson PublishersCrimsonpublishersPPrs
This article reviews the experience of loneliness and how it is influenced, and influences, the ill person and the hospitalized individual. Social ties enhance the immune system and help individuals cope with stress and illness. Loneliness has physical, emotional, and cognitive negative effects. Loneliness, which can involve both excruciating physical and mental suffering, is an ancient nemesis. Loneliness is implicated in numerous somatic, psychosomatic, and psychiatric diseases [1]. It is a mundane yet arcane human affliction that is often hazardous to health and hostile to happiness [2]. In this article, I review the experience of loneliness as it affects us when we are not doing well, such as when we are ill or hospitalized.
This document discusses chronic illness management. It defines a chronic illness as a condition lasting 3 months or longer that can be unpredictable. Common chronic illnesses include heart disease, cancer, diabetes and arthritis. Risk factors include behaviors like smoking, poor diet and lack of exercise, as well as genetic predisposition. Chronic diseases account for most American deaths each year. Health psychology examines the biological, psychological and social factors related to illness and health. Clinical health psychologists help patients manage chronic conditions through cognitive and behavioral therapies.
Quality of life and comorbid anxiety disorder in persons with schizophrenia, ...iosrphr_editor
BACKGROUND: Quality of life is considered in clinical psychiatry as an intermediate and distal outcome in the management of major mental disorders. Anxiety disorder is the commonest mental disorder which can be identified easily and can be treated easily. Treating co-morbid Anxiety disorders has multiple benefits of improving quality of life, reducing distress to the patient and family, and performance of the patient. AIM: To assess the quality of life and comorbid anxiety disorder in persons with schizophrenia, schizoaffective and bipolar affective disorder under remission.
An overview of depression and its pharmacotherapypharmaindexing
This document provides an overview of depression and its pharmacotherapy. It defines depression as a common and serious mental health disorder. Left untreated, depression can lead to complications like suicidal thoughts and negatively impact quality of life. The document classifies depression, discusses its prevalence, risk factors, and health impacts. It causes symptoms like sadness, loss of interest, and changes in appetite and sleep. Pharmacotherapy options for depression include antidepressants, often used for mild to moderate cases. Psychotherapy combined with antidepressants can increase treatment success rates compared to medication alone.
This document provides information and advice for coping with chronic illness. It discusses the importance of acceptance, maintaining a positive attitude, taking control through education and active participation in treatment, building support networks, managing stress, addressing potential depression or anxiety, quitting smoking if applicable, and finding appropriate resources and support groups.
Factors associated with the presence of diabetic ketoacidosis at diagnosis of...松波動物病院メディカルセンター
This systematic review identified 46 studies from 31 countries involving over 24,000 children with new onset type 1 diabetes. The studies compared various factors to determine which were associated with the presence of diabetic ketoacidosis (DKA) at diagnosis. Younger age, diagnostic errors, ethnic minority status, lack of health insurance, lower body mass index, preceding infections, and delayed treatment were associated with increased risk of DKA. Having a family member with diabetes, higher parental education, and living in an area with a higher background rate of type 1 diabetes were protective factors against DKA. Many children presented with DKA despite being seen by a doctor before diagnosis, suggesting potential opportunities for earlier diagnosis and treatment.
This document proposes a study of the social and behavioral factors influencing diabetic retinopathy among Mexican Americans in Starr County, Texas. The study would use focus groups to examine how emotional distress from vision loss due to diabetic retinopathy may lead to a cycle worsening the condition. Researchers hypothesize that lack of knowledge about diabetic retinopathy and its relationship to vision loss contributes to visual deterioration. The study aims to apply concepts from social cognitive theory to understand how internal and external factors interact regarding diabetic retinopathy among the target population.
1. Infectious diseases are caused by microorganisms like bacteria, viruses, fungi or parasites that can be passed from person to person. They remain a leading cause of death worldwide.
2. The document discusses the routes of transmission for infectious agents, including direct contact, airborne transmission, and environmental survival of the infectious agent outside a host. Factors like these determine how quickly and widely an agent can spread.
3. Major infectious disease pandemics and epidemics throughout history have had significant social and economic impacts. The COVID-19 pandemic demonstrates how easily infections can spread globally in the modern, interconnected world.
Chronic illnesses are health conditions that last over six months. Examples include cancer, heart disease, and arthritis. Factors that contribute to chronic illnesses include heredity, lifestyle, and environment. People with chronic illnesses have ongoing needs related to employment, financial support, health care, housing, and self-esteem. Their socioeconomic status, age, and any disabilities can impact their ability to access resources to manage their condition.
Research- Lockdown and it's impact on Physical and Mental well beingSuprity Goswami
The document discusses the impact of lockdown measures imposed during the COVID-19 pandemic on the physical and mental health of people in India. It notes that the lockdown caused major disruptions to daily routines and responsibilities, hindering physical mobility and social interactions. This increased stress, anxiety, and other negative mental health outcomes. Prolonged isolation and lack of physical activity also increased risks of health issues like obesity, sleep disorders, and reduced quality of life. Women, the elderly, and economically disadvantaged groups tended to face more adverse effects. The lockdown highlighted the need to consider both physical and mental health impacts of crisis responses.
Chronic illnesses like heart disease, cancer, stroke, COPD, and diabetes are generally incurable and worsen over time. They are the major causes of death and health care costs in the US. Risky behaviors in youth and middle age such as smoking, poor diet, physical inactivity, obesity, and alcohol abuse put people at higher risk of developing chronic conditions. Adopting a healthy lifestyle through not smoking, eating well, exercising regularly, and limiting alcohol can help prevent chronic diseases and reduce their impact on one's health as they age.
Psychological impact of chronic illness2Omar Moatamed
Chronic illness can cause psychological stress and impact coping abilities. It involves a cognitive appraisal of the illness in relation to one's resources. While it may cause anxiety, depression, guilt or anger, social support and personality can mediate these effects. Common emotional reactions include denial, anger, depression, and acceptance through various stages. Multimodal interventions aim to help patients adjust, manage stress and pain, learn coping skills, and strengthen family communication. Chronic illness strongly impacts social and emotional well-being, and better coping is linked to improved prognosis and health outcomes.
This document discusses several concepts related to disease causation and pathogenesis. It introduces theories of disease causation including the germ theory, biomedical model, and theories of multifactorial causation. It describes the epidemiological triad of agent, host, and environment. It also discusses the natural history of disease, including prepathogenesis and pathogenesis phases, and the iceberg phenomenon where most disease is hidden and subclinical.
Type 1 diabetes is an autoimmune disease where the body's immune system destroys the beta cells in the pancreas that produce insulin. It requires lifelong treatment with insulin injections and careful management of diet and blood sugar levels. The document provides details on the history, causes, symptoms, diagnosis, treatment, and lifelong prognosis of Type 1 diabetes. Treatment involves regulating blood sugar through insulin injections, diet, exercise, and personal hygiene. The costs of managing the disease are significant. While it currently has no cure, advances in treatment have improved life expectancy and quality of life for those living with Type 1 diabetes.
This document discusses concepts related to disease causation and the natural history of disease. It defines disease, illness, and sickness, and describes key concepts like the germ theory of disease, epidemiological triad, multifactorial causation, and web of causation. It discusses factors related to agents, hosts, and environments that influence disease occurrence. It also outlines the pre-pathogenesis and pathogenesis phases in the natural history of disease.
This document discusses chronic diseases, specifically obesity, coronary heart disease, hypertension, and diabetes mellitus. It defines each condition, discusses their prevalence, risk factors, measurement, prevention, and management. Obesity is defined by BMI measurements and poses health hazards like increased mortality and morbidity. Prevention focuses on diet, exercise, and lifestyle modifications. Hypertension is a major risk factor for other diseases and its management requires patient education and controlling risk factors through medication and lifestyle changes. Diabetes mellitus can be prevented through identifying at-risk groups and promoting healthy behaviors.
Women are diagnosed with bipolar disorder on average 3.2 years later than men and are more likely to experience a delay in seeking treatment. They are also more likely to have a depressive first episode and experience more rapid cycling of moods. Women tend to have more severe depressive episodes and mixed episodes than men. Improving recognition of gender differences and barriers to recovery such as unemployment, lack of social support and exploitation could help enhance quality of life and management of symptoms for women living with bipolar disorder.
This document summarizes key aspects of bipolar disorder, including:
1) Bipolar disorder is characterized by recurring manic or hypomanic episodes that alternate with depressive episodes. It exists on a spectrum from bipolar I to bipolar II disorder.
2) Bipolar disorder has a lifetime prevalence of around 2.4% worldwide and is associated with significant disability. However, it often goes undiagnosed for around 10 years.
3) People with bipolar disorder have high risks of suicide, psychiatric comorbidities, and medical comorbidities. They also face impairments in education, work and development due to the disorder.
This literature review examines previous studies on children undergoing treatment for chronic or life-threatening diseases. The studies found that these children often have lower health-related quality of life than their healthy peers. They also found that current quality of life tests may be too brief or generalized to fully assess these children's experiences. The review suggests that an intervention center could help children through difficult medical treatments by utilizing general quality of life tests along with more customized evaluations. This would help the center better understand children's specific needs and improve their health outcomes and social development.
