Psychosocial factors in inflammatory bowel disease.

From the case example, it can be seen that when the physician considered the psychosocial aspects of the disease in the treatment of Ms. B, she was able to make a complete recovery, something the medications themselves had been unable to do. Although originally thought to be a purely psychosomatic illness, research in IBD in the past three decades has shown that psychosocial aspects are an important component of IBD, but they are not the cause of the disease. Several studies have indicated that stress can adversely affect the gastrointestinal tract directly, by altering inflammatory mediators and gastrointestinal neurotransmitters. To get a complete clinical assessment of how a patient is functioning with the disease, it is important to incorporate psychosocial information into daily patient care in addition to laboratory measurements of disease severity. How does one obtain the psychosocial information for an individual patient? An understanding of the positive and negative factors that may influence how a patient adapts to chronic illness is important, including the patient's social support system, the self-confidence of the patient, and the presence of any comorbid psychiatric disease. In addition, HRQOL can help the clinician identify areas that may be of concern to large groups of patients with the same disease. By incorporating information obtained through HRQOL and modifying it to the psychosocial situation of the individual patient, the treatment plan becomes a negotiated agreement between the physician and the patient. These steps may lead to increased compliance, decreased likelihood of misunderstanding between the physician and the patient, and improvement in the health status of patients with IBD.