Comparative analysis of anxiety-depressive spectrum disorders in patients with rheumatic diseases


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Abstract

Research 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.

About the authors

T A Lisitsyna

Federal State Budgetary Scientific Institution «Research Institute of Rheumatology named after V.A. Nasonova»

Email: talisitsyna@rambler.ru
в.н.с. лаб. системных ревматических заболеваний, ORCHID ID orcid.org/0000-0001-9437-406X

D Yu Veltishchev

Moscow Research Institute of Psychiatry, Branch «National Medical Research Center of Psychiatry and Narcology» Ministry of Health of Russia

руководитель отд-ния стрессовых расстройств

O F Seravina

Moscow Research Institute of Psychiatry, Branch «National Medical Research Center of Psychiatry and Narcology» Ministry of Health of Russia

н.с. отд-ния стрессовых расстройств

O B Kovalevskaya

Moscow Research Institute of Psychiatry, Branch «National Medical Research Center of Psychiatry and Narcology» Ministry of Health of Russia

н.с. отд-ния стрессовых расстройств

M N Starovoytova

Federal State Budgetary Scientific Institution «Research Institute of Rheumatology named after V.A. Nasonova»

с.н.с. лаб. микроциркуляции и проблем воспаления

O V Desinova

Federal State Budgetary Scientific Institution «Research Institute of Rheumatology named after V.A. Nasonova»

н.с. лаб. микроциркуляции и проблем воспаления

A A Abramkin

Federal State Budgetary Scientific Institution «Research Institute of Rheumatology named after V.A. Nasonova»

аспирант

P S Ovcharov

Federal State Budgetary Scientific Institution «Research Institute of Rheumatology named after V.A. Nasonova»

аспирант

V I Vasil’ev

Federal State Budgetary Scientific Institution «Research Institute of Rheumatology named after V.A. Nasonova»

в.н.с. лаб. интенсивных методов терапии

Z S Alekberova

Federal State Budgetary Scientific Institution «Research Institute of Rheumatology named after V.A. Nasonova»

в.н.с. лаб. системных ревматических заболеваний

V N Krasnov

Moscow Research Institute of Psychiatry, Branch «National Medical Research Center of Psychiatry and Narcology» Ministry of Health of Russia

директор филиала Московского научно-исследовательского института психиатрии

E L Nasonov

Federal State Budgetary Scientific Institution «Research Institute of Rheumatology named after V.A. Nasonova»; I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Department of Rheumatology, Institute of Professional Education

научный руководитель ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»

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