Whalley2007 correlation of psychological and physicalbenwhalley
This study examined the relationship between psychological and physical symptoms in a healthy population without diagnosed diseases. A survey was completed by 1,143 women measuring symptoms related to conditions associated with inflammatory diseases (such as allergies and gastrointestinal issues), as well as psychological symptoms of depression and tiredness. After controlling for response bias, tiredness was found to correlate with most physical symptoms, but depression did not. This suggests immune dysregulation may explain the co-occurrence of psychological and physical symptoms even in healthy individuals.
16. Stress And The Git Does It Cause Crohns Diseaseensteve
The document discusses the relationship between stress and Crohn's disease. It summarizes that while stress does not appear to cause Crohn's disease, stress may modulate the disease course by influencing the brain-gut axis. Stress can diminish protective intestinal factors and increase permeability through pathways like the HPA axis and sympathetic nervous system. Some studies have found an association between psychological distress levels and future Crohn's disease activity, but the evidence regarding stressful life events triggering relapse is inconsistent.
International Journal of Humanities and Social Science Invention (IJHSSI) is an international journal intended for professionals and researchers in all fields of Humanities and Social Science. IJHSSI publishes research articles and reviews within the whole field Humanities and Social Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
This document discusses concepts related to disease, including definitions of disease, illness, and sickness. It covers concepts of causation from earlier theories to the germ theory and multifactorial causation. The natural history of disease and spectrum of disease are described. Risk factors, risk groups, and the iceberg model of disease are also summarized. The document concludes with concepts of disease control and monitoring.
Psycho social dynamics in causation of diseaseaneez103
This document discusses concepts related to health, disease, and their determinants from various perspectives. It defines health positively as a state of complete physical, mental, and social well-being, and not just the absence of disease. Health is influenced by biological, behavioral, environmental, and socioeconomic factors. Disease results from the interaction between an external agent, the host, and the environment. A holistic view recognizes the multidimensional nature of health and its dependence on psychological, social, cultural, economic, and political influences. Maintaining health requires efforts at the individual, community, national, and international levels.
Spirituality and Attitude towards Death among Senior Citizens with Special Re...AnuragSingh1049
Death is an unpredictable and undeniable event that occurs in everyone’s life regardless of age, time, place etc. One of the common experiences for those are unprepared for this reality is Anxiety. The attitude of senior citizens towards death vary from person to person and they adopt different strategies to cope with their anxieties. Spiritual practice is one of the coping strategies adopted by senior citizens. The present study tries to examine the association between spirituality and attitudes towards death among 100 senior citizens ( 65 years and above) in residential houses and in old age homes. Participants were asked to respond to two different questionnaires namely, Death Attitude Profile-Revised developed by Wong, Recker, Gosser (1994) and Spirituality Experience Index- Revised developed by Genia, V (1991) including a 32-item and 23-item respectively. Data was collected during March-April, 2018 by using SPSS software and data were analysed using the statistical tools namely, simple percentages, means, standard deviation, Pearson's correlation, t-Test and ANOVA. The scale had a high level of internal consistency, as determined by a Cronbach's alpha of 0.712. The study concludes that higher the level of spirituality (spiritual openness) lower the level of fear of death. Those with higher level of spirituality avoid thinking and talking about death to be away from anxiety. There is a negative correlation between spirituality and positive dimension of attitude towards death (Escape acceptance) higher the level of spirituality, lower the attitude towards escape acceptance (death as an escape from a painful existence) but there was no correlation between spiritual support and any of the death attitude dimensions.
2010 12 09 maîtrisez vos documents électroniques by competiticCOMPETITIC
Maîtrisez vos documents électroniques : Contrats, factures, notes de travail … Comment gérer aujourd'hui vos documents numérisés ?
Avec le développement de la dématerialisation des échanges (et sa reconnaissance juridique), le document électronique, dématerialisé, envahit peu à peu l'entreprise, en impactant les procédures d’archivage, de stockage … l’entreprise doit faire évoluer ces procédures pour optimiser ses process. Qu’appelle-t-on un document numérisé ? Comment le sauvegarder, l'archiver ? Comment l'exploiter pour optimiser le fonctionnement de l'entreprise ? Quelle est sa valeur juridique ?
Teks tersebut membahas berbagai persoalan teologi dalam Islam seperti sifat-sifat Allah, pelaku dosa besar, akal dan wahyu, kekuasaan Tuhan dan perbuatan manusia, serta kekuasaan mutlak dan keadilan Tuhan menurut berbagai aliran seperti Asy'ariyah, Maturidiyah, Mu'tazilah, dan lainnya.
1. Infectious diseases are caused by microorganisms like bacteria, viruses, fungi or parasites that can be passed from person to person. They remain a leading cause of death worldwide.
2. The document discusses the routes of transmission for infectious agents, including direct contact, airborne transmission, and environmental survival of the infectious agent outside a host. Factors like these determine how quickly and widely an agent can spread.
3. Major infectious disease pandemics and epidemics throughout history have had significant social and economic impacts. The COVID-19 pandemic demonstrates how easily infections can spread globally in the modern, interconnected world.
Chronic illnesses are health conditions that last over six months. Examples include cancer, heart disease, and arthritis. Factors that contribute to chronic illnesses include heredity, lifestyle, and environment. People with chronic illnesses have ongoing needs related to employment, financial support, health care, housing, and self-esteem. Their socioeconomic status, age, and any disabilities can impact their ability to access resources to manage their condition.
Research- Lockdown and it's impact on Physical and Mental well beingSuprity Goswami
The document discusses the impact of lockdown measures imposed during the COVID-19 pandemic on the physical and mental health of people in India. It notes that the lockdown caused major disruptions to daily routines and responsibilities, hindering physical mobility and social interactions. This increased stress, anxiety, and other negative mental health outcomes. Prolonged isolation and lack of physical activity also increased risks of health issues like obesity, sleep disorders, and reduced quality of life. Women, the elderly, and economically disadvantaged groups tended to face more adverse effects. The lockdown highlighted the need to consider both physical and mental health impacts of crisis responses.
Chronic illnesses like heart disease, cancer, stroke, COPD, and diabetes are generally incurable and worsen over time. They are the major causes of death and health care costs in the US. Risky behaviors in youth and middle age such as smoking, poor diet, physical inactivity, obesity, and alcohol abuse put people at higher risk of developing chronic conditions. Adopting a healthy lifestyle through not smoking, eating well, exercising regularly, and limiting alcohol can help prevent chronic diseases and reduce their impact on one's health as they age.
Psychological impact of chronic illness2Omar Moatamed
Chronic illness can cause psychological stress and impact coping abilities. It involves a cognitive appraisal of the illness in relation to one's resources. While it may cause anxiety, depression, guilt or anger, social support and personality can mediate these effects. Common emotional reactions include denial, anger, depression, and acceptance through various stages. Multimodal interventions aim to help patients adjust, manage stress and pain, learn coping skills, and strengthen family communication. Chronic illness strongly impacts social and emotional well-being, and better coping is linked to improved prognosis and health outcomes.
This document discusses several concepts related to disease causation and pathogenesis. It introduces theories of disease causation including the germ theory, biomedical model, and theories of multifactorial causation. It describes the epidemiological triad of agent, host, and environment. It also discusses the natural history of disease, including prepathogenesis and pathogenesis phases, and the iceberg phenomenon where most disease is hidden and subclinical.
Type 1 diabetes is an autoimmune disease where the body's immune system destroys the beta cells in the pancreas that produce insulin. It requires lifelong treatment with insulin injections and careful management of diet and blood sugar levels. The document provides details on the history, causes, symptoms, diagnosis, treatment, and lifelong prognosis of Type 1 diabetes. Treatment involves regulating blood sugar through insulin injections, diet, exercise, and personal hygiene. The costs of managing the disease are significant. While it currently has no cure, advances in treatment have improved life expectancy and quality of life for those living with Type 1 diabetes.
This document discusses concepts related to disease causation and the natural history of disease. It defines disease, illness, and sickness, and describes key concepts like the germ theory of disease, epidemiological triad, multifactorial causation, and web of causation. It discusses factors related to agents, hosts, and environments that influence disease occurrence. It also outlines the pre-pathogenesis and pathogenesis phases in the natural history of disease.
This document discusses chronic diseases, specifically obesity, coronary heart disease, hypertension, and diabetes mellitus. It defines each condition, discusses their prevalence, risk factors, measurement, prevention, and management. Obesity is defined by BMI measurements and poses health hazards like increased mortality and morbidity. Prevention focuses on diet, exercise, and lifestyle modifications. Hypertension is a major risk factor for other diseases and its management requires patient education and controlling risk factors through medication and lifestyle changes. Diabetes mellitus can be prevented through identifying at-risk groups and promoting healthy behaviors.
