Unaddressed anxiety in patients with IBD ‘will impact their disease outcomes’
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SAN DIEGO — Anxiety left unaddressed in the context of inflammatory bowel disease care “will impact the disease course and outcomes,” according to a presenter at Digestive Disease Week 2022.
“Anxiety occurs on a spectrum,” Laurie Keefer, PhD, director of psychobehavioral research at the Icahn School of Medicine at Mount Sinai and a member of the Healio Gastroenterology Peer Perspective Board, told attendees. “There is the productive anxiety that got me out of bed this morning and to my lecture a little early. There are anxiety symptoms — panic, worry, nervousness — that we see with our patients. Then, there are anxiety disorders, in which these symptoms are persistent, with patients unable to control those feelings of unease, worry or fear.”
How can gastroenterologists tell if their patients are anxious? Keefer noted that patients may report hot flashes and chills, complaints of tingling or numbness, autonomic arousal, palpitations, sweating, trembling or shaking.
“You will see that these complaints are related to the mind and body panic attacks, with muscle tension and restlessness, and sometimes patients will present with a globus sensation, a lump in the throat,” Keefer said. “I point this out because it’s not so simple to just look at anxiety in the emotional way that we tend to think about it. You are going to see it clinically in your practice presenting as symptoms that will potentially affect your treatment decision-making.”
Often asked how to measure anxiety, Keefer outlined several key tools, including the NIH Patient-Reported Outcomes Measurement Information System (PROMIS), the Hospital Anxiety and Depression Scale (HADS) and the Generalized Anxiety Disorder-7 (GAD-7) assessment.
“Or you could just ask,” Keefer noted. “Why don't you ask your patients about what kinds of concerns they have or what worries them? Or what makes them anxious or how they are feeling physiologically to try to have that conversation, instead of relying on one specific one-dimension tool.”
Keefer highlighted that “anxiety does occur on a spectrum” but if it is not addressed in the context of the IBD patient’s care, “it will impact their disease outcomes.”
“Most of our anxiety measurements do focus on worrying, but there are other types of anxiety, and they also affect care,” Keefer said. “I just want to make sure people are thinking about that when thinking about how anxiety may manifest.”
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Keefer L. Sp307: A deep dive into manifestations of anxiety in IBD. Presented at: Digestive Disease Week; May 21-24, 2022; San Diego (hybrid meeting).
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