Stressors and depressive disorders in rheumatic diseases

The 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

Anxiety, depression and stress tension screening in patients with rheumatic and musculoskeletal diseases at the onset of the 2019 coronavirus disease (COVID-19) pandemic

The aim - screening of anxiety, depression and stress in patients with rheumatic and musculoskeletal diseases (RMD) and medical workers at the beginning of the COVID-19.Material and methods. 150 patients (men/women: 39 (26.0%)/111 (74.0%); mean age - 43.2±16.1 years) with RMD, hospitalized at the V.A. Nasonova Research Institute of Rheumatology (Moscow) from July to November 2020, and 32 relatively healthy medical workers (men/women: 3 (9.38%)/29 (90.6%), mean age - 40.7±14.6 years) as a control group was included in the study. The Hospital Anxiety and Depression Scale (HADS) and the Depression Anxiety and Stress Scale - 21 Items (DASS-21) were used for anxiety, depression and stress screening. Results. Frequency of anxiety-depressive spectrum disorders in patients with RMD was 48% (according to DASS-21) and 27.2% (according to HADS), which did not differ significantly from the control group - 46.9% and 18.8% respectively. According to the DASS-21, patients with systemic sclerosis were significantly more likely to have a combination of clinically significant anxiety, depression and stress compared to healthy control (6 (46.2%) vs 4 (12.5%); p=0.02) and patients with spondyloarthritis (6 (46.2% vs 5 (16.1%); p=0.045). The severity of anxiety was significantly higher among patients with RMD - systemic lupus erythematosus, primary Sjogren's syndrome and systemic sclerosis, according to both scales. The severity of depression, anxiety and stress was significantly higher in women with RMD, rural residents and patients taking moderate and high doses of glucocorticoids. The pathological stress level was experienced by younger medical workers (27.5±5.45 vs 45.8±13.8 years; p=0.001). The transferred coronavirus infection did not lead to an increase in the severity of depression, anxiety and stress tension among patients, however, among medical workers, the frequency of clinically significant anxiety (4 (57.1%) vs 6 (24%)) and stress (3 (42.8%) vs 5 (20%)) was 2.2-2.9 times higher in those who have been ill. When compared with the results of the similar screening by HADS in 2012, the proportion of RМD-patients with clinically significant anxiety and depression over the past 8 years and in connection with the pandemic COVID-19 has not significantly changed.Conclusion. A new threat to health, isolation and uncertainty at the beginning of the COVID-19 were an additional stressful factor for patients with RМD, however, given the high background prevalence of low-severity chronic depression with frequent onset before RМD, the factor of the COVID-19 is not a key factor in provoking mental disorders

Efficacy of olokizumab against comorbid depressive disorder in patients with rheumatoid arthritis: Preliminary results of the study

Background. Interleukin (IL) 6 plays an important role in the pathogenesis of comorbid rheumatoid arthritis (RA) depression, and IL-6 inhibitors (i) used to treat RA patients may have an antidepressant effect.Objective – to evaluate the effectiveness of Russian iIL-6 olokizumab (OKZ) in reducing symptoms of depression in patients with moderate/high RA activity.Material and methods. To date, 49 RA patients have been included, of which 43 (87.7%) are women, with an average age of 47.8±12.8 years; with a predominant high activity of RA according to DAS28 (CRP) indices (89.8%), SDAI (79.6%) and CDAI (75.5%) and inefficacy of stable 12-week therapy of сDMARDs. In all patients, a psychiatrist, in accordance with ICD-10, diagnosed depression (chronic or recurrent) of varying severity during a semi-structured interview. At week 0, all patients were randomized by the method of sequential numbers in a ratio of 1:1:1 to one of the 3 study groups: group 1 – cDMARDs+OKZ 64 mg subcutaneously once every 4 weeks (n=18); group 2 – cDMARDs+OKZ 64 mg subcutaneously once every 4 weeks + psychopharmacotherapy (PPT) (n=26); group 3 – cDMARDs+PPT (n=5). The duration of the study is 24 weeks. The dynamics of depression severity was assessed on the PHQ-9, MADRS scales; anxiety – HAM-A; experimental psychological projective techniques were also used.Results. After 12 and 24 weeks of therapy, there was a significant decrease in the severity of depression and anxiety in all groups of patients. However, the difference between the final and initial values of all scales was statistically significantly greater (p<0.05) in the groups of patients receiving PPT: cDMARDs+OKZ+PPT (ΔPHQ-9 24–0 =–6.75±3.91; ΔMADRS 24–0 =–22.5±4.83; ΔHAM-A 24-0 =–14.6±5.37) and cDMARDs+PPT (ΔPHQ-9 24–0 =–15.5±3.53; ΔMADRS 24–0 =–25.0±1.41; ΔHAM-A 24-0 =–18.5±3.53), compared with the cDMARDs+OKZ group (ΔPHQ-9 24–0 =–4.00±3.89; ΔMADRS 24-0 =–5.75±8.29; ΔHAM-A 24–0 =–8.50±8.21). According to a semi-structured interview with a psychiatrist and design experimental psychological techniques, the proportion of patients without depression after 24 weeks of therapy was significantly higher in the groups of patients receiving PPT: 90% in the group of cDMARDs+OKZ+PPT and 100% – cDMARDs+PPT, as opposed to 25% in the group of cDMARDs+OKZ. OKZ therapy contributed to the normalization of night sleep but did not lead to a decrease in the frequency and severity of cognitive disorders (CD).Conclusions. OKZ has an antidepressant effect in RA patients, leads to a decrease in the frequency of sleep disorders, but a com[1]plete regression of depression symptoms is possible because of the appointment of OKZ without PPT only in 25% of RA patients, mainly in patients with mild depression. Optimal for the complete regression of depression, anxiety and a decrease in the frequency and severity of CD is a combination of OKZ and PPT

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

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

Possibilities of using Tanakan ® in therapy for generalized anxiety syndrome

The 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

The 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

The 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

The 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

Interleukin 6 as a pathogenic factor mediating clinical manifestations and a therapeutic target for rheumatic diseases and depressive disorders

The 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.</jats:p