Women are diagnosed with bipolar disorder on average 3.2 years later than men and are more likely to experience a delay in seeking treatment. They are also more likely to have a depressive first episode and experience more rapid cycling of moods. Women tend to have more severe depressive episodes and mixed episodes than men. Improving recognition of gender differences and barriers to recovery such as unemployment, lack of social support and exploitation could help enhance quality of life and management of symptoms for women living with bipolar disorder.
This document summarizes key aspects of bipolar disorder, including:
1) Bipolar disorder is characterized by recurring manic or hypomanic episodes that alternate with depressive episodes. It exists on a spectrum from bipolar I to bipolar II disorder.
2) Bipolar disorder has a lifetime prevalence of around 2.4% worldwide and is associated with significant disability. However, it often goes undiagnosed for around 10 years.
3) People with bipolar disorder have high risks of suicide, psychiatric comorbidities, and medical comorbidities. They also face impairments in education, work and development due to the disorder.
This literature review examines previous studies on children undergoing treatment for chronic or life-threatening diseases. The studies found that these children often have lower health-related quality of life than their healthy peers. They also found that current quality of life tests may be too brief or generalized to fully assess these children's experiences. The review suggests that an intervention center could help children through difficult medical treatments by utilizing general quality of life tests along with more customized evaluations. This would help the center better understand children's specific needs and improve their health outcomes and social development.
Whalley2007 correlation of psychological and physicalbenwhalley
This study examined the relationship between psychological and physical symptoms in a healthy population without diagnosed diseases. A survey was completed by 1,143 women measuring symptoms related to conditions associated with inflammatory diseases (such as allergies and gastrointestinal issues), as well as psychological symptoms of depression and tiredness. After controlling for response bias, tiredness was found to correlate with most physical symptoms, but depression did not. This suggests immune dysregulation may explain the co-occurrence of psychological and physical symptoms even in healthy individuals.
16. Stress And The Git Does It Cause Crohns Diseaseensteve
The document discusses the relationship between stress and Crohn's disease. It summarizes that while stress does not appear to cause Crohn's disease, stress may modulate the disease course by influencing the brain-gut axis. Stress can diminish protective intestinal factors and increase permeability through pathways like the HPA axis and sympathetic nervous system. Some studies have found an association between psychological distress levels and future Crohn's disease activity, but the evidence regarding stressful life events triggering relapse is inconsistent.
International Journal of Humanities and Social Science Invention (IJHSSI) is an international journal intended for professionals and researchers in all fields of Humanities and Social Science. IJHSSI publishes research articles and reviews within the whole field Humanities and Social Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
This document discusses concepts related to disease, including definitions of disease, illness, and sickness. It covers concepts of causation from earlier theories to the germ theory and multifactorial causation. The natural history of disease and spectrum of disease are described. Risk factors, risk groups, and the iceberg model of disease are also summarized. The document concludes with concepts of disease control and monitoring.
Psycho social dynamics in causation of diseaseaneez103
This document discusses concepts related to health, disease, and their determinants from various perspectives. It defines health positively as a state of complete physical, mental, and social well-being, and not just the absence of disease. Health is influenced by biological, behavioral, environmental, and socioeconomic factors. Disease results from the interaction between an external agent, the host, and the environment. A holistic view recognizes the multidimensional nature of health and its dependence on psychological, social, cultural, economic, and political influences. Maintaining health requires efforts at the individual, community, national, and international levels.
Spirituality and Attitude towards Death among Senior Citizens with Special Re...AnuragSingh1049
Death is an unpredictable and undeniable event that occurs in everyone’s life regardless of age, time, place etc. One of the common experiences for those are unprepared for this reality is Anxiety. The attitude of senior citizens towards death vary from person to person and they adopt different strategies to cope with their anxieties. Spiritual practice is one of the coping strategies adopted by senior citizens. The present study tries to examine the association between spirituality and attitudes towards death among 100 senior citizens ( 65 years and above) in residential houses and in old age homes. Participants were asked to respond to two different questionnaires namely, Death Attitude Profile-Revised developed by Wong, Recker, Gosser (1994) and Spirituality Experience Index- Revised developed by Genia, V (1991) including a 32-item and 23-item respectively. Data was collected during March-April, 2018 by using SPSS software and data were analysed using the statistical tools namely, simple percentages, means, standard deviation, Pearson's correlation, t-Test and ANOVA. The scale had a high level of internal consistency, as determined by a Cronbach's alpha of 0.712. The study concludes that higher the level of spirituality (spiritual openness) lower the level of fear of death. Those with higher level of spirituality avoid thinking and talking about death to be away from anxiety. There is a negative correlation between spirituality and positive dimension of attitude towards death (Escape acceptance) higher the level of spirituality, lower the attitude towards escape acceptance (death as an escape from a painful existence) but there was no correlation between spiritual support and any of the death attitude dimensions.
2010 12 09 maîtrisez vos documents électroniques by competiticCOMPETITIC
Maîtrisez vos documents électroniques : Contrats, factures, notes de travail … Comment gérer aujourd'hui vos documents numérisés ?
Avec le développement de la dématerialisation des échanges (et sa reconnaissance juridique), le document électronique, dématerialisé, envahit peu à peu l'entreprise, en impactant les procédures d’archivage, de stockage … l’entreprise doit faire évoluer ces procédures pour optimiser ses process. Qu’appelle-t-on un document numérisé ? Comment le sauvegarder, l'archiver ? Comment l'exploiter pour optimiser le fonctionnement de l'entreprise ? Quelle est sa valeur juridique ?
Teks tersebut membahas berbagai persoalan teologi dalam Islam seperti sifat-sifat Allah, pelaku dosa besar, akal dan wahyu, kekuasaan Tuhan dan perbuatan manusia, serta kekuasaan mutlak dan keadilan Tuhan menurut berbagai aliran seperti Asy'ariyah, Maturidiyah, Mu'tazilah, dan lainnya.
By Nobuaki Ogawa, EFI DirectSmile
In this session, you will learn how you can easily utilize continuous delivery practices with Jenkins CI. From build, deploy, test, maintenance and monitoring, lots of processes can be easily orchestrated with Jenkins. Nobuaki will cover a very simple case for which he implemented continuous delivery with Jenkins CI, Azure and Selenium. This project is a basic case of continuous delivery. Especially noteworthy, for a Windows program. :-)
Surviving the Future with Drought Preparednesstaliean
- St. Lucia experienced a severe drought in 2015, with rainfall levels 33.5 mm below the previous year's levels for May. While annual rainfall has remained consistent, patterns have changed with more days without rain and heavier rainfall.
- The drought officially ended in July but rainfall is predicted to be below normal until October. Water rationing continued as the main water reservoir level remained low.
- Adapting to climate change includes improving water conservation and harvesting practices across sectors like tourism and agriculture which are heavily reliant on consistent water supply. Strengthening legislation and enforcement of water abstraction and management is also needed to prepare for more frequent weather extremes.
This document discusses building a professional digital profile and developing digital literacy skills. It emphasizes that a standard CV is no longer sufficient, and that job seekers should recognize building an online personal brand through social media is now critical for career development. It provides tips for curating an online presence that actively promotes one's skills and positively influences potential employers. Developing digital literacy involves skills like effectively managing, evaluating, and communicating information online to showcase knowledge and stand out among peers.
This document provides an overview of a session plan on digital literacy. It discusses evaluating online information, relevant articles, and a digital literacy conference. It also includes a student video on living and working on the web. Several topics within the scope of digital literacy are explored, such as information management, creating materials, effective communication, and digital identity and behavior. The document highlights the importance of digital skills for employment and shares examples of digital champions who helped with events and now work in digital fields.
Dokumen tersebut membahas tentang pendekatan dalam pencarian pengetahuan tentang Tuhan menurut perspektif Al Quran. Terdapat empat pendekatan yang diambil Nabi Ibrahim yaitu pendekatan empiris, rasional, kritis, dan intuitif melalui berdialog dengan Tuhan. Dokumen juga membahas teori perkembangan agama manusia dari dinamisme ke politeisme ke monoteisme serta pandangan agama Hindu dan Buddha tentang konsep Tuhan.
Dokumen tersebut membahas tentang politik anggaran dan strategi pem bahasan perubahan APBD. Secara garis besar membahas tentang siklus penyusunan anggaran daerah, dasar hukum perubahan APBD, jadwal penyusunan KU-P dan PPAS-P, penyusunan DPPA-SKPD, dan klasifikasi belanja.
The ALS Ice Bucket Challenge was started to raise awareness and funds for ALS/Lou Gehrig's disease. It involves dumping a bucket of ice water on one's head and challenging others to do the same within 24 hours, or donate to ALS research. The challenge went viral on social media in 2014, with many celebrities participating. It significantly increased donations to ALS associations, with $98.2 million donated from July to August 2014 compared to $2.7 million the prior year. The challenge also dramatically grew visits to ALS association websites and the Wikipedia page on ALS.
