Introduction:The adverse experience in childhood (parental deprivation mostly) (AEC) has an important role in predisposing to mood and immuno-inflammatory rheumatic disorders in adults via chronic stress mechanisms. The primary Sjögren's Syndrome (SS) - a chronic, systemic autoimmune disease, which has some common pathogenic links with stress-related mental disorders.Objectives/Aims:To evaluate the AEC and MD presentation in SS patients.Methods:80 inpatients (mean age 46,2+12,3 yrs) suffering SS were enrolled in the study. MD were diagnosed in accordance with ICD-10 criteria. The severity of depression, anxiety, stress were measured with HADS, MADRS, HAM-A, PSS-10.Results:The AEC had 78,7% of SS patients (recurrent events – 32,5%). Patients with AEC had an increased risk of developing dysthymia (OR=1,34; 95% CI=0,26–6,83) and depressive episode (OR=1,75 (0,35–8,65)) in adults. Recurrent depression was not revealed in patients with ACE. However, patients with AEC had no reliable differences in the MADRS, HAM-A, HADS, PSS-10 compared to patients without AEC. Patients with AEC had an increased risk of suicide attempts (OR=2,15; (0,25–37,2)) and suicidal thoughts (OR=4,58; (0,25–18,5)). The reliable correlations of the severity of SS symptoms (dry eyes/mouth, lymphoma) and AEC have not been confirmed. Patients with AEC had early onset SS (33,6±13,0 vs 38,1±14,2) and MD (28,4±12,6 vs 34,1±13,5) than patients without AEC.Conclusion:AE? is a significant risk factor for depression and suicidal thoughts and attempts in patients suffering SS.
Background The physical and mental well being of patients with primary SS are significantly reduced [1]. Among the most significant causes are mental disorders and chronic fatigue, diagnosed in most patients suffering SS [2, 3, 4]. In the results of some previous studies fatigue had direct correlations with the diagnosis of depressive disorders but not with eyes/mouth dryness or immunology markers [3, 5]. Objectives To evaluate the occurrence rate/severity of fatigue and its relations with the severity of depression, anxiety and some clinical manifestations in SS patients. Methods 80 inpatients (mean age 46,2±12,3 yrs) suffering SS were enrolled in the study. Mental disorders (MD) were diagnosed in accordance with ICD-10 criteria. Mean age of patients during MD and SS manifestation - 31,18±14,6 and 34,6±13,3 acc. The severity of depression, anxiety, stress and fatigue were measured by HADS, MADRS, HAM-A, PSS-10 and FSS. Results Among the patients complaints had prevailed headaches (33.7%), eyes and mouth dryness (42.5%, 53.7%), memory decline (73.7%) and fatigue (93.75%). The severe fatigue (FSS) was revealed in 72.5% patients. FSS correlated with the depression severity (MADRS) (r=0.22), complaints on eyes dryness (r=0.26), cryoglobulins (r=0,25) level. The FSS score had significant correlations with anxiety and depression severity (HADS (r=0.38), WBI-WHO-5 (r=-0.52), HAM-A (r=0.34), MADRS (r=0.42) scores) and also menopausal period (r=0.32). MD were diagnosed in 78 (97.5%) of SS patients: depressive episode (mild/moderate; single/recurrent, n=27; 33.7%); dysthymia (n=12;15%); generalized anxiety disorder (n=9;11.3%); adjustment disorder (n=11;13.7%); schizotypal disorder (SD) (n=19;23.75%). Mean age of SS had significant direct correlation with the mean age of MD (r=0.82) manifestation. However, eyes/mouth dryness, immune disturbances, diagnosis of generalized vasculitis and lymphoma had pronounced correlations with the severity of anxiety and depression (MADRS and HAM-A scores). The significant differences in the occurrence rate of severe fatigue in different MD were not revealed. Conclusions Fatigue has significant associations both as with MD diagnosis (anxiety and depressive disorders) as clinical manifestations of SS. References Valtysdottir S.T., Gudbjornsson B., Lindqvist U, at al. Anxiety and depression in patients with primary Sjogren's syndrome. J Rheumatol. 2000;27:165 9. O Shelomkova, D Veltishchev, T Lisitsyna, V Vasiliev, O Kovalevskaya, O Seravina, V Krasnov, E Nasonov. Stress factors and mental disorders in Sjogren's syndrome: clinical-psychopathological and psychological analysis. J. Soc. I Clin. Psychiatry. 2013 (3): 36-42. Barendregt P., Visser M., Smets E. Fatigue in primary Sjögren's syndrome. Ann Rheum Dis. 1998 May; 57(5): 291–295. Segal B, Thomas W, Rogers T, at al. Prevalence, severity, and predictors of fatigue in subjects with primary Sjögren's syndrome. Arthritis Rheum.2008 Dec 15;59(12):1780-7. Tensing EK, Solovieva SA, Tervahartiala T, Nordstrom DC, Laine M, Ni...
