For women, pregnancy and motherhood are developmental milestones that are highly emphasized by our culture. The high-tech reproductive technologies have associated psychological and ethical issues that must be addressed by the infertile couple.
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There have been some controversies regarding the role of psychological factors in the course of IBD. The purpose of this paper is to review that role.
The possible mechanisms by which stress could be translated into IBD symptoms, including changes in motor, sensory and secretory gastrointestinal function, increase intestinal permeability, and changes in the immune system are, then reviewed.
The prevalence rate, the timing of onset, and the impact of anxiety and depression on health-related quality of life are then reviewed. Finally issues about illness behavior Psychological issues the necessity of integrating psychological interventions with conventional treatment protocols are explained.
To date, there is no certain cure for IBD, and treatment is aimed at managing the inflammatory response during flares and maintaining remission with a focus on adhering to therapy [ 2 ]. The etiology of IBD is unknown, but genetic, immune, and environmental factors are each thought to play a role in its causation [ 134 ].
These factors Psychological issues together, so in a person who is predisposed genetically, environmental factors trigger immune dysfunction and bowel symptoms [ 5 ]. One of these environmental triggers may be psychological factors particularly psychological stress.
The Taking Sides Collection on McGraw-Hill Create® includes current controversial issues in a debate-style forma designed to stimulate student interest and develop critical thinking skills. This Collection contains a multitude of current and classic issues to enhance and customize your course. You can browse the entire Taking Sides Collection on Create or you can search by topic, author, or. Inflammatory bowel disease (IBD) including Crohn’s disease (CD) and ulcerative colitis (UC) is a chronic and disabling disease with unknown etiology. There have been some controversies regarding the role of psychological factors in the course of IBD. The purpose of this paper is to review that role. First the evidence on role of stress is reviewed focusing on perceived stress and patients. Issues In Child Abuse Accusations Issues In Child Abuse Accusations (ISSN ) is a multidisciplinary journal presenting scholarship from disciplines such as law, law enforcement, psychology, psychiatry, sociology, social work, medicine, history, and theology. Its goal is to advance our care for children through pointing to the mistakes of the rush to solve the problem of child abuse.
Historically, it was first in the s that gastroenterologists and psychiatrists suggested that emotional life events and experiences are likely related to exacerbation of intestinal symptoms [ 6 ]. At that time, IBD was considered as a psychosomatic disease, and Psychological issues relation to stress and other psychological factors was thought so strong that researchers felt no need to use any control group in their studies.
A few decades later, this finding was questioned mostly due to methodological weaknesses and uncontrolled studies published in this area. For a while IBD was considered as an organic disease, and psychological influences were discounted as contributing to it.
But further anecdotal evidence and clinical observations indicated that stressful experiences could adversely affect the course of IBD. Indeed many review articles have now emphasized the relationship between stress and IBD [ 6 — 10 ], concluding that confusions and controversies in published reports were partly due to differences in definitions of stress e.
These trends have contributed to resolving controversies, and illuminating the role of psychological stress in IBD. Thus, while the role of stress in the onset of IBD has not been established, there is no doubt that stress is a triggering and exacerbating factor in relation to the course and symptoms of IBD [ 8101213 ].
Indeed it can be considered as one of the determinants of disease relapse [ 121415 ]. However, there are some discordant reports about a relation between stress and disease onset, like that of Li et al. Possible Mechanisms of the Effects of Psychological Stress on Patients with IBD In the light of recent advances in psychobiological research, what are the mechanisms by which the course of IBD can be influenced by stress?
Nonspecific Effects Many of the IBD symptoms experienced by patients may be due to stress-induced changes in gastrointestinal GI function. There is a richly innervated nerve plexus between the enteric nervous system ENS and its spinal and autonomic connections to the central nervous system, known as the brain-gut axis.
GI motor, sensory and secretory function as well as thresholds for the perception of pain [ 13 ], can be affected by psychological and emotional stress directly or indirectly through this axis.
These effects are mediated by substance P SPvasoactive intestinal protein VIP [ 18 ], several neuropeptides, neurotransmitters, and hormones [ 1219 ]. Stress stimulates the secretion of corticotropin-releasing factor CRF either from central or peripheral parts of CNS hypothalamus and adrenal cortex, resp.
Endogenous CRF mediates the stress-induced inhibition of the upper GI tract motility and stimulation of colonic motility [ 1220 ].
Thus when symptoms such as abdominal pain and change in bowel function occur in IBD without significant disease activity, they may be attributed, at least in some instances, to alterations in motor and sensory function as a result of psychological stress. Intestinal Permeability Psychological stress can also increase intestinal permeability, probably as a result of alterations in the cholinergic nervous system and mucosal mast cell function [ 21 ].
This increased permeability in turn reduces mucosal barrier function and alters bacteria-host interaction [ 1223 ]. However, based mainly on animal studies, these observations are likely to play a role in the pathophysiology of human IBD.
Immunological Mechanisms Finally, stress is also likely to mediate its effect on IBD through the immune system [ 1519 ]. On the one hand, it is believed that an inadequately controlled response within the intestinal mucosa leads to inflammation in patients who are genetically predisposed to IBD.
Dysfunction of the intestinal immune system and cross-reactivity of its cells against host epithelial cells have been implicated as major mechanisms by which the inflammatory response occurs [ 5 ].
On the other hand, it is increasingly recognized that the hypothalamus-pituarity-adrenal HPA axis, autonomic nervous system ANSand ENS can interact directly with the immune system.
Cytokines are essential immune molecules in the pathogenesis of IBD [ 2425 ].Family Problems - Sometimes family conflicts occur because one or more family members has a psychological disorder, such as those described above.
However, family conflicts also arise because of communication problems, parenting issues, school problems and sibling conflict.
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Mental health is a state of successful performance of mental function, resulting in productive activities, . Psychology Topics Psychology is a diverse discipline grounded in science, but with nearly boundless applications in everyday life.
Scientific research conducted by psychologists, organized by topics here, can inform and guide those seeking help with issues that affect their professional lives, family relationships and emotional wellness.
The involvement of countertransference with assisted suicide has been evaluated by Varghese and Kelly. 52 They report that: [T]he subjective evaluation by a doctor of a patient's 'quality of life' and the role of such an evaluation in making end-of-life decisions of themselves raise significant countertransference issues.