Dokumen tersebut membahas tentang langkah-langkah penyusunan instrumen tes, mulai dari penentuan tujuan tes, penyusunan kisi-kisi soal, penulisan soal, validasi soal, perakitan soal menjadi perangkat tes, uji coba soal, bank soal, penyajian tes kepada siswa, hingga skoring jawaban siswa. Kisi-kisi soal digunakan sebagai pedoman dalam penulisan dan perakitan soal, dan mencakup ident
Makalah ini membahas cara menginstall sistem operasi Windows 7 dengan 4 langkah utama: (1) mengatur BIOS untuk boot dari CD/DVD, (2) membuat partisi baru untuk Windows 7, (3) melakukan proses instalasi, (4) mengisi identitas pengguna.
Crimson Publishers: The Impact of Chronic Diseases on Patients and Their Fami...CrimsonGastroenterology
The Impact of Chronic Diseases on Patients and Their Families: Case of Ulceratice Colitis and Crohn’s Disease by Maria Tsoukka in Gastroenterology Medicine & Research: Bowel Disease
Background: The purpose of the study is to identify the potential psychological effects of ulcerative colitis and Crohn’s disease on patients and their family environment.Aim: The objective aims of this current research are to identify the causal factors creating psychological problems among patients and their family members, exploring ways to eliminate them and create a general picture for their psychological condition in relation to the diseases at a Pancyprian level.Methods: The Greek translation of the Hospital Anxiety and Depression Scale (HADS) and the Greek translation of the Health Survey (SF-12) will be used for evaluating the psychological effects of ulcerative colitis and Crohn disease on patients and their families. In addition, the Greek translation of the inflammatory Bowel Disease Questionnaire will be used only on the patients. The questionnaires will be handed out to the patients and their attendants in Gastroenterology dispensaries all over Cyprus. Conclusion: In the context of improving health care quality, it was indicated that multifaceted interventions are more effective than simpler interventions and that the insistence on change requires a multi-layered approach. A major focus of health policy is the effective management of long term diseases both for reducing the burden on patients and professionals as well as of the health services also. Studying the Group of patients with IBD could be an important example of study as the patients themselves are chronic patients with 20 years being the peak age onset of the diseases and life expectancy of healthy individuals.
Inflammatory Bowel Disease And Industrialization EssayPatricia Viljoen
This document discusses inflammatory bowel disease (IBD) and ulcerative colitis. IBD refers to conditions where the immune system causes chronic inflammation in the gastrointestinal tract. The two main types of IBD are Crohn's disease and ulcerative colitis. Ulcerative colitis only affects the large intestine, causing ulcers, bleeding and diarrhea. A diagnosis involves evaluating symptoms, medical history, and using endoscopy and biopsy to examine the intestine. While there is no cure for IBD, treatments aim to reduce inflammation and symptoms.
2 hours agoLorie Valentin Week 8 Initial Post Valentin, Lori.docxvickeryr87
2 hours ago
Lorie Valentin
Week 8 Initial Post Valentin, Lorie
COLLAPSE
Top of Form
Initial Post Week 8
NURS 6501: Advanced Pathophysiology
Gastrointestinal Disorders
Lorie Valentin RN, BSN
Gastrointestinal Disorders
Gastrointestinal symptoms such as pain, bloating, nausea, vomiting, and diarrhea, are a common manifestation of many different etiologies. Medication side effects, viral illness or stress are just a few. Sometimes though, these symptoms can indicate a bigger problem and a more chronic illness that needs to be addressed. Two of these chronic illnesses are inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). Because of the similarities in their presentation it can sometimes be hard to tell the difference between the two, but it is important to accurately identify which is the causative factor, because pathophysiology and treatment are very different (Huether & McCance, 2017).
IBD
IBD is one of several disease that cause inflammation of the mucosa of the intestines. Ulcerative colitis (UC) and Crohn disease are two of the inflammatory diseases. Both are autoimmune disease that cause ulceration of the mucosa, resulting in thickening in the lining causing narrowing of the lumen (Huether & McCance, 2017). Crohn’s additional can cause ulceration through the full thickness of the intestinal wall and often has additional inflammatory manifestation concurrently (Hammer & McPhee, 2019). Both have a high risk of infection and malignancy due to remodeling of the tissue. The most common symptoms are pain, bloating, diarrhea and blood in the stool ((Huether & McCance, 2017).
IBS
IBS is similar in presentation to IBD, but lacks the autosomal component. IBS is thought to be the result of environmental factors (Huether & McCance, 2017). IBS is diagnosed based on symptom presentation without a detectable disease process (Huether & McCance, 2017). Symptoms of IBS are pain, bloating, diarrhea or constipation, or alternating diarrhea and constipation, nausea, and gas. Treatment is usually based on lifestyle changes and avoiding triggers (Huether & McCance, 2017).
Treatments
The treatment for mild to moderate IBD is most often aminosalicylates, such as sulfasalazine or mesalamine (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). During acute exacerbations often corticosteroids are added, but if symptoms continue or for severe cases immunosuppressant medications might be needed to return to a remission state (Arcangelo et al., 2017). The treatment for IBS is behavioral changes to include reducing stress and dietary changes to reduce triggers and improve gut flora (Huether & McCance, 2017). Similar changes in diet are recommended for those with both IBD and IBS, reduction in inflammatory items such as gluten and increasing anti-inflammatory nutrients like omega 3 fatty acids and probiotics to improve gut flora (Arcangelo et al., 2017; Huether & McCance, 2017).
Genetic Influences
Genetics is.
This document discusses concepts related to illness, disease, and chronic conditions. It defines illness as a personal state of feeling unwell compared to previous functioning, while disease refers to biological or physiological abnormalities. Chronic conditions require long-term management and do not resolve spontaneously. The document outlines various factors that influence disease risk, common causes of disease, classifications of disease, and terminology used in understanding health conditions. It also discusses the effects of illness on individuals and families.
This document discusses various theories of disease causation and pathogenesis. It describes old theories from Ayurveda and Chinese medicine that attributed disease to imbalances in bodily principles. It also covers the germ theory proposed by Pasteur and Koch, and the biomedical model. More recent theories recognize multifactorial causation involving genetic, social, environmental, and lifestyle factors. The pathogenesis of disease is explained as the progression from pre-pathogenesis through clinical symptoms to recovery or death. An iceberg model is used to represent the majority of hidden or subclinical cases that maintain disease prevalence.
psychiatry.Somatoform disorders animation part i.(dr.nzar)student
Somatoform disorders involve patients who believe their suffering comes from undiagnosed physical issues. This document discusses somatization disorder specifically. It is characterized by multiple medically unexplained symptoms affecting multiple body systems. Factors associated with somatization disorder include abuse history, depression, and high levels of somatization. Both physical and sexual abuse history are independently linked to increased gastric sensitivity. Physical abuse history and somatization are also independently associated with slower gastric emptying. Psychological processes may influence gastric function through brain-gut pathways.
When the body is under stress, it produces more of the hormone cortisol, which acts as an anti-inflammatory agent. When cortisol is produced peripherally in the gums, it stimulates mast cells to produce more proteins, simultaneously increasing inflammation and the progression of periodontal disease.
Running head LIVING WITH CHRONIC ILLNESS1Living with Chroni.docxwlynn1
Running head: LIVING WITH CHRONIC ILLNESS 1
Living with Chronic Illnesses 2
Living with chronic illnesses: How are those with a chronic illness treated by their families since their diagnosis?
Maura K. Little
University of West Florida
Abstract
This study aims to figure out what the relationship and meaning of the ways that a family treats a family member with a chronic mental or physical illness. The exploration of the way those with a chronic illness are treated since their diagnosis is important to understand the perceptions, behaviors, and communication that surrounds illness. Chronic mental illness will be analyzed against chronic physical illness to assess similarities and differences in family behaviors. Participants included individuals selected from local support groups based on their illness as well as family structure. An ethnographic study would be used to compare both the verbal and nonverbal relationship between the ill family member and the rest of the family.
Introduction
This study aimed to focus on both physical chronic illnesses and mental chronic illnesses and their effects on family communication, particularly surrounding the diagnosis of the illnesses.
Family has a large impact on the perceptions of illness. In recent times, the publicity around individuals with chronic illnesses, both mental and physical, has increased dramatically in the media. From the production of films about those with physical chronic illnesses to celebrity diagnosis of a mental illness, illness is something our society is beginning to talk about more frequently. However there are certain stigmas attached to these illnesses that make it harder for patients and their families to cope with their situation. Most often because of the portrayals of chronic illness that romanticize illnesses and do not necessarily show all of the effects of these illnesses on the patient or their family.
Both mental and physical chronic illnesses are much more complex than how they are portrayed in the media. These illnesses often produce copious amounts of side effects that bring a whole new level of challenges to the patient's struggle through their daily life and readjustment after diagnosis. One effect that is often not publicized as much as others is the relationships that exist between the patient and their family. These family relationships may change drastically with the diagnosis of and grappling with a chronic illness, changing how family members perceive one another, how they act, and even how they communicate. All of these things depend upon the nature of the family, and the illness and produce different changes. However, through all different types of families and illnesses, communication in situations like these is essential to understanding one another. According to Rosland (2009), several interviews and focus groups showed that family members lowered stress, and are central to patient success. In most instances, the family i.
