Understanding/ Treating Neuropsychiatric Symptoms of Pediatric Physical Illness

Summary

Principal Investigator: Eva Szigethy
Abstract: Abstract Depression is costly and has detrimental effects on disease course in physically ill populations. This proposal takes a novel multi-dimensional approach to assess the neurobiological basis of depression in chronic pediatric physical illness using inflammatory bowel disease (IBD) as a model. It also evaluates the efficacy of a modified cognitive behavioral therapy (CBT) on emotional well-being, physical health, economic costs, and neurobiological outcomes. These results will provide key building blocks for a paradigm shift within medicine by integrating behavioral health into the comprehensive medical care of physical illnesses. Little is known about how the brain and body interact to increase depressive vulnerability, particularly during key developmental periods during childhood and adolescence. Adult studies identify disruptions in limbic and prefrontal brain activity in the pathophysiology of depression. Cytokines secondary to inflammation and exogenous treatment with steroids can cause mood and cognitive changes in these same brain regions. It is important to understand the neuropsychiatric effects of IBD and its treatment on underlying brain structures during adolescence, a critical developmental period for brain maturation underlying emotional regulation and cognitive processing. More importantly, neuronal plasticity during adolescence may still allow reversibility of disease-related brain effects through teaching coping strategies for life-long illness management that could change developmental trajectories and reduce vulnerability in adulthood. Using translational neuroscience approaches, this proposal will examine: 1) brain regions that underlie emotional and cognitive processing in youth with active IBD and depression using brain functional magnetic resonance imaging compared to youth with IBD and no depression, and normal controls;and 2) the efficacy of a combined CBT-physical illness narrative intervention targeting emotional and cognitive processing compared to supportive non-directive therapy at: (a) improving emotional well being;(b) alleviating physical symptoms; and (c) reducing health care costs.
Funding Period: 2007-09-30 - 2012-08-31
more information: NIH RePORT

Top Publications

  1. ncbi Inflammatory bowel disease
    Eva Szigethy
    Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
    Child Adolesc Psychiatr Clin N Am 19:301-18, ix. 2010
  2. pmc Psychosocial issues in pediatric inflammatory bowel disease: report of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition
    Laura M Mackner
    Center for Biobehavioral Health, Nationwide Children s Hospital, Columbus, OH, USA
    J Pediatr Gastroenterol Nutr 56:449-58. 2013
  3. pmc Predictors of depression in youth with Crohn disease
    Jeffrey G Clark
    Cleveland Clinic, Lerner College of Medicine, Case Western Reserve University, Cleveland, OH Division of Pediatric Gastroenterology, Children s Hospital of Pittsburgh Graduate School of Public Health Division of Rheumatology and Clinical Immunology, University of Pittsburgh Medical Coping Clinic, Children s Hospital of Pittsburgh, Pittsburgh, PA Department of Gastroenterology Department of Psychiatry, Boston Children s Hospital, Boston, MA Department of Psychiatry, Children s Hospital of Pittsburgh, Pittsburgh, PA
    J Pediatr Gastroenterol Nutr 58:569-73. 2014
  4. pmc Depression subtypes in pediatric inflammatory bowel disease
    Eva M Szigethy
    Department of Pediatric Gastroenterology, Children s Hospital of Pittsburgh Department of Psychiatry, University of Pittsburgh School of Medicine Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora Department of Psychiatry, Boston Children s Hospital Department of Pediatric Gastroenterology, Boston Children s Hospital, Boston, MA
    J Pediatr Gastroenterol Nutr 58:574-81. 2014
  5. pmc Impact of inflammatory bowel disease and high-dose steroid exposure on pupillary responses to negative information in pediatric depression
    Neil P Jones
    Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15224, USA
    Psychosom Med 73:151-7. 2011
  6. ncbi Cognitive-behavioral therapy for children with comorbid physical illness
    Rachel D Thompson
    Psychology Department, University of Cincinnati, 4150 Edwards One, Cincinnati, OH 45221 0376, USA
    Child Adolesc Psychiatr Clin N Am 20:329-48. 2011

Detail Information

Publications6

  1. ncbi Inflammatory bowel disease
    Eva Szigethy
    Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
    Child Adolesc Psychiatr Clin N Am 19:301-18, ix. 2010
    ..While there is convincing evidence that such interventions can help improve anxiety, depression, and health-related quality of life, their effects on IBD severity and course await further study...
  2. pmc Psychosocial issues in pediatric inflammatory bowel disease: report of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition
    Laura M Mackner
    Center for Biobehavioral Health, Nationwide Children s Hospital, Columbus, OH, USA
    J Pediatr Gastroenterol Nutr 56:449-58. 2013
    ..Several interventions have empirical support or show promise for addressing psychosocial difficulty, and recommendations for monitoring and treating these issues are provided...
  3. pmc Predictors of depression in youth with Crohn disease
    Jeffrey G Clark
    Cleveland Clinic, Lerner College of Medicine, Case Western Reserve University, Cleveland, OH Division of Pediatric Gastroenterology, Children s Hospital of Pittsburgh Graduate School of Public Health Division of Rheumatology and Clinical Immunology, University of Pittsburgh Medical Coping Clinic, Children s Hospital of Pittsburgh, Pittsburgh, PA Department of Gastroenterology Department of Psychiatry, Boston Children s Hospital, Boston, MA Department of Psychiatry, Children s Hospital of Pittsburgh, Pittsburgh, PA
    J Pediatr Gastroenterol Nutr 58:569-73. 2014
    ..The aim of the study was to determine whether infliximab use and other potential predictors are associated with decreased prevalence and severity of depression in pediatric patients with Crohn disease (CD)...
  4. pmc Depression subtypes in pediatric inflammatory bowel disease
    Eva M Szigethy
    Department of Pediatric Gastroenterology, Children s Hospital of Pittsburgh Department of Psychiatry, University of Pittsburgh School of Medicine Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora Department of Psychiatry, Boston Children s Hospital Department of Pediatric Gastroenterology, Boston Children s Hospital, Boston, MA
    J Pediatr Gastroenterol Nutr 58:574-81. 2014
    ..The association between inflammatory bowel disease (IBD) and depression provides a unique opportunity to understand the relation between systemic inflammation and depressive symptom profiles...
  5. pmc Impact of inflammatory bowel disease and high-dose steroid exposure on pupillary responses to negative information in pediatric depression
    Neil P Jones
    Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15224, USA
    Psychosom Med 73:151-7. 2011
    ..In systemic inflammation, proinflammatory cytokines have been implicated in altering activity in brain regions known to affect emotion processing and emotion regulation in depression...
  6. ncbi Cognitive-behavioral therapy for children with comorbid physical illness
    Rachel D Thompson
    Psychology Department, University of Cincinnati, 4150 Edwards One, Cincinnati, OH 45221 0376, USA
    Child Adolesc Psychiatr Clin N Am 20:329-48. 2011
    ..Future research recommendations in this challenging population are also addressed...