IntroductionThe primary Sjögren's Syndrome (SS) - a chronic, systemic autoimmune disease, characterized by lymphocytic infiltration of endocrine glands, functional impairment of the salivary and lachrymal glands, which has some common pathogenic links with stress-related mental disorders (MD).ObjectivesTo evaluate the occurrence rate/severity of MD and the influence of stress factors in SS patients.Methods50 inpatient women (mean age 46+13.16 yrs) suffering SS were enrolled in the study. MD were diagnosed in accordance with ICD-10 criteria. The severity of depression, anxiety and stress load were measured with MADRS, HAM-A and PSS.ResultsMD were diagnosed in 42 (84%) of SS patients: depressive episode (mild/moderate; single/recurrent, n=9;18%); dysthymia (n=9;18%); generalized anxiety disorder (n=7;14%); adjustment disorder (n=8;16%); schizotypal disorder (n=9;18%). Mean severity levels of anxiety, depression and stress were 16.5+6.5; 17.2+7.9 and 16.9+6.0 accordingly. The acute stress factors and reactions were preceded the SS symptoms in most cases (n= 27, 54%). MD had the significant precipitating chronic stress factors in 36 (72%) patients. The adverse experience in childhood (parental deprivation mostly) had 32 (64%) of SS patients (recurrent events - 48%).ConclusionThe study revealed high occurrence rate of MD, precipitating stress factors and childhood adverse experience in SS patients. The results support the stress-diathesis model of mental disorders in patients suffering rheumatic disease.
Background The primary Sjögren’s Syndrome (SS) - a chronic, systemic autoimmune disease, characterized by lymphocytic infiltration of endocrine glands, functional impairment of the salivary and lachrymal glands, which has some common pathogenic links with stress-related mental disorders (MD). The physical and mental well being of the patients with primary SS are significantly reduced. The patients with SS have significantly high scoring rates for anxiety, depression, paranoid ideation and somatization compared to the controls. Objectives To evaluate the occurrence rate/severity of MD and the influence of stress factors in SS patients. Methods 50 inpatient women (mean age 46±13.2 yrs) suffering SS were enrolled in the study. MD were diagnosed in accordance with ICD-10 criteria. The severity of depression, anxiety, stress and fatigue were measured with MADRS, HAM-A, PSS-10 and FSS. Results The acute stress factors and reactions were preceded the SS symptoms in most cases (54%). The variants of stress factors revealed: “danger” (40%), “loss” (38%), “frustration” (16%) and “disaster” (6%). In most cases “loss”, “frustration”, “disaster” were related to acute and “danger” - chronic reactions (p<0,05). The adverse experience in childhood (parental deprivation mostly) had 32 (64%) of SS patients (recurrent events - 48%). MD had the significant provocative chronic stress factors in 36 (72%) patients. Mean severity level of stress (PSS10) was 16.9±6.04 points. High levels of daily stress had 17 (34%) of patients. MD were diagnosed in 42 (84%) of SS patients: depressive episode (mild/moderate; single/recurrent, 18%); dysthymia (18%); generalized anxiety disorder (14%); adjustment disorders (16%); schizotypal disorder (18%). Mean severity levels of anxiety and depression were 16.5±6.5 and 17.2±7.9 accordingly. Nearly one-third of patients had applied to psychiatrists in the past. Suicide attempts and suicidal thoughts had 6 (10%) and 10 (20%) patients accordingly before and during the disease. Fatiguewasone ofthe most often symptoms of SS revealed in most cases (60%). The severity of fatigue (Me 4.2±1.9 points) had significant correlations with the severity of anxiety and depression (r=0,4). Conclusions The study revealed high occurrence rate of MD, provocative stress factors and childhood adverse experience in SS patients. The results support the stress-diathesis model of mental disorders in patients suffering SS. Disclosure of Interest None Declared
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