This study aims to examine how families treat members who have been diagnosed with chronic mental or physical illnesses. The researcher will conduct an ethnographic study involving purposive sampling of families with various chronic illnesses. Participants will be recruited from local support groups. The researcher will observe family interactions and conversations in their homes to analyze changes in communication, behaviors, and relationships since the diagnosis. Both verbal exchanges and nonverbal interactions will be recorded and compared to stories from before the diagnosis. The findings will help understand how chronic illnesses impact family dynamics and shed light on the patient's experience.
This document discusses somatoform disorders. It begins by defining somatoform disorders as mental illnesses characterized by physical symptoms that cannot be fully explained medically and cause impairment. Key points include: somatoform disorders involve the presentation of physical complaints due to psychological factors; they are characterized by multiple somatic complaints and persistent healthcare seeking despite reassurance; and common types include somatization disorder, conversion disorder, and hypochondriasis. Treatment involves identifying and addressing the underlying psychological causes through cognitive behavioral therapy and other approaches.
Inflammatory Bowel Disease (IBD) - Symptoms and Causes.pptxMediEND
Inflammatory bowel disease (IBD) is a chronic and often debilitating condition that affects millions of people worldwide. It is a complex group of diseases that can have a significant impact on both individuals and the healthcare system. In this presentation, we have defined IBD and discussed its prevalence, symptoms, causes, diagnosis, and treatment options. Our aim is to inform readers about this condition and increase awareness and understanding of its symptoms and causes.
Depression Depression is not a normal part of aging, and studi.docxcuddietheresa
Depression
Depression is not a normal part of aging, and studies show that most older people are satisfied with their lives, despite physical problems (National Institute of Mental Health [NIMH], 2014b). To understand depression, the nurse must understand the influence of late-life stressors and changes and the beliefs older people, society, and health professionals may have about depression and its treatment.
Prevalence
Depression remains underdiagnosed and undertreated in the older population and is considered a significant public health issue (Abbasi & Burke, 2014).
Depression is the fourth leading cause of disease burden globally and is projected to increase to the second leading cause by 2030 (World Health Organization, 2014).
Approximately 1% to 2% of adults 65 years and older are diagnosed with major depressive disorder. An additional 25% have significant depressive symptoms that do not meet the criteria for major depressive disorder (Avari et al., 2014).
Symptoms that do not meet the criteria for major depressive disorder have been referred to as minor depression, subsyndromal depression, dysthymic depression, and mild depression.
The DSM-5 replaced the term dysthymia with the term persistent depressive disorder to describe symptoms that are long standing (lasting 2 years or longer) but do not meet the criteria for major depressive disorder.
Recognition and treatment are important because persistent depressive disorder has a negative impact on physical and social functioning and quality of life for many older people and is associated with an increased risk of a subsequent major depression (Harvath & McKenzie, 2012; Uher et al., 2014).
Rates of depression are higher in older adults who experience physical illness, who have cognitive impairment, or who reside in institutional settings. Fourteen percent (14%) of patients receiving home care meet the criteria for depression, and nearly half of all nursing home residents receive antidepressants for depression (Abbasi & Burke, 2014; Smith et al., 2015).
Depression is a major reason why older people are admitted to nursing homes.
Prevalence rates of depression in older adults likely underestimate the extent of the problem. The stigma associated with depression may be more prevalent in older people, and they may not acknowledge depressive symptoms or seek treatment. Many elders, particularly those who have survived the Great Depression, both world wars, the Holocaust, and other tragedies, may see depression as shameful, evidence of flawed character, self-centered, a spiritual weakness, and sin or retribution. Perceived stigma may be less of a concern for the future older population who are more aware of mental health concerns and more likely to seek treatment.
Health professionals often expect older people to be depressed and may not take appropriate action to assess for and treat depression. The differing presentation of depression in older people, as well as the increased pr ...
Young girls in developed countries are primarily affected with eating disorders. Persons with anorexia are honest, do not disobey, and hide their inner feeling, tend to be good in whatever they do and often excellent athletes. Research says that anorexia people eat less to gain a sense of control over their lives.
Running head SCHIZOPHRENIA MENTAL DISORDER .docxtoltonkendal
Running head: SCHIZOPHRENIA MENTAL DISORDER 1
SCHIZOPHRENIA MENTAL DISORDER 2
Schizophrenia Mental Disorder
Student’s Name
Course Name
Instructor’s Name
University Affiliation
Schizophrenia Mental Disorder
Introduction
Schizophrenia is a type of psychological illness. It is a chronic and unembellished mental disorder that mainly distresses an individual’s thinking, norms as well as to their extent of sensation. According to modern day research, reports indicates that persons who have schizophrenia might appear as if they have misplaced touch with realism. However, much it is not collective as in comparison with the other mental disorders, its symptoms seem to be much disabling in nature (Miller, 2012). An example is a reduction of a person’s pleasure in their daily undertakings. It raises the question; what can a man do in the absence of desire and affection in all their doings? From the information as already mentioned above, this paper takes turn providing an enhanced analysis of the mental disorder disease – Schizophrenia.
Signs and Symptoms
In close to all the reported cases, signs and symptoms of schizophrenia often start from ages ranging between 16 and 30. There are however fewer cases that the disease has identification among the children. In this paper, it classifies the symptoms and signs into three categories. They include the positive, negative, as well as to the cognitive symptoms as illustrated below.
Positive signs:
In this category, they have a regard for psychotic norms. It means that it is hard to depict the signs commonly in people who are living a healthy lifestyle. However, the given individuals might tend to part ways with their connectivity with different components of reality. The symptoms might include: -
· Delusions
· Agitated movements of the body in a disorderly manner
· Hallucinations
· Unfamiliar perspective of thinking entailing disorderly thoughts and imaginations
Negative symptoms:
In this set, symptoms have a closer affiliation with disturbances to both the common behaviors as well as to particular emotions (Mueser, 2011). The symptoms comprise of: -
· Condensed level of speaking
· Reduction in the extent of both pleasure and feelings in a person’s everyday life undertakings
· Decline on the voice tone as well as the ordinary portrayal of emotions
· Hardships in commencing and sustaining of various activities
Cognitive symptoms:
In this set of symptoms, it varies from one given an individual to the other. To certain people, the symptoms are observable as being delicate in nature. On the other hand, the symptoms prove to be extra severe (Weiberger et al., 2011). In such situations, the affected persons are capable of recognizing alterations in either the facets of thinking and imagination, as well as to variations in their memory. Examples of symptoms ...
Health Services Utilization Carly's Study DesignCarly Thompson
This document outlines a study examining barriers to eating disorder treatment among women. The study will use Anderson's Behavioral Model framework to identify predisposing, enabling, and need factors that influence barriers. The dependent variable is barriers to inpatient and intensive outpatient treatment. Independent variables include demographic, clinical, social, and system-related factors. The study aims to compare barriers across eating disorder subtypes to address disparities in access and utilization of treatment. Key hypotheses predict financial barriers will impact bulimia and OSFED most while shame will impact anorexia most.
Disorganized Diseases: Are they a Simple Explosion of Random Energy and there...asclepiuspdfs
Objective: The study has two objectives: (1) To determine the prevailing characteristics of a given set of patients with “disorganized disease” and (2) to determinate the prevailing outcomes for these patients in family medicine to assess their implications for decision-making. Participants and Methods: A qualitative, longitudinal, and retrospective cases series study based on a single cohort was carried out. Analyses based on a retrospective study of case records from June to October 2017, in a family medicine office in the Health Center Santa Maria de Benquerencia, Toledo, Spain. A convenience sample was selected consisting of patients who consulted during that period and who met the criteria for entering the study. These cases were considered in the epidemiological term as index cases, which means that beyond these the study should be expanded. Hence, in addition, using a technique of snowball “mental” or “astute clinical observation” others patients attended previously were included until the saturation of the data. The cases were described in short case reports. An analysis of the content of these reports was carried out, defining categories of qualitative data. The results were interpreted, and a generalization was drawn from these cases.
Carter Sherman Annotated Bib. Bipolar DisorderCarter Sherman
This annotated bibliography summarizes research on the bio-psycho-social aspects of bipolar disorder. Key findings include:
1. Bipolar disorder is often associated with co-occurring mental illnesses and lower quality of life, even during stable phases.
2. Social factors like interpersonal problems, occupational issues, and early onset may predict higher suicide risk. Mortality is also elevated compared to the general population.
3. Physical health problems and sleep disturbances are more common for those with bipolar disorder. Severe mental illness increases risks of chronic health issues.
4. Men and women experience different symptoms, though rates are consistent between genders. Diagnosis and treatment can also differ based
An overview of depression and its pharmacotherapypharmaindexing
This document provides an overview of depression and its pharmacotherapy. It defines depression as a common and serious mental health disorder. Left untreated, depression can lead to complications like suicidal thoughts and negatively impact quality of life. The document classifies depression, discusses its prevalence, risk factors, and health impacts. It causes symptoms like sadness, loss of interest, and changes in appetite and sleep. Pharmacotherapy options for depression include antidepressants, often used for mild to moderate cases. Psychotherapy combined with antidepressants can increase treatment success rates compared to medication alone.
