TY - JOUR
T1 - Symptom-network dynamics in irritable bowel syndrome with comorbid panic disorder using electronic momentary assessment
T2 - A randomized controlled trial of escitalopram vs. placebo
AU - Kreiter, Daniël
AU - Drukker, Marjan
AU - Mujagic, Zlatan
AU - Vork, Lisa
AU - Rutten, Bart P F
AU - van Os, Jim
AU - Masclee, Ad A M
AU - Kruimel, Joanna W
AU - Leue, Carsten
N1 - Funding Information:
AM has received a ZON MW, The Netherlands Organization for Health Research and Development, health care efficiency grant to evaluate efficacy of peppermint oil in IBS. AM has received an unrestricted research grant from Will Pharma S.A. and research funding from Allegan and Grünenthal on IBS topics. AM has given scientific advice to Bayer (topic: IBS) to Kyowa Kirin (topic: constipation) and to Takeda (topic: gastroparesis). AM received funding from Pentax Europe GmBH. AM has received funding from the Dutch Cancer Society related to endoscopy and to colorectal polyps.
Publisher Copyright:
© 2020 The Author(s)
PY - 2021/2
Y1 - 2021/2
N2 - INTRODUCTION: Momentary ecological assessment indicated alleviated abdominal pain in escitalopram treatment of irritable bowel syndrome (IBS) with comorbid panic disorder. Hitherto, little is known about symptom formation, i.e., how psychological impact physical symptoms, and vice versa, and about the effect of SSRI-treatment on symptom formation.OBJECTIVE: To investigate how psychological and somatic symptoms co-vary over time in IBS patients with comorbid panic disorder and how they are affected by escitalopram treatment.METHODS: Experience sampling data from 14 IBS patients with panic disorder were obtained from a single-centre, double-blind, parallel-group, randomized controlled trial on escitalopram versus placebo. At baseline, after three and six months, multilevel time-lagged linear regression analysis was used to construct symptom networks. Network connections represented coefficients between various affect and gastrointestinal items.RESULTS: Connectivity increased up to 3 months in both groups. Between 3 and 6 months, connectivity decreased for placebo and further increased in the escitalopram group. Additionally, a steep increase in node strength for negative affect nodes was observed in the escitalopram network and the opposite for positive affect nodes. Over time, group symptom networks became increasingly different from each other. Anxious-anxious and enthusiastic-relaxed became significantly different between groups at 6 months. The connection that changed significantly in all analyses was anxious-anxious.CONCLUSIONS: Escitalopram treatment was associated with changes in the symptom networks in IBS patients with panic disorder. While mood and physical symptoms improve over time, mainly connectivity between mood nodes changed, possibly pointing towards a healthier emotion regulation resulting in alleviation of physical symptoms.
AB - INTRODUCTION: Momentary ecological assessment indicated alleviated abdominal pain in escitalopram treatment of irritable bowel syndrome (IBS) with comorbid panic disorder. Hitherto, little is known about symptom formation, i.e., how psychological impact physical symptoms, and vice versa, and about the effect of SSRI-treatment on symptom formation.OBJECTIVE: To investigate how psychological and somatic symptoms co-vary over time in IBS patients with comorbid panic disorder and how they are affected by escitalopram treatment.METHODS: Experience sampling data from 14 IBS patients with panic disorder were obtained from a single-centre, double-blind, parallel-group, randomized controlled trial on escitalopram versus placebo. At baseline, after three and six months, multilevel time-lagged linear regression analysis was used to construct symptom networks. Network connections represented coefficients between various affect and gastrointestinal items.RESULTS: Connectivity increased up to 3 months in both groups. Between 3 and 6 months, connectivity decreased for placebo and further increased in the escitalopram group. Additionally, a steep increase in node strength for negative affect nodes was observed in the escitalopram network and the opposite for positive affect nodes. Over time, group symptom networks became increasingly different from each other. Anxious-anxious and enthusiastic-relaxed became significantly different between groups at 6 months. The connection that changed significantly in all analyses was anxious-anxious.CONCLUSIONS: Escitalopram treatment was associated with changes in the symptom networks in IBS patients with panic disorder. While mood and physical symptoms improve over time, mainly connectivity between mood nodes changed, possibly pointing towards a healthier emotion regulation resulting in alleviation of physical symptoms.
KW - Experience sampling method
KW - Irritable bowel syndrome
KW - Panic disorder
KW - Psychological networks
KW - Selective serotonin reuptake inhibitor
UR - http://www.scopus.com/inward/record.url?scp=85098872662&partnerID=8YFLogxK
U2 - 10.1016/j.jpsychores.2020.110351
DO - 10.1016/j.jpsychores.2020.110351
M3 - Article
C2 - 33412422
SN - 0022-3999
VL - 141
JO - Journal of Psychosomatic Research
JF - Journal of Psychosomatic Research
M1 - 110351
ER -