A group-based patient education programme for high-anxiety patients with Crohn disease or ulcerative colitis.

BACKGROUND: The inflammatory bowel diseases (IBD) ulcerative colitis (UC) and Crohn disease (CD) affect a person's health-related quality of life (HRQOL). IBD patients report high levels of anxiety, which correlates with the degree of perceived dissatisfaction with the information on disease-related themes provided in routine health care. The aim of this study was to evaluate changes in anxiety after participation in a group-based educational intervention for IBD patients screened for high anxiety. METHODS: The programme consisted of 8 sessions, and 49 patients participated. Anxiety was assessed using the Hospital Anxiety and Depression (HAD) Scale at baseline and 6 months after intervention. HRQOL was assessed with the Inflammatory Bowel Disease Questionnaire (IBDQ) and the SF-36 health survey. Participant satisfaction with education was measured using a study-specific questionnaire. RESULTS: No significant change on the HAD anxiety score was found at the 6-month follow-up for those who participated in the education programme despite the fact that the participants reported they had gained better knowledge of disease-related items. Furthermore, there were no significant changes over time regarding bowel symptoms, systemic symptoms, emotional functioning and social functioning of the IBDQ or generic HRQOL (SF-36). CONCLUSIONS: IBD patients with a high anxiety level reported improved satisfaction with information about disease-related items, but did not indicate any benefits in terms of reduced anxiety or improved HRQOL after participating in the education programme, not at least in the short-term perspective. In this selected group of patients, psychosocial problems other than disease-related concerns were found that warrant other approaches.

[Stress-related syndromes--contemporary illnesses]. / Stressrelaterade syndrom--den nya tidens ohälsa.

There are many indications that distress within the family as well as at work are strong predictors for developing stress-related disorders. The relatively new diagnoses burnout, chronic fatigue syndrome and fibromyalgia syndrome probably represent different ways of reacting to an overwhelming situation. The boundary between these diseases, on the one hand, and depression, heart disease or infarction on the other is often diffuse, and the new diagnoses may well delineate preliminary stages of more serious diseases such as angina pectoris or myocardial infarction. There is evidence that also other causes of death may be related to stress. These circumstances reflect not only considerable suffering on the part of individuals, but also a substantial economic burden for society.

The impact of life events in female patients with fibromyalgia and in female healthy controls.

The aim was to investigate if female fibromyalgia patients (FMS) had experienced more negative life events than healthy women. Furthermore, the life events experienced in relation to onset of the FMS were evaluated. Another important area was to investigate the impact of the events experienced in the patients compared to healthy women. A new inventory was constructed to assess life events during childhood, adolescence and in adulthood as well as life events experienced in relation to the onset of the disorder. Forty female FMS patients and 38 healthy age-matched women participated in the study. During childhood or adolescence 51% of the patients had experienced very negative life events as compared to 28% of the controls. Conflict with parents was the most common life event. Before onset, 65% of the patients experienced some negative life event. Economic problems and conflicts with husband/partner were common. During the last year, 51% of the patients had life events which they experienced as very negative, compared to 24.5% of the controls (P < 0.01). Stressful life events in childhood/adolescence and in adulthood seem to be very common in FMS. Furthermore, the life events were experienced as more negative than the life events experienced by healthy controls.

Citalopram in patients with fibromyalgia--a randomized, double-blind, placebo-controlled study.

The effect of the selective serotonin reuptake inhibitor citalopram was studied in a randomized, double-blind, placebo-controlled, 4-month trial in patients with the fibromyalgia syndrome (FMS) who all fulfilled the American College of Rheumatology criteria. The citalopram doses varied between 20-40 mg daily. Forty female patients, 21 patients in the citalopram and 19 in the placebo group, participated. Assessment of pain, depressive symptoms and physical functioning were made using Visual Analogue Scales (VAS), the Montgomery Asberg Depression Rating Scale (MADRS) and the Fibrositis Impact Questionnaire (FIQ). In the global judgement of improvement, no significant changes were found between the citalopram and placebo groups as concerns pain or well-being, either in the Intention to Treat (ITT) analysis or in the completer analysis. However, among the completers, it was a tendency that more patients in the citalopram group (52.9%) were improved as compared to the placebo group (22.2%) concerning well-being. Furthermore, the results indicated that treatment with citalopram had a significant effect on pain on the VAS after 2 months of treatment compared to baseline. After 4 months, however, the effect had diminished. Measured with the FIQ, significant differences in the pain ratings were seen at the end of the trial. Significant effects on the depressive symptomatology measured by means of the MADRS were seen already after 1 month of treatment and were increasing further at the end of the trial, when a significant difference between the groups was also found.

Plasma oxytocin levels in female fibromyalgia syndrome patients.

OBJECTIVES: Fibromyalgia syndrome (FMS) is a chronic pain disorder, where 90% of the patients struck by the disorder are women. The neuropeptide oxytocin is known to have antinociceptive and analgesic, as well as anxiolytic and antidepressant effects, which makes this neuropeptide of interest in fibromyalgia research. The aim of this study was to assess oxytocin concentrations in female FMS patients with different hormonal status and in depressed and non-depressed patients and relate oxytocin concentrations to adverse symptoms as pain, stress, depression, anxiety and to the positive item happiness. METHODS: Thirty-nine patients and 30 controls registered these symptoms daily during 28 days and blood samples for the assessment of oxytocin were drawn twice in all patients and controls. Besides the daily ratings, depression was also estimated with the self-rating instrument Beck Depression Inventory (BDI). RESULTS: Depressed patients according to the BDI differed significantly with low levels of oxytocin compared to the non-depressed patients and the controls. Low levels of oxytocin were also seen in high scoring pain, stress and depression patients according to the daily ratings; however, these subgroups were small. A negative correlation was found between the scored symptoms depression and anxiety and oxytocin concentration, and a positive correlation between the item happiness and oxytocin. The oxytocin concentration did not differ between the hormonally different subgroups of patients or controls. CONCLUSION: The results suggest that the neuropeptide oxytocin may, together with other neuropeptides and neurotransmitters, play a role in the integration of the stress axes, monoaminergic systems and the pain processing peptides in the pathophysiologic mechanisms responsible for the symptoms in the FMS.

[Stress can induce neuroendocrine disorders and pain]. / Stress kan ge neuroendokrina störningar och smärttillstånd.

In this article, a number of hormones and neuropeptides regulating pain, well-being and stress are shown to play important roles in the association between stress perception and nociception. Derangements in the stress axis may be induced by a variety of factors in which life events, personality, psychosocial circumstances and gender all may contribute. When such derangements are long-lasting, probably several neuroendocrine modifications are induced, giving rise to many of the symptoms seen in chronic pain syndromes including fibromyalgia.

Plasma levels on nociceptin in female fibromyalgia syndrome patients.

Fibromyalgia syndrome (FMS) is a frequent pain disorder in women. The pathophysiologic mechanism behind this disorder is still unexplained; however, alterations in both monoamines, neuropeptides and in the stress axis have been found. This study was designed to determine the levels of the newly discovered neuropeptide nociceptin in hormonally different FMS patients and corresponding controls. The results showed that the nociceptin concentrations of the patients were lower than in controls. It also showed decreased levels with significant differences between the cyclic patients in the luteal phase of the menstrual cycle, compared to the corresponding controls. Our results suggest that the perturbed nociceptin concentrations of the FMS patients may be linked to both the sex hormones and to the stress system and that these changes might be one of several possible pathophysiologic mechanisms involved in the FMS.