Journal Article Annotations
2022, 1st Quarter
Annotations by Ashwini Nadkarni, MD
January, 2022
The finding:
This population-based cohort study found that patients with schizophrenia have a higher risk of developing IBD and tend to do so at a younger age in comparison to matched controls. Risk of developing IBD was also higher among patients with more frequent psychiatric hospitalizations. Antipsychotic usage did not reduce the risk of patients developing IBD. These findings were thought to be explained by overlap in genetic risk, mechanisms for systemic inflammation, and gut dysbiosis.
Strength and weaknesses:
This study was a robust and comprehensive evaluation of the risk of new onset IBD among patients with schizophrenia. However, the study was limited to an adult population and examined a cohort of patients from Taiwan. Thus, data on the use of certain antipsychotics including lurasidone, sertindole, and perphenazine were not available. Both of these factors affect generalizability.
Relevance:
The study informs on the importance of timely medical intervention for IBD in patients with schizophrenia to improve prognosis and disease trajectory. When C-L psychiatrists are asked to consult on patients with schizophrenia who describe symptoms of IBD (problematic motility, blood in the stool, abdominal pain), advocacy for early recognition and workup of such concerns is key.
The finding:
This meta-analysis compared acupuncture versus sham acupuncture and pharmacotherapy based on 24 randomized controlled trials with 2151 patients. The pooled results showed that acupuncture was relatively effective in relieving anxiety and depression symptoms in patients with functional gastrointestinal disorders (FGIDs), but the current evidence does not explain whether this effect was a placebo effect.
Strength and weaknesses:
Due to the nature of acupuncture therapy, blinding of subjects and intervention implementers cannot be performed as simply as in drug studies. Thus, the trials included had deficiencies in their design leading to bias and lower quality research methods.
Relevance:
Patients with FGIDs may be present to the care of C-L psychiatrists in inpatient or collaborative care settings. FGIDs are gut-brain interaction disorders and symptoms are closely associated with depressive, anxiety and trauma and stress related disorders. Patients often experience adverse side effects or refractoriness to traditional pharmacotherapy. Therefore, a well-tolerated treatment that can relieve both gastrointestinal symptoms and psychological symptoms in patients with FGIDs is lacking. However, acupuncture still requires greater empirical support before it can be routinely recommended by C-L psychiatrists.
The finding:
This cohort study investigated the frequency and relative risk of gastrointestinal and somatoform symptoms five months after SARS‐CoV‐2 infection. Results demonstrated that gastroenterological symptoms may persist after SARS‐CoV‐2 infection but with mild intensity. In addition, SARS‐CoV‐2 infection increases the risk of chronic fatigue and somatization.
Strength and weaknesses:
Subject recruitment was vulnerable to selection bias: subjects were recruited through an internet survey assessment potentially leading to more anxious patients included in the study. Recall bias may also have been an issue given assessment of symptoms during the acute phase of the infection. The questionnaire used has been shown to be a reliable and valid tool for assessment of severity and impact of gastrointestinal symptoms but has not validated for online usage. The study was conducted in Italy and therefore may be limited in its generalizability across diverse population and cultures.
Relevance:
SARS-CoV-2 affects the brain gut axis and increases the risk for chronic fatigue and somatoform disorders. C-L psychiatrists treating patients with co-morbid gastrointestinal disorders may benefit from recognizing the impact that COVID infection can have on further somatoform symptoms.