Functional Assessment and Clinical Resource Document for Crohn’s
Disease, Irritable Bowel Syndrome and Ulcerative Colitis (Irritable
Bowel Diseases)
Ryan Barnett, M.S.
Functional Assessment
1. How bad is your experienced daily pain? Is it aching, shooting, throbbing, stabbing?
2. Is your pain level stable or variable? What factors contribute to increases or
decreases (Foods, Times of day, etc)?
3. On a scale of 1 (very mild) to 10 (excruciating), what is your pain level right now? At
your worst? At its best?
4. How do you IBD symptoms interfere with daily functioning? Describe a typical day.
(Trips to restroom, vomiting, diarrhea, blood in stool, missed social or occupational
obligations)
5. What would you be doing differently if you did not have the IBD symptoms?
6. How do you cope with the IBD symptoms? Adaptive coping or maladaptive?
7. When were you diagnosed? What was going on in your life at that time? (generally a
correlation between stress and worsening IBD symptoms)
8. How many times per day/week/month do interfering symptoms occur? How often
do you experience flare-ups requiring medical attention?
9. How long do the symptoms/ flare-ups last?
10. What have you done in the past that has decreased the pain? Medical procedures,
substance use, medication, self-management strategies?
11. What makes the IBD symptoms worse?
12. How many hospitalizations have you had as a result of IBD symptoms?
13. Do the IBD symptoms affect you emotionally? If so, describe how.
14. How do others respond to your IBD symptoms (family, friends, coworkers)?
15. How would you like others to respond to your IBD symptoms?
16. Do you experience fatigue related to your IBD symptoms? What is your typical
energy level (10 point scale)? What is your energy level when experiencing IBD
symptoms (10 point scale)?
17. Have you decreased physical activity as a result of your IBD symptoms?
18. Are you on a specific diet for your IBD?
19. Are you interested in learning to take control of your life so you are living more as
you like rather than having IBD symptoms control so much of your life?
Possible BHC Recommendations:
 Monitoring pain (on a 10-point scale), focus on relationship between specific foods
and situations with worsening symptomatology
 Decrease consumption of alcohol and trigger foods
 Increase exercise
 Engage in relaxation exercises (deep breathing, PMR, imagery)
 Distraction techniques (e.g., focus on reading an enjoyable book or engaging in
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activities)
Assess self-talk and replace unhealthy thinking with helpful thoughts
Use support network rather than withdrawing
IBD Information
Etiology
 No known cause for IBD’s
 Appears to be an interaction between
 Inherited genes
 The immune system
 Environmental factors
 Recent research suggests that there may be a link between a frame-shift mutation in NOD2
associated with individuals who have Crohn’s disease
 NOD2, a gene that encodes a protein with homology to plant disease resistance gene
products is located in the peak region of linkage on chromosome 16 (Ogura et. al,
2001).
Prevalence
 Approximately 7 of every 100,000 people in the United Sates have Crohn’s disease
(Nachimuthu & Piccione, 2011).
 Americans have one of the highest prevalence rates in the world
 Higher prevalence than Europe, South Africa, Australia, Asia,
and South America.
Affected Populations
 Crohn’s is generally a disease of adolescents and young adults between 14-35
 Has been seen in patients over 70 and in young children
 An estimated 140,00, or 10 percent of individuals affected are youngsters under the age of
18
 Males and Females equally affected
 Race and Ethnicity
 American Jews of European decent- 4-5x more likely to develop
 European heritage more likely to develop
 Rise in African American cases
 Whites + African Americans> Hispanics & Asians
 It has also been found that 20% of people with Crohn’s Disease have a sibling, parent or
child with some form of IBD
Presentation
 Varies greatly from person to person
 Typical symptoms
 Persistent diarrhea, frequent bowel movements, abdominal cramps and pain, fever,
rectal bleeding, loss of appetite, weight loss, fatigue, anal fissures, fistulas,
malnutrition, joints, eyes, skin and liver may also be affected, children who have
Crohn’s may suffer delayed growth, depression, anxiety, social anxiety
Course
 Individuals will present with symptoms of the condition
 The symptoms will likely get worse until medicine or surgery intervention
 Following treatment, likely to go into remission
 Periods of remission vary, and the disease will likely become active again
 Medication is also utilized during remission to control levels of inflammation and to help
prevent flares
Medical Definition
 According to the Mayo Clinic Crohn’s disease is an inflammatory bowel disease (IBD) which
causes inflammation of the lining or your digestive tract.
Presentation to a Health Psychologist
 May present with a variety of symptoms
 Constant abdominal pain & diarrhea
 Rectal bleeding
 Weight loss
 Arthritis
 Malnutrition
 Skin problems
 Fatigue
 Fever
 Children-stunted & delayed growth
 Adjustment issues-coping with a chronic illness
 Depression
 Anxiety
 Emotional distress may pre-empt a flare
 Such illnesses seem to pose a threat to their entire quality of life -- their physical and
emotional well-being, social functioning, and sense of self-esteem (Crohn’s and Colitis
Foundation).
