FACTORS ASSOCIATED WITH ANXIETY AND DEPRESSION SPECTRUM DISORDERS IN BEHCHET’S DISEASE

Objective: to determine the main factors associated with the development and manifestations of anxiety and depression spectrum disorders (ADSDs) in patients with Behcet’s disease (BD).

Subjects and methods. This investigation was conducted within the framework of the interdisciplinary scientific program «Stress factors and mental disorders in rheumatic diseases». A total of 116 patients with BD were examined. Most of them were men (69.8%), whose mean age (M±σ) was 33.4±9.82 years; the median duration of BD was 120.0 [70.0; 192.0] months; 51.9% of the patients were natives of the North Caucasus. All the patients had a reliable diagnosis of BD according to the International Study Group for Behcet’s disease (ISGBD) criteria (1990). Disease activity was assessed using the Behcet’s Disease Current Activity Form (BDCAF); the subjective status of patients was evaluated using the visual analog scale (VAS) for general health assessment. ADSDs were diagnosed by a psychiatrist according to the ICD-10 during semi-structured interviews using the Hospital Anxiety and Depression Scale (HADS), the Hamilton Anxiety Rating Scale (HAM-A), and the Montgomery-Asberg Depression Rating Scale (MADRS). Clinical and psychological techniques were applied to assess cognitive functions (memory, attention, and logical thinking); stress levels were estimated by the 10-Item Perceived Stress Scale (PSS-10).

Results and discussion. ADSDs were diagnosed in 91 (78.4%) patients with BD. The predominant RTDs were dysthymia (39.6%) and recurrent depressive disorder (38.4%). Generalized anxiety disorder was found in only 7.69%, a single depressive episode was in 13.2%. Different degrees of cognitive impairment (CI) were observed in 91 (78.4%) patients. Multivariate analysis and linear regression were used to build a predictive model, from which it follows that ADSDs in patients with BD are primarily associated with sleep disorders (β=0.412), asthenia (β=0.149), CI (β=0.137), chronic stress (β=-0.010) and its severity (β=0.134), early childhood psychic trauma (ECPT) before the age 7 years (β=0.152), the development of ADSD before the onset of BD (β =0.160), older age of eye involvement in the pathological process (β=0.089), gastrointestinal tract (GIT) involvement within BD (β=0.096), high C-reactive protein (CRP) levels (β=0.177), and poor subjective status of patients (β=0.120) (area under the ROC-curve, 0.940).

Conclusion. Chronic ADSDs are encountered with high frequency in patients with BD and frequently occur simultaneously with the latter or during its development. Their occurrence is favored to the greatest extent by ECPT and obvious chronic psychosocial stress preceding ADSDs. GIT involvement, late-onset ocular pathology, high CRP levels, and poor subjective status are common to patients with BD and ADSDs. Sleep disorders, asthenic syndrome, and CI are significant in the pattern of ADSDs. 

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