1. Symptom Severity and Psychological Distress in IBD Patients 1
Reducing Symptom Severity in Patients with Inflammatory
Bowel Disease by Treating Psychological Distress
Danielle R Olson
Kent State University
2. Symptom Severity and Psychological Distress in IBD Patients 2
Inflammatory Bowel Disease, or IBD, is a disease of the digestive system
that has debilitating symptoms, and patients are usually given several types of
incredibly strong prescriptions that often have their own adverse side effects. Aside
from severe physical symptoms, the disease is often accompanied by negative
psychological symptoms as well. In fact, research has shown that there is a
correlation between psychological distress and the severity of symptoms in patients
suffering from IBD. However, there is currently no positive treatment or
standardized psychological support for these patients, with the main focus primarily
on pharmaceutical and biological aspects. In this proposal, an intervention will be
developed and administered to newly diagnosed patients in an effort to decrease
psychological distress and in turn, hopefully decrease the severity of physical
symptoms that accompany the disease.
Definition
IBD is a chronic autoimmune disease that affects the digestive system,
causing severe inflammation of the smooth muscles and lining of the digestive tract.
(CCFA) In autoimmune diseases, the immune system mistakenly attacks healthy
cells and tissues in different areas of the body. The inflammation seen in IBD is
caused by the body’s immune system attacking the digestive tract. This causes
irritability and sensitivity in the bowels due to the body’s inability to regulate the
immune system. (Porcelli & Leandro, 2007) This inflammation causes severe and
often incapacitating symptoms. There are no known causes or cures for the disease,
and patients’ experience lifelong periods of relapses and remissions. Patients are
3. Symptom Severity and Psychological Distress in IBD Patients 3
faced with lifelong unpredictability and current treatments focus on medication to
achieve and prolong remission. (Rochelle & Fidler, 2012)
There are two specific types of IBD, Crohn’s disease and Ulcerative Colitis. Crohn’s
disease, which is typically the more severe of the two, is characterized by inflammation and
symptoms anywhere in the digestive tract, from the mouth to the rectum. The severe
inflammation can cause scar tissue leading to bowel blockage, deep tissue ulcers, and fistulas,
which are abnormal passageways from the digestive tract to nearby tissue and organs. (Cleveland
Clinic, 2016) Those suffering from Ulcerative Colitis, or UC, experience the same type of
inflammation, but it is primarily restricted to the large intestine and rectum rather than the entire
digestive tract. UC is characterized by “tiny ulcers and small abscesses…that flare up
periodically and cause bloody stools and diarrhea.” (Cleveland Clinic, 2016) Both diseases are
diagnosed by undergoing a number of tests including endoscopy, blood tests, stool samples,
barium x-rays and colonoscopies, MRIs, and CT scans. (Cleveland Clinic, 2016)
Historical Misconceptions & Stigmas
Until recently, there have been a number of misconceptions and stigmas that prevented
the understanding and treatment of these diseases. When it was first recognized as an illness in
the early 1900’s, IBD was thought to be a psychosomatic disorder, meaning that the cause and
symptoms that were physically expressed came from a psychological origin. Stress, psychiatric
disease, and psychological illness were regarded as the only cause, with no attention or
acknowledgment given to a possible biological origin. (Porcelli, Leoci & Guerra, 1996) Patients
experiencing symptoms of IBD were often institutionalized for insanity. Others felt that the
disease was a manifestation of a hostile family dynamic. Some doctors and researchers felt that
an unstable relationship with one’s mother could eventually lead to a rage filled implosion that
4. Symptom Severity and Psychological Distress in IBD Patients 4
manifested as an upset of the digestive system. (Gerson, Grega, & Nathan-Virga, 1993)
However, research and medical advancements have since shown that IBD is in fact an organic
disease, helping to prove that symptoms and flare-ups have a biological basis and are not a
mental manifestation. The nature of the symptoms stemming from IBD also make it difficult to
discuss and therefore can hinder diagnosis and research. Due to society’s reluctance to discuss
bodily functions, it is not surprising that patients would be embarrassed to discuss the symptoms
and difficulties they face, even with medical professionals. (Hatch, 1996) This stigma makes
talking about the disease embarrassing for patients and can create psychological distress. It has
been discovered that physical, as well as psychological stress, can have devastating effects on
patients with IBD.
Physical Symptoms
IBD can affect patients in a variety of different ways. The most obvious are the physical
symptoms that are experienced. The most common physical symptoms for both Crohn’s and UC
are chronic pain and fatigue, severe diarrhea, vomiting, rectal bleeding, malnutrition,
dehydration, and anemia. Others may include extreme urgency in defecation, body aches, muscle
cramps, perspiration, low appetite, malnutrition, weight loss, and fever. (Gerson et al., 1993)
There are also a number of physical symptoms external to the digestive system such as joint
pain, skin disorders and irritations, kidney and gallstones, swelling of the mouth and eyes, and
liver disease. (Cleveland Clinic, 2016)
Psychological Symptoms
Symptoms however, are not exclusively physical in nature. Having to deal with the
severity of the physical symptoms frequently experienced by IBD patients long-term
5. Symptom Severity and Psychological Distress in IBD Patients 5
undoubtedly contributes to the psychological stress that also accompanies the disease. There is a
plethora of psychological symptoms that are experienced by patients with IBD. Anxiety and
depression are the two most common psychological disturbances found in patients and research
has shown that these can be a direct result from, and have a significant effect on the physical
symptoms presented by the disease. Research has shown that even though UC is no longer
thought to be psychosomatic in nature, psychological symptoms do largely contribute to the
course of the disease and to the patient’s quality of life. (Porcelli & Leandro, 2007) When given
assessments regarding stress associated with an ongoing medical condition, IBD patients
reported more disruption regarding psychological and social aspects than physical. (Drossman,
Patrick, Mitchell, Zagami, & Applebaum, 1989) This is not meant to downplay or discredit the
severity of the physical symptoms experienced by patients, but rather introduce and highlight the
importance and impact that psychological symptoms have on the patient’s well-being. This also
helps to introduce the correlation between a patient’s level of psychological distress and
symptom severity. Guthrie, Jackson, Shaffer, Thompson, Tomenson, & Creed all recorded
evidence showing an increase in psychological distress following an increase in physical
symptoms. (2002) Gerson et al. discuss how stress can be a causative factor, but only if there is
an underlying and biological predisposition. (1993) The major finding in the study done by
Porcelli, Leoci, and Guerra (1996) was that there is an overwhelmingly strong correlation
between symptom severity and the amount of psychological distress experienced by patients with
IBD.
This type of psychological stress cannot only exacerbate physical symptoms, but affect
how the patients sees themselves and their ability to control the disease. Personal perceptions can
play a contributing factor when it comes to patient’s psychological health. Negative personal
6. Symptom Severity and Psychological Distress in IBD Patients 6
perceptions can especially cause an increase in psychological disturbances. Fear of symptoms
and public embarrassment, along with the fear of the inability to manage those symptoms and
control the disease can be incredibly stressful. This will not only increase the chance for
symptom severity due to increased stress, but will have a huge impact of the patient’s quality of
life, or QOL, from a personal and social standpoint. In a study done by Hall et al., (2005)
Interviewees saw their illness in terms of their bodies being ‘under attack’ by an
inconvenient, chronic, smelly, painful, and embarrassing disease. IBD was seen as an
unpredictable illness responsible for restriction in activity or freedom and affected all
aspects of everyday life. This included social and family relationships, fulfilling roles
such as caring for the family as well as social activities, work, travel, shopping and even
in some cases simply leaving the house. (p. 446)
When the normality of everyday life is disrupted, this can bring on depression, anxiety,
and feelings of hopelessness, all of which decrease a patient’s QOL. Increased fear, depression
and anxiety can also lead to social avoidance and isolation. Hall et. al. noted major issues among
patients to be a fear of bowel incontinence and avoidance of social situations, both of which
create a deficit in both physical and psychological control. (2005) Gerson et al., (1993) further
discussed how the disease can have a social impact on patients’ lives by stating that due to the
lifelong unpredictability of the disease, the patients are constantly preoccupied with avoiding
public embarrassment caused by disease symptoms, which makes forming healthy relationships
with others difficult. Disease knowledge and perceived control over the disease also had an
impact on QOL. As reported by Rochelle and Fidler, (2012) patients who did not understand the
lifelong consequences had a higher QOL score than those who were educated to the disease’s
7. Symptom Severity and Psychological Distress in IBD Patients 7
progression and prognosis, and those who felt in control of the disease had higher QOL scores
that those who did not feel in control.