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Medications
*Note many medications have debilitating side effects, including increased pain, disruption
of digestion, weight gain, depression and significant mood swings with steroids
Aminosalicylates(5-ASA)
 a class of anti-inflammatory drugs (sulfasalazine and oral formulations of
mesalamine)
 Asacol, Colazal, Dipentum or Pentasa
 used to treat mild to moderate symptoms.
Corticosteroids
 Prednisone and methylprednisolone are available orally and rectally.
 Corticosteroids nonspecifically suppress the immune system
 used to treat moderate to severely active Crohn's disease
Immune modifiers
 Azathioprine (Imuran)
 6-MP (Purinethol)
 MethotrexateImmune modifiers, sometimes called immunomodulators
 Used to help decrease corticosteroid dosage and also to help heal fistulas
 Help maintain disease remission.
Antibiotics
 Metronidazole
 Ampicillin
 Ciprofloxacin
Biologic therapies
 infliximab (Remicade)
 The first biologic therapy to treat inflammatory bowel disease
 For moderately to severely active Crohn’s
 Infused into blood weekly to monthly
 Other Biologic therapies include : Adalimumab (Humira) & Natalizumab (Tysabri)
 Cannabis (Medical Marijuana)
 Currently not legally available in Florida, but is in Alaska, Arizona, California,
Colorado, Washington DC, Delaware, Hawaii, Maine, Michigan, Montana, Nevada,
New Jersey, New Mexico, Oregon, Rhode Island, Vermont, Washington
 “Crohn’s disease, characterized by intestinal inflammation, is another example of a
Th1-mediated disease. Anecdotal reports of beneficial marijuana use for this disease
gain support by examining modern pharmaceutical approaches. Down-regulation of
Th1 effectors has produced dramatic results in the treatment of this disease. New
immuno-therapeutic strategies that treat Crohn’s disease with antitumor necrosis
factor (TNF-alpha) antibodies, have induced complete remissions and few side
effects. THC has been shown to inhibit THF-alpha. Thus, the same therapeutic
targets of the newest pharmaceuticals are acted upon by one of nature’s oldest
medicines.”-CannabisMD.net
Nutrition
 Crohn’s patients have difficulties absorbing proper nutrients from their food
 Experience a lack of appetite
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Demand for energy and caloric needs as a result of the disease
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Vital to maintain proper nutrition with foods from all of the food groups
 Some may not be able to tolerate dairy products
 Each individual is different, but generally, soft bland foods cause less discomfort than
spicy or high fiber foods
Evidence Based Psychological Treatments
 Cognitive Behavioral Therapy techniques have been utilized to help in the treatment
of Crohn’s disease
 Szigethy et al., 2007
 This study demonstrated that this modified CBT intervention was more effective
than no treatment and also showed flexibility in delivery across a broad range of
therapists.
Websites and Brevard County Resources
 http://www.ccfa.org/
 FLORIDA CHAPTER of Crohns and Colitis Foundation
21301 Powerline Rd., Suite 301
Boca Raton, Fl 33433
Phone: (561) 218-2929
Fax: (561) 218-2240
Email: kkeohane@ccfa.org
 Support Groups
 MELBOURNE
Melbourne Public Library
540 East Fee Avenue
Meets: The fourth Wednesday Bi-Monthly (July, Sept., Nov., March)
6:30 pm - 7:30 p.m.
Facilitator: Robert Peach
Tel: (321) 806-3349
Email: rcpeach2000@yahoo.com
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References
About Crohn's Disease. (2009). Available at:
http://www.ccfa.org/info/about/crohns. Accessed June 10, 2011.
Blanchard, Edward B., (2001). Irritable bowel syndrome: Psychosocial assessment
and treatment, (pp. 133-138). Washington, DC, US: American Psychological
Association, xi, 1-373 pp.
Crohn's disease. From Mayo Foundation for Medical Education and R
Research.(2010). Available at: http://www.mayoclinic.com/health/crohnsdisease/DS00104. Accessed June 17, 2011.
Knutson, Doug, Greenberg, Greg, & Cronau, Holly. (2003, August 15). Management of
crohn's disease- a paractical approach. Retrieved from
http://www.aafp.org/afp/2003/0815/p707.html
Nachimuthu, Senthil, & Piccione, Paul. (2011).Crohn's disease. Retrieved from
http://www.emedicinehealth.com/crohn_disease/article_em.htm#Crohn's
Disease Overview
NIH Publication No. 06-3410. From National Digestive Diseases Information
Clearinghouse.(2006). Available at:
http://digestive.niddk.nih.gov/ddiseases/pubs/crohns/. Accessed June 17,
2011.
ProCon.org. (2011, June 15). Can marijuana help people with Crohn's disease or
other gastrointestinal disorders. Retrieved from
http://medicalmarijuana.procon.org/view.answers.php?questionID=000138