From the Guidelines
Managing psychosis in a patient with Crohn's disease should prioritize a multidisciplinary approach, incorporating both pharmacological and non-pharmacological interventions, with a focus on cognitive behavioral therapy (CBT) and stress management techniques, as these have been shown to be effective in reducing symptoms and improving quality of life, as highlighted in the 2018 study published in Gastroenterology 1. When considering the management of psychosis in a patient with Crohn's disease, it is essential to determine if the psychosis is related to the disease itself, its medications, or is an independent condition.
- If the psychosis is steroid-induced, tapering the corticosteroid dose under medical supervision and considering a switch to budesonide or non-steroidal treatments for Crohn's may be necessary.
- For treating the psychosis, atypical antipsychotics are generally preferred due to their lower risk of gastrointestinal side effects, with medications like quetiapine or risperidone being potential options, as they have a more favorable side effect profile compared to typical antipsychotics.
- Non-pharmacological approaches, including CBT and hypnosis, have been demonstrated to be effective in managing symptoms of digestive disorders, including Crohn's disease, by helping patients divert their brain's attention away from symptoms and reducing the perceived threat of these symptoms, as discussed in the study 1.
- Ensuring regular follow-up to assess both psychiatric symptoms and Crohn's disease activity is crucial, and considering psychiatric consultation for complex cases can provide additional support.
- Addressing nutritional deficiencies common in Crohn's, such as B12, folate, and vitamin D, is also important, as these can impact mental health and overall well-being. The goal of management should be to effectively control psychosis while minimizing the exacerbation of Crohn's symptoms, recognizing the potential immune-mediated mechanisms contributing to neuropsychiatric manifestations in Crohn's disease, and prioritizing interventions that improve quality of life and reduce morbidity and mortality, as emphasized by the study 1.
From the Research
Managing Psychosis in Crohn's Disease Patients
To manage psychosis in a patient with Crohn's disease, it is essential to consider the potential underlying causes of the psychotic symptoms.
- Vitamin B12 Deficiency: Research suggests that vitamin B12 deficiency can be a cause of psychotic symptoms 2, 3. A significant proportion of patients with Crohn's disease suffer from vitamin B12 deficiency, especially those with ileal resection or active disease 4.
- Medication Side Effects: Certain medications used to treat Crohn's disease, such as infliximab and azathioprine, can have severe side effects, including neutropenia and thrombocytopenia 5. However, there is no direct evidence linking these medications to psychosis.
- Underlying Medical Conditions: Psychotic symptoms can also be a manifestation of underlying medical conditions, such as malignant catatonia or neuroleptic malignant syndrome 3.
Treatment Approaches
Treatment approaches for managing psychosis in Crohn's disease patients may include:
- Vitamin B12 Replacement Therapy: Replacing vitamin B12 deficiency can lead to improvement in psychotic symptoms 2, 3.
- Medication Management: Careful management of medications used to treat Crohn's disease, including monitoring for potential side effects and adjusting treatment regimens as needed.
- Psychiatric Treatment: Treatment of underlying psychiatric conditions, such as bipolar disorder, may also be necessary 3.