In extreme cases, the psychological disturbance experienced from IBD symptoms can be
so severe that an independent psychosomatic disorder called Bowel Obsession Syndrome can
develop. Bowel Obsession Syndrome, or BOS, is a relatively new diagnosis, gaining medical
recognition approximately twenty years ago. The clinical characteristics of BOS as described by
Porcelli and Leandro are,
Overwhelming and irrational severe fear of fecal incontinence
Ideational rambling over bowel habits, ranging from possible public humiliation
to perceived unavailability of bathrooms outside the home
Compulsive behaviors aimed at maintaining body control, including spending
excessive amounts of time on the toilet and restricting food intake
Various symptoms that overlap a number of disorders, including panic disorder,
social phobia, specific phobia, or agoraphobia without panic symptoms (2007)
Although extreme and rare, BOS is an excellent example of just how influential the
psychological symptoms that accompany IBD can be. In the case study done by Procelli and
Leandro (2007), the patient was diagnosed with IBD, an prescribed a treatment plan by his
doctor that included a very restrictive diet, lifestyle free of toxins (alcohol and tobacco), and total
avoidance of sexual and physical activity. This extreme treatment plan and lack of education on
the actual disease caused crippling fear and social isolation. As a result, “the patient began to
develop a deeper fear of leaving home and compulsive rituals of defecation-checking.” (Procelli
and Leandro, 2007)
8. Symptom Severity and Psychological Distress in IBD Patients 8
In the case studies of BOS done by Hatch, (1996) social isolation and public
embarrassment are also discussed. Circumstances that were seen as the most stressful were those
that did not have a public restroom available such as driving on the highway, densely populated
public events, and public buses and trains. Hatch (1996) also noted that the deeply overwhelming
fear of accidental public defecation prevented patients from leaving their home and developing
social lives. Although these cases of BOS are rare, psychological distress brought on by physical
symptoms in patients with IBD are not. Clearly, treatment is needed to cure both the physical and
psychological aspects of this disease.
Current Treatments
The main focus in current treatments for IBD have a very strong pharmaceutical and
biological focus. The aim of current treatments is to get to and stay in a period of remission for
as long as possible. While controlling the physical symptoms and preventing relapses is a critical
part of treatment, little to no emphasis has been placed on psychological treatments. The most
common form of treatment is pharmaceutical medication, and if symptoms and disease
progression are severe, surgery. When patients were questioned by Hall et al. (2005) as to how
they were treating and controlling their disease and its symptoms, pharmaceuticals and diet
restrictions were seen as the main ways to obtain or achieve some level of control. The patients
also listed other strategies, some negative and some positive, regarding how they coped with
symptoms. The most common negative strategies were, “situational avoidance, planning outings
around toilet availability,” and “keeping secret about the disease”. (Hall et al., 2005) The positive
strategies listed are: “adapting or learning to cope, information seeking, social support seeking,”
and “seeking healthcare.” (Hall et al., 2005) It is clear that the majority of strategies, whether
positive or negative, focus on physical symptoms, and little regard is given to treating
9. Symptom Severity and Psychological Distress in IBD Patients 9
psychological symptoms even by patients. This could be a direct result from the medical
community lacking information regarding psychological distress and its relationship with disease
and symptom severity.
Since medication is the primary form of treatment, it is worth noting what kinds of
medication are most commonly prescribed and what effect they have on IBD sufferers. During a
flare-up, IBD patients are often prescribed corticosteroids. This is an orally or rectally
administered anti-inflammatory drug that reduces swelling in the digestive tract and can bring on
remission. It is not however, prescribed for long term use due to its many and somewhat severe
side effects. Side effects include, but are not limited to: weakening of the bones, increased facial
hair, weight gain, mood swings, and psychosis and other psychiatric symptoms. (CCFA, 2015)
Although the side effects of this immune suppressing drug can actually increase psychologic
distress, therefore increasing symptom severity, it is still one of the most commonly prescribed
medications.
Other common medications include 5-aminosalicylic drugs, which reduce inflammation,
and immunosuppressants, which lower immune system functioning are often used to treat IBD
but can leave patients highly susceptible to infections. Biologics, or biological therapies are most
often used for moderate to severe disease activity. “Biologics are antibodies grown in the
laboratory that stop certain proteins in the body from causing inflammation.” (ccfa.org, 2015)
Biological therapies are created to be disease specific, and while the have fewer possible side
effects than other commonly prescribed medication, the ones that they do have can be much
more severe. While side effects from biologics usually only occur while taking other
medications, most IBD patients take several prescriptions simultaneously. Side effects from
10. Symptom Severity and Psychological Distress in IBD Patients 10
biologic can include increased cancer risk, liver problems, lupus-like reactions, and nervous
system disorders. (ccfa.org, 2015)
If medications fail to treat the disease, the only other option is surgery. Surgeries can
include a full colectomy, a proctocolectomy, a permanent ileostomy, or an ileal pouch,
depending on the disease’s progression and severity. (Cleveland Clinic, 2016) While these and
other medications can help to prevent flare-ups and maintain remission, they do not serve to
alleviate the psychological symptoms if IBD. Pharmaceutical treatment alone is not enough to
help patients maintain a high QOL. The focus then, rather than relying heavily on strong
medication, should be on developing and administering a treatment that can help to alleviate the
symptoms and control the disease without the harmful, severe, and invasive side effects that are
currently available. Research has shown correlations between psychological distress and
symptom severity, therefore, if physical and psychological aspects play a role in disease
progression, why are we not treating both, rather than just the physical?
Treating with Psychology
There is evidence showing that treating psychological symptoms can be an effective way
of managing the illness and increasing the QOL for patients. By treating the psychological
symptoms and decreasing psychological distress, it is proposed that the symptom severity will
decrease and that patient QOL will increase. Rochelle and Fidler, (2012) stressed the need of
addressing the psychological and well as the physical aspects when discussing any type of
chronic disease. There is obviously more to IBD than strictly biological and physical elements.
Therefore, a multi-faceted disease needs a multi-faceted treatment approach.
11. Symptom Severity and Psychological Distress in IBD Patients 11
By using a biopsychosocial model of treatment, a patient can receive treatment in all
areas of life that is affected by the disease including, physical, mental, and social aspects. This
approach has been suggested in other research as well. Drossman, (1996) supports a
biopsychosocial treatment approach in his study and discusses how this will best help to find
suitable treatments for the disease. Research done by Seres, Kovacs, Kovacs, Kerekgyarto, Sardi,
Demeter, et. al., shows that disease activity and symptom severity are the factors affecting
patients the most. (2008) If it is acknowledged that psychological distress has a direct impact on
symptom severity, and that symptom severity is one of the most important factors for patients, it
stands to reason that they should be receiving treatment for the psychological distress caused by
the disease. This point is best demonstrated by Guthrie, et al.,
The presence of psychological disorder in inflammatory bowel disease contributes to
poor health-related quality of life, regardless of the severity of the condition. Detection
and treatment of psychological disorder in inflammatory bowel disease carries the
potential to improve health-related quality of life for these patients. (2002)
In the case study done by Porcelli and Leandro (2007) regarding BOS, treatment was
successful and used a collaboration of healthcare professionals working together, including a
gastroenterologist, psychiatrist, and psychologist. Hatch (1996) gives yet another example of
how this biopsychosocial approach can be effective by stating that using therapy along with
biological treatments prove to be the most successful. While these are small and isolated cases, it
is believed that a standardized program of education, social support, and psychological screening
and treatment can be developed for a widespread application to newly diagnosed IBD patients in
an effort to decrease psychological distress and symptom severity.
12. Symptom Severity and Psychological Distress in IBD Patients 12
Introducing Additional Treatments
Illness education is a crucial part of helping patients to cope and accept this disease.
Being diagnosed with a chronic, lifelong illness and not understanding the implications of that
diagnosis are sure to cause some level of anxiety. Very few newly-diagnosed patients have ever
heard of the disease, and those who did have knowledge did not hold a deep understanding. (Hall
et al., 2005) This shows a strong educational and informational foundation is critical to patient’s
confidence in understanding the disease and feeling able to manage it. However, care must be
taken in exactly how this information in administered. In one study by Rochelle and Fidler,
(2012) it was demonstrated how patients that had a good understanding of their disease had
higher levels of anxiety than those who did not have a good understanding. It is proposed that the
reason for this correlation is due to the fact that having a good understanding of the disease also
means that patients have been informed on the limited number of treatments available. It is
hypothesized that by administering education along with psychological support, that the
correlation between knowledge and anxiety will weaken. In the same study, Rochelle and Fidler
(2012) state that they encourage disease education, and patient understanding will increase
patients’ confidence and sense of control.
Introducing and teaching different coping mechanisms is another way to increase patient
control and confidence. Educational programs made specifically for IBD patients are thought to
be potentially beneficial regarding personal perceptions. (Rochelle & Fidler, 2012) By
introducing stress relieving techniques and learning how to lower anxiety levels, the patient may
have less symptom related psychological stress. Social support is another fundamental part of a
successful integration plan. By creating support groups for patients with IBD, whether in person
or online, being able to discuss the emotional and physical difficulties of the disease with other
13. Symptom Severity and Psychological Distress in IBD Patients 13
patients could prove to be therapeutic and beneficial. Social awareness may be the most difficult
part for patients to deal with. Trying to explain the disease and symptoms to others can be
difficult and embarrassing. By giving patients tools and ideas on how to educate others, this
could help to alleviate a large source of the patients stress and anxiety. Studies have shown that
there are a common set of concerns that most IBD patients share. These include normality of
personal health, restrictions on personal freedom, disease control, coping strategies, self-
management, reluctance to confide in physicians, and a wide knowledge range. (Hall et al.,
2005) This intervention hopes to address these concerns.
