15 research outputs found
Stressors and depressive disorders in rheumatic diseases
Get PDFThe paper discusses the common comorbidity of immune inflammatory rheumatic diseases (RD) and depression. It considers the causes and mechanisms, which are common to these diseases, namely, the provocative role of chronic psychosocial stress; neuroendocrine dysregulations of an immune response, which give rise to the hyperproduction of the proinflammatory cytokines determining the magnitude of the major clinical syndromes of RD and depression — chronic pain, fatigue, sleep disorders, functional insufficiency. The impact of depression on patient treatment adherence and efficiency and the course and outcome of RD is discussed. Particular attention is given to the timely therapy of depression in RD, to the effect of genetically engineered biological agents on depressive symptomatology, to the need for a personified approach to prescribing antidepressants. By taking into account the importance of detection and treatment of depressive disorders in rheumatologic practice from the clinical standpoint and in terms of medical, social, and economic consequences, the author propose an interdisciplinary approach to managing the patients with RD with the participation of rheumatologists, psychiatrists, neurologists, and medical psychologists
Objective: to specify the frequency and pattern of mental disorders in patients with rheumatoid arthritis (RA) and their association with a number of demographic parameters, stressors, inflammatory activity, duration of RA and its therapy, pain, and concomitant cardiovascular diseases (CVD).Subject and methods. One hundred and sixteen patients with verified RA were examined; 86% were women with a median age of 50 years (range, 41 to 55 years) and a median RA duration of 94.5 months (range, 45 to 228 months). Disease activity was assessed using the DAS 28 scoring system; the Brief Pain Inventory (BPI) was used for pain assessment. CVD was diagnosed by a cardiologist applying echocardiography, Doppler ultrasound, and 24-hour and blood pressure monitoring. Mental disorders were identified by a psychiatrist in accordance with ICD-10, by employing a number of psychiatric and psychological scales.Results. Mental disorders were found in 86% of the patients. There was a preponderance (85%) of anxiety-depressive spectrum disorders (ADSD): depressive episode (37%), including that within recurrent depressive disorder (19%); dysthymia (23%); adjustment disorders (16%); and generalized anxiety disorder (9%). Moderate cognitive impairment was revealed in 52% of the patients with ADSD. Schizophrenia was detected in 1%; 76 % of the RA patients had sleep disorders; 63 and 52% reported a stressful event at the onset of RA or before its exacerbation, respectively. The patients with ADSD did not differ from those without ADSD in age, gender, disease duration and activity, but they had more frequently aseptic bone necroses (ABN), X-ray stage IV, Class III functional insufficiency (FI), higher severity index and HAQ index. The patients with ADSD experienced stronger pain (p < 0.05). They took glucocorticoids for a shorter time (p < 0.05). Basic anti-inflammatory drugs were taken by the patients with and without ADSD at a similar frequency, but the patients with ADSD received methotrexate less often. ADSD was more common in patients with RA and CVD (angina pectoris, atherosclerosis, acute cerebrovascular insufficiency). Conclusion. Mental disorders with a predominance of ADSD are typical of the majority of patients with RA. Stressful events often precede the onset of RA and its exacerbation. The incidence of ADSD does not depend on age, gender, and disease duration and activity, but correlates with joint destructive changes (ABN and X-ray stage IV), pain intensity, FI, severity index and HAQ, less aggressive therapy for RA, and CVD.
Get PDFComparative analysis of anxiety-depressive spectrum disorders in patients with rheumatic diseases
Get PDFResearch objective - comparative analysis of incidence and structure of anxiety-depressive spectrum disorders (ADD) in patients with various rheumatic diseases (RD). Materials and methods. 613 patients with RD were enrolled in the study: 180 with a reliable diagnosis of systemic lupus erythematosus (SLE), 128 with rheumatoid arthritis (RA), 110 with systemic sclerosis (SSc), 115 with Behcet's disease (BD), 80 with primary Sjögren's syndrome (pSS). Female prevailed in all groups (95% of patients with pSS, 88,2% - SSc, 87,2% - RA, 85,5% of SLE) except BD patients (70% male). The mean age was 42.3±1.54 years and was lower in patients with BD (33.3±0.98 years) and SLE (34.6±0.93 years) compared to patients with SSc (49.9±2.47 years), RA (47.4±0.99 years) and pSS (46.2±2.3 years). The mean RD duration was 130,0±8,65 months and was more at BD - 148,5±10,4 months, pSS - 141,6±8,92 months, RA - 138,4±10,1months, and less at SLE - 134,9±8,8 months and SSc - 87,0±5,04 months. The mean SLE activity index SLEDAI was 9,13±0,63 points (high), RA (DAS28) - 5,26±0,17 points (high), BD (BDCAF) - 3,79±0,2 points (moderate) and SSc by G. Valentini - 1,1±0,20 points (moderate). Glucocorticoids took 100% of patients with pSS, 91,1% - SLE, 90% - SSc, 87% - BD and 67,2% - RA patients; conventional disease modifying anti-rheumatic drugs (cDMARDs) took 90% of patients with SSc, 84% - BD, 79,6% - RA, 68% - pSS, 40,6% - SLE. Biologic DMARDs took 32% of patients with RA, 17,4% - BD, 7,3% - SSc and 7,2% - SLE. Mental disorders were diagnosed by psychiatrist as a result of screening by the hospital anxiety and depression scale (HADS) and in semi-structured interview in accordance with the ICD-10/ DSM-IV. The severity of depression was evaluated by Montgomery-Asberg Depression Rating Scale (MADRS) and anxiety - by Hamilton Anxiety Rating Scale (HAM-A). Projective psychological methods were used for cognitive impairment detection. Results. Screening of depressive disorders (HADS-D≥8) was positive in 180 (29,4%) patients with RD, including 74 (41%) patients with SLE, 38 (35%) - SSc, 29 (23%) - RA, 23 (20%) - BD and 16 (20%) - pSS; anxiety disorders (HADS-A≥8) - in 272 (44,4%) patients, including 66 (52%) patients with RA, 40 (50%) - pSS, 77 (43%) - SLE, 45 (41%) - SSc and 44 (38%) - BD. In accordance with the ICD-10/ DSM-IV depressive disorders have been identified in 389 (63%) patients, including 94 (73%) patients with RA, 71 (64,5%) - SSc, 69 (60%) - BD, 90 (50%) - SLE and 39 (49%) - pSS; anxiety disorders - in 377 (61,5%) patients, including 20 (25%) patients with pSS, 44 (24,5%) - SLE, 29 (23%) - RA, 20 (17%) - BD and 7 (6,4%) - SSc. Conclusion. Anxiety-depressive spectrum disorders are typical for most patients with RA, SLE, SSc, pSS and BD. ADDs diagnosis in RD patients with the use of the HADS did not reveal a significant proportion. To obtain objective data on the frequency and structure of ADDs, psychopathological and clinical psychological diagnosis is necessary
Possibilities of using Tanakan ® in therapy for generalized anxiety syndrome
No full textThe review considers the treatment of anxiety disorders (generalized anxiety and the anxious variant of adaptation disorders) with Tanakan® that is a standardized gingko biloba extract. The successful use of the drug in moderate anxiety states in elderly patients having cognitive disorders of cerebrovascular nature is now beyond question. However, the pronounced stimulating effect of Tanakan® requires that caution should be exercised when giving it in anxiety syndrome
Neurasthenia: history and the present
No full textThe paper provides a historical analysis of the concept of neurasthenia with emphasis on its psychopathological heterogeneity. It considers predisposing and initiating factors in the genesis of neurasthenia. Particular emphasis is placed on its differential pharmacotherapy, by keeping in mind its predisposing factors. The results of studies confirming the efficacy of Tanakan® in different types of this abnormality are given
MENTAL DISORDERS IN PATIENTS WITH RHEUMATIC DISEASES: DIAGNOSIS AND TREATMENT
No full textThe paper considers the prevalence, pattern, and clinical features of mental disorders (MDs) that are characteristic of patients with immune-mediated inflammatory rheumatic diseases (RDs). It discusses in detail risk factors for MDs, their pathogenesis, association with inflammatory activity, and major clinical symptoms of RD. Particular emphasis is placed on the diagnosis and treatment of MDs in patients with RDs in primary health care facilities and at rheumatology hospitals
Interleukin 6 as a pathogenic factor mediating clinical manifestations and a therapeutic target for rheumatic diseases and depressive disorders
Get PDFThe review summarizes current idea on the key role of interleukin 6 (IL-6) in the pathogenesis of rheumatic diseases (RDs) and depressive disorders. It considers in detail the mechanisms by which IL6 induces the clinical and laboratory manifestations of RDs and depression; the influence of precipitating and predisposing stress factors, including childhood mental traumas, which increase the risk of RDs and depression, on IL-6 production. Particular attention is paid to the consideration of prospects for using IL-6 inhibitors in the therapy of depression
Psychiatric aspects of spondyloarthritis
Get PDFSpondyloarthritis refers to immune-mediated inflammatory rheumatic diseases characterized by the most pronounced pain, inflammatory activity and disability of patients of working age. One of the most frequent comorbid to spondy-loarthritis diseases that weigh down the course and outcomes are anxiety-depressive spectrum disorders. Chronic inflammation with hyperproduction of cytokines of the interleukin-23/interleukin-17 axis and violation of intracellular signaling of these cytokines, developing against the background of a violation of the stress and immune response, is a key pathogenetic mechanism that combines spondyloarthritis and anxiety-depressive spectrum disorders, and dictates approaches to their therapy. The article discusses the current understanding of the prevalence of mental disorders among patients with spondyloarthritis and their negative impact on the course and outcomes of the rheumatic disease, the common pathogenesis and provoking factors, the influence of antidepressants on spondyloarthritis outcomes and anti-inflammatory drugs, primarily interleukin-17 inhibitors and tumor necrosis factor alpha inhibitors on the symptoms of anxiety-depressive spectrum disorders
THE CLINICAL AND PATHOGENETIC RELATIONSHIP BETWEEN BEHCET'S DISEASE AND MENTAL DISORDERS
No full textThe paper analyzes the results of an investigation into the relationship between Behcet's disease (BB) and mental disorders. It establishes the importance of an emotional stress factor for developing the clinical symptoms and disease. In its turn, the systemic immune inflammatory disease and its complications become a source of mental disorders. The literature describes different variants of BB, but anxiety-depressive spectrum disorders and moderate cognitive impairments are most common. The presence of depression contributes significantly to lower quality of life in patients with BB
