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Psychiatric screening recommended in pediatric patients with inflammatory bowel disease

Psychiatry
4 months ago, OP Editor

At the recent 2019 Advances in Inflammatory Bowel Diseases Annual Meeting (AIBD) in Orlando, Florida, researchers revealed that pediatric inflammatory bowel disease (IBD) patients took antidepressants and other psychotropic drugs at a higher rate of 28.5% compared with other children of the same age in a retrospective chart review study.1 Results also showed that 43% of these patients did not receive mental health services.1 These findings are important in raising awareness of psychiatric disorders in this particular patient population and suggest that regular screening measures should be implemented for early intervention.1

IBD is a collective term for disorders that involve chronic inflammation of the digestive tract of which 25% of sufferers are diagnosed under 20.2 There is a rising incidence of pediatric IBD in Hong Kong, from 0.17 per 100,000 population in 2006 to 0.55 per 100,000 population in 2016.3 The disease can be more aggressive in young patients, with some requiring hospitalization, surgery and steroid use, and may therefore be associated with increased psychological stress.4,5 As such, previous research has found that pediatric IBD patients suffer from depressive and anxiety disorders at a higher rate than other children.6 Given that psychiatric disorders are generally undertreated in the adult IBD population, a retrospective chart review was used to assess the usage of psychotropic medication and mental health services in pediatric patients with IBD, at the University of Rochester Medical Center (URMC).1

The study analyzed 400 patients who were seen at the URMC between 2016 and 2019 and excluded those with a medication history of treating attention deficit hyperactivity disorder and chronic migraine. Patients had a mean age at diagnosis of 11.5 years and 57% of them were male.1 Overall, 28.5% of patients had taken or were taking psychotropic drugs to treat a psychological disorder, which is 10 times higher than the rate of the general pediatric population.1 Results also showed that the most common disorders were anxiety (23%) and depression (14%), which were primarily being treated with selective serotonin reuptake inhibitors.1 Interestingly, 75% of the mental health service and psychiatric medication usage began after IBD diagnosis, suggesting that IBD may contribute to the development of mental health disorders.1 Additionally, 43% of patients taking psychotropic medication were not being attended to by a mental health provider.1

Based on these findings, the authors concluded that mental health services in this particular patient population are underutilized, and that routine anxiety and depression screening programs should be implemented so that patients can receive the appropriate therapy. Clinicians should also be more active in initiating discussions about mental health with their patients during their clinic or hospital visits. Future longitudinal studies may assess the effects of early interventions on reducing the risk of developing psychiatric illnesses in IBD patients.

1. Conboy N, Saubermann L. P086 Increased Need for Psychotropic Medication and Mental Health Service Usage in Pediatric Patients With Inflammatory Bowel Disease (IBD): The American Journal of Gastroenterology. 2019;114:S22-S23.

2. Baldassano RN, Piccoli DA. Inflammatory bowel disease in pediatric and adolescent patients. Gastroenterol Clin North Am. 1999;28(2):445-458.

3. Paediatric inflammatory bowel diseases in Hong Kong: A single center analysis of 11-year data. http://www.hkjpaed.org/aspr2017/detail.asp?id=25. Accessed January 7, 2020.

4. Cuffari C. Diagnostic Considerations in Pediatric Inflammatory Bowel Disease Management. Gastroenterol Hepatol (N Y). 2009;5(11):775-783.

5. Moon JS. Clinical Aspects and Treatments for Pediatric Inflammatory Bowel Diseases. Pediatr Gastroenterol Hepatol Nutr. 2019;22(1):50-56.

6. Thavamani A et al. Burden of Psychiatric Disorders among Pediatric and Young Adults with Inflammatory Bowel Disease: A Population-Based Analysis. Pediatr Gastroenterol Hepatol Nutr. 2019;22(6):527-535.

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