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Emotional sequelae of chronic inflammatory bowel disease in children and adolescents
Insights
Further research is needed to understand the link between emotional disorders and pediatric inflammatory bowel disease (IBD). A collaborative approach between child psychiatry and pediatric IBD clinics improves patient care.
Area of Science:
- Pediatric gastroenterology
- Child and adolescent psychiatry
- Psychosomatic medicine
Background:
- A link between emotional disorders and chronic inflammatory bowel disease (IBD) is established in ulcerative colitis.
- This association is probable but unproven in pediatric Crohn's disease.
- Families of children with Crohn's disease may resist acknowledging this link.
Purpose of the Study:
- To investigate the prevalence of psychiatric illness in pediatric Crohn's disease patients and their families.
- To evaluate the effectiveness of integrated child psychiatry and pediatric IBD care.
- To inform future planning for pediatric IBD services.
Main Methods:
- The study proposes an objective investigation into psychiatric conditions within patient families.
- Experience highlights the benefits of a close liaison between a Child Psychiatry Unit and a Pediatric Inflammatory Bowel Disease Clinic.
- This contrasts with the lesser efficacy of referrals to separate psychiatric units.
Main Results:
- Integrated care models involving child psychiatrists, social workers, and therapists are more effective.
- Such collaborative services are resource-intensive, requiring significant time and financial investment.
- Careful financial planning is essential when establishing new pediatric IBD clinics with integrated psychiatric support.
Conclusions:
- Close collaboration between child psychiatry and pediatric IBD services enhances patient management.
- The integration of mental health support into pediatric IBD care is crucial but costly.
- Future pediatric IBD clinic development must prioritize financial planning for comprehensive psychiatric liaison teams.
Abstract:
It is clear that further study needs to be made of the link between emotional disorder and chronic inflammatory bowel disease in children. It is commonly accepted that such a link exists in ulcerative colitis and although there is at present no proof in either direction it seems highly probable that such a relationship is also present in Crohn's disease. We have seen that the families of children with Crohn's disease appear to find it much more than ordinarily difficult to accept such a relationship, but an objective study is projected to explore the presence of psychiatric illness in our patients and their families. Such a study will be extremely time consuming, requiring the services of a part-time research worker, and the exigencies of clinical service have so far prevented its being set in motion. We feel that our experience in St Bartholomew's Hospital during the past seven years has very clearly demonstrated the value of close liaison between the Child Psychiatry Unit and the Paediatric Inflammatory Bowel Disease Clinic, and the much greater efficacy of such a liaison as against referrals made to a separate Psychiatric Unit. It should be emphasized, however, that a liaison of this sort is time consuming, and in our experience has involved child psychiatrists, social workers, child psychotherapists and behaviour therapists. Thus the provision of such a service is expensive both in time and money. Where a new Paediatric Inflammatory Bowel Disease Clinic is being projected there must be very careful forward planning, looking particularly at financial implications if a psychiatric liaison team is to be included.