Understanding and Treating Neuropsychiatric Symptoms of Pediatric Physical Illness
Condition: Inflammatory Bowel Disease; Ulcerative Colitis; Crohn's Disease; Depression
MeSH terms: Crohn Disease; Inflammatory Bowel Diseases
Study type: Interventional

Summary: 
      This research will examine the impact of brain activity, cognitive processing immune
      functioning, and gastrointestinal functioning on depressive symptoms and response to a
      psychotherapeutic intervention in youths with Inflammatory Bowel Disease (IBD).
    

Detailed description: 
      Depression is costly, worsens morbidity and mortality, and has detrimental effects on disease
      course in physically ill populations. This research 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 in youth. 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 research 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; 2) the inter-relationship between depressive symptoms in IBD
      and brain, immune, and gastrointestinal functioning; and 3) efficacy of a combined
      CBT-physical illness narrative intervention targeting emotional and cognitive processing
      compared to supportive non-directive therapy in the depressed IBD cohort with longitudinal
      tracking of emotional, physical health, economic, and neurobiological outcomes.
    

Intervention name(s): Primary and Secondary Coping Enhancement Training; Supportive Non-directive Therapy
Intervention type(s): Behavioral; Behavioral
Intervention description(s): A cognitive behavioral therapy designed to help individuals cope with physical illness.; A non-structured therapy designed to provide a supportive atmosphere in which individuals may discuss concerns and process events in their lives
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Basic Science