Psychological screenings could be the most critical and important part in preventing or
helping to reduce psychological distress in IBD patients. The best place for this screening to be
administered would be in the gastroenterologist’s office. By performing this screening at the time
of diagnosis, physicians would be able to see signs of distress much sooner and could refer
patients to a mental health professional to receive treatment before the symptoms become severe.
As mentioned in Guthrie et al., (1998) being able to receive a psychological assessment in the
gastroenterologist clinic would be both appropriate and beneficial. By using cognitive
restructuring and behavioral therapy, the patient in Porcelli and Leandro’s (2007) study no longer
experienced OCD-like symptoms and was able to leave their home without fear, anxiety, or
depression. Patients have shown to be more than willing to take an active role in disease
management. The majority of interviewees in the study by Hall et al. stated that they would in
fact prefer a treatment program where they could self-manage their disease with the help of their
doctor. (2005) If given the right set of tools and information, patients will not only be more at
ease and confident, but ready to take a more involved and proactive role in managing their
disease.
14. Symptom Severity and Psychological Distress in IBD Patients 14
Proposed Intervention
In an effort to accomplish these suggested goals, an intervention will be introduced in an
effort to help newly diagnosed IBD patients lower their psychological distress and in turn
decrease the severity of their symptoms. This intervention will include illness and disease
education, coping mechanisms, social support and awareness strategies, and psychological
screenings and referrals. By introducing psychological treatments and implementing this
biopsychosocial approach, it will help to give patients a more complete treatment plan than what
is currently available.
By providing psychological support along with educational tools, it is hypothesized that
symptom severity will decrease among newly diagnosed patients, compared to those patients
who are newly diagnosed and not given additional psychological treatment.
15. Symptom Severity and Psychological Distress in IBD Patients 15
Method
Participants
The population that will be included in this study will be an equally represented amount
of both men and women ranging in age from 18-30, as it is most common for IBD patients to be
diagnosed with the disease during this age range. This disease affects both men and women and
most patients are diagnosed before the age of 30. (CCFA, 2015) This sample will included newly
diagnosed IBD patients only, in an effort to see if the intervention will be successful when
presented with the diagnosis and part of treatment and education. For this study, we will obtain
an N of at least 34, based on a ∝ of .05 and power of .8. While a minimum of 34 subjects in
required, our goal is to obtain an N of 50.
Materials
Educational Materials. Educational pamphlets discussing the disease symptoms,
treatments, and available support will be administered along with a list of contacts which provide
free support to IBD patients such as the CCFA and Cleveland Clinic websites. These will be
mailed to the patients after completing an online registration.
Disease Severity. Severity of symptoms will be measured using the CDAI (Crohn’s
Disease Activity Index, 2011), which calculates a patient’s symptoms, medication use, and
general well-being. This assessment uses both “yes” and “no” questions such as, “has the patient
in the last 7 days, taken any anti-diarrheal drugs?”, and a Likert scale of 0-3 or 4. A sample
question of this nature asks the patient to rate his or her general well-being on a scale of 0-4. This
scale is used by both doctors and researchers when assessing IBD symptom severity.
(http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0048967/)
16. Symptom Severity and Psychological Distress in IBD Patients 16
Psychological well-being. Patients will be screened for depression, anxiety, and panic
disorders. Depression screening will be done using the Patient Health Questionnaire-9 (PHQ-
9) developed by Spitzer, Williams, Kroenke, and colleagues in 1998. It is a 4 point Likert scale,
ranging from not at all to nearly every day. Samples include, “little interest or pleasure in doing
things”. Anxiety screening will be done using the Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition developed by the American Psychiatric Association, 1994. It is a yes
or no scale of 18 questions. Sample includes “inability to control worry”. Panic disorders will be
screened using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.
Washington, DC, American Psychiatric Association, 1994. This is a yes or no scale consisting of
27 questions. Samples include, “repeated or unexpected “attacks” during which you suddenly are
overcome by intense fear or discomfort for no apparent reason”. All three of these assessments
can be found on the Anxiety and Depression Association of America’s website. Screenings will
be done at the initial time of diagnosis, and again after the 1 year study period to see if symptoms
were reduced.
(http://www.adaa.org/living-with-anxiety/ask-and-learn/screenings)
Procedure
Subjects will be recruited through Cleveland Clinic Gastroenterologists. Any patient
receiving a new diagnosis of IBD will be given the opportunity to participate in the study given
they meet the sample parameters. Upon agreeing to participate in the study, patients will be
given information on how to sign up online. Since the registration and majority of
communications will take place online, internet access will be required. Patients will sign up
online and receive educational materials via the mail. They will meet at a scheduled time for the
screenings to be administered both before and after the study period. After the initial screenings
17. Symptom Severity and Psychological Distress in IBD Patients 17
are complete, participants will partake in weekly scheduled support activities, whether online
chats, group meetings, or one on one psychological sessions. Consent and confidentiality forms
will be administered and filled out online as well. All participants will receive a $50 Amazon
Gift Card at the initial screening and for every scheduled activity they complete. The study will
last a time period of one year.
18. Symptom Severity and Psychological Distress in IBD Patients 18
Budget
Personnel
1 Primary Researcher @ 50,000 per year x 1 year = 50,000
1 Graduate Assistant @ 15,000 per year x 1 year = 15,000
Total 65,000
Materials
Initial registration packet administered @ clinic x 50 = 69.99
Participation Manual and contact info x 50 = 497.75
Educational material in binder x 50 = 756.00
Support group/network pamphlet x 50 = 158.50
Total 1,483
Participants
Initial and Final Screenings @ $50/screening x 50 participants
x 2 screenings = 5,000
Weekly Meetings @ $50/meeting x 50 participants
x 50 meetings = 125,000
Total 130,000
Total Expenses 196,483
19. Symptom Severity and Psychological Distress in IBD Patients 19
References
The Cleveland Clinic Foundation. (2012) Ulcerative Colitis. Retrieved from:
http://my/clevelandclinic.org/health/diseases_conditions/hic_ulcerative_colitis
The Cleveland Clinic Foundation. (2016) Crohn’s disease. Retrieved from:
http://my/clevelandclinic.org/health/diseases_conditions/hic_inflammatory_bowel_diseas
e_ibd_quanda/hic_crohns_disease
Drossman, D., Patrick, D., Mitchell, C., Zagami, E., Appelbaum, M. (1989). Health-related
quality of life in inflammatory bowel disease: Functional status and patient worries and
concerns. Digestive Disease and Sciences, 34(9), 1379-1386.
Gerson, M., Grega, C., Nathan-Virga, S. (1993). Three kinds of coping: Families and
inflammatory bowel disease*. Family Systems Medicine, 11(1), 55-65.
Guthrie, E., Jackson, J., Sc, Schaffer, J., Thompson, D., Tomenson, B., Creed, F. (2002).
Psychological disorder and severity of inflammatory bowel disease predict health-related
quality of life in ulcerative colitis and Crohn’s disease. The American Journal of
Gastroenterology, 97, 8.
Hall, N., Rubin, G., Dougall, A., Hungin, A.P.S., Neely, J. (2005). The fight for ‘health-related
normality’: A qualitative study of the experiences of individuals living with established
inflammatory bowel disease (IBD). Journal of Health Psychology, 10(3), 443-455.
Hatch. M. (1995). Conceptualization and treatment of bowel obsessions: two case reports.
Behaviour Research and Therapy, 35(3), 253-257.
20. Symptom Severity and Psychological Distress in IBD Patients 20
Irwin M. and Suzanne R. Rosenthal IBD Resource Center. (2015, January). CCFA Fact Sheet
News from the IBD help center: Biologics. Retrieved from: http://www.ccfa.org
Irwin M. and Suzanne R. Rosenthal IBD Resource Center. (2015, January). CCFA Fact Sheet
News from the IBD help center: Corticosteroids. Retrieved from: http://www.ccfa.org
Mesalamine. (2009). Retrieved from: http://www.drugs.com/ppa/mesalamine-5-aminosalicyclic-
acid-5-asa.html
Porcelli, P., Leoci, C., Guerra V. A. (1996). A prospective study of the relationship between
disease activity and psychologic distress in patients with inflammatory bowel disease.
Scandinavian Journal of Gastroenterology, 31, 792-796.
Porcelli, P., Leandro, G. (2007). Bowel obsession syndrome in a patient with ulcerative colitis.
Psychosomatics, 48, 448-450.
Rochelle, T., Fidler, H. (2012). The importance of illness perceptions, quality of life and
psychological status in patients with ulcerative colitis and Crohn’s disease. Journal of
Health Psychology 18(7), 972-983.
Seres, G., Kovacs, Z., Kovacs, A., Kerekgyarto, O., Sardi, K., Demeter, P., …Tury, F. (2008).
Different associations of health related quality of life with pain, psychological distress
and coping strategies in patients with irritable bowel syndrome and inflammatory bowel
disorder. Journal of Clinical & Psychological Med Settings, 15, 287-295.