M e d i c a l P s y c h o l o g y U n i t, D e p a r t m e nt of C l i n i c a l N e u r o s c i e n c e s a n d M e n t a l H e a l t h Fa c u l t y

Transcription

1 R. Fonseca; M. Figueiredo-Braga M e d i c a l P s y c h o l o g y U n i t, D e p a r t m e nt of C l i n i c a l N e u r o s c i e n c e s a n d M e n t a l H e a l t h Fa c u l t y of M e d i c i n e, U n i v e r s i t y of Po r t o Po r t u ga l

2 BACKGROUND

3 FATIGUE Fatigue is common in numerous chronic diseases, associated with physical or psychological symptoms or as an unique manifestation; Fatigue is both an highly prevalent symptom and a prognostic marker in major depressive disorder. Vaccarino, A.L., et al, 2008 Dittner, A.J., et al, 2004

4 SYSTEMIC LUPUS ERYTHEMATOSUS Autoimmune disease characterized by various clinical manifestations and an unpredictable course; 9 women : 1 men; Fatigue affects up to 90% of the SLE patients. In 50% of them, fatigue is the most severe manifestation of the disease; Krupp, L.B., et al, 1989 Psychiatric disease and cognitive impairment are frequent comorbidities; Depression is the most prevalent psychiatric condition in SLE. Iverson G.L., 2002

5 ETIOLOGY Physical activity Sleep quality Fatigue in SLE Disease activity/damage Mood Quality of life A d apted f r o m Z o n ana - Nacach, A., e t a l,

6 AIMS To detect and characterize fatigue in a sample of Portuguese patients diagnosed with SLE and To compare the obtained results with fatigue occurring in a sample of depressed patients without physical illnesses To clarify the association of fatigue with anxiety, depression and disturbed sleep in both groups To uncover possible pathophysiological mechanisms involved in the occurrence of fatigue in SLE patients

7 METHODS

8 Population: 53 female patients: 24 diagnosed with SLE, according to ACR criteria 29 diagnosed with depression Instruments: Socio-demographic questionnaire Fatigue Severity Scale (FSS) Pittsburgh Sleep Quality Index (PSQI) Hospital Anxiety and Depression Scale (HADS) SF-36v2 Health Survey (SF-36v2) Phone interview (September to December 2012)

9 RESULTS

10 SOCIO-DEMOGRAPHIC CHARACTERIZATION Total SLE n = 53 n = 24 Age (years) 1, (12.57) (11.47) (2.34) Depression n = (13.67) (2.73) P (95%CI) Education (years) 1, (4,28) 9.04 (4.15) (0.85) (3.72) (0.81) Marital status Single 12 (22.6) 5 (20.8) 7 (24.1) Married 37 (69.8) 19 (79.2) 18 (62.1) Divorced 3 (5.7) 0 (0) 3 (10.3) Widow 1(1.9) 0 (0) 1 (3.4) 1 Mean (Standard Deviation), 2 SEM (Standard error mean), 3 n (%), 4 T Test, 5 Chi-square Test (CI) Confidence interval

11 GENERAL HEALTH MEASURES Total SLE n = 53 n = 24 Weight (kg) 1, (18.98) 64.2 (12.45) (2.54) Height(m) 1, (0.07) 1.61 (0.07) (0.01) Depression n = (23.08) (4.44) 1.64 (0.07) (0.01) P (95%CI) Smoking habits 3 Smoker 15 (28.3) 6 (25) 9 (31) Non-Smoker 35 (66) 18 (75) 17 (58,6) Alcohol consumption 3 Yes 4 (7.5) 2 (25) 2 (6.9) No 46 (86.2) 22 (75) 24 (82.8) Length of disease (years) 1,6 11.7(7.2) 2 1 Mean (Standard Deviation), 2 SEM (Standard error mean), 3 n (%), 4 T Test, 5 Chi-square Test, 6 Minimum, Maximum (CI) Confidence interval 31

12 FATIGUE (FSS) Fatigue Severity Scale mean score SLE Depression * p<.005 * Normal fatigue SLE Prevalence of clinical fatigue Clinical fatigue Normal fatigue Depression Clinical fatigue Clinical fatigue was defined by a score >3 in FSS. ( Kr u p p, L. B., et a l., )

13 ANXIETY AND DEPRESSION (HADS) 14 HADS - A and HADS-D mean score HADS_A SLE HADS_D HADS_A Depression HADS_D

14 SLEEP (PSQI) 12 PSQI mean score Prevalence of disturbed sleep SLE Depression 0 Good sleeper SLE Poor sleeper Good sleeper Depression Poor sleeper A global score > 5 defines poor sleepers. (Buysse D.J., et al, 1989)

15 QUALITY OF LIFE (SF-36V2) Total n = 106 SLE n = 24 Physical functioning 1, (26.04) (27.41) (5.59) Role limitations due to physical (27.35) 42.7 (31.53) health problems 1,2 (6.43) Social functioning 1, (28.79) (34.36) (7.01) Mental health 1, (19.16) 50.00(21.06) (4.34) Role limitations due to emotional (26.20) (28.41) problems 1,2 (5.80) Vitality 1, (19.30) (23.27) (4.75) Bodily pain 1, (33.91) (34.73) (7.09) General health 1, (24.61) (20.38) (4.16) 1 Mean (Standard Deviation), 2 SEM (Standard error mean), 3 n (%), 4 T Test, (CI) Confidence interval Depression n = (20.78) (3.86) (19.36) (3.66) (22.32) (4.22) (17.10) (3.17) (24.35) (4.52) (13.97) (2.59) (24.19) (4.57) (22.18) (4.12) P (95%CI)

16 FATIGUE, ANXIETY, DEPRESSION AND SLEEP

17 FATIGUE AND QUALITY OF LIFE

18 FATIGUE AND PAIN

19 FATIGUE IN SLE Fatigue was associated with impaired physical functioning and limitations due to physical health problems (p=,000, R=-,733; p=,000, R=-,793); Fatigue correlated with worse quality of sleep, which was positively related with anxiety and depression (p=,001, R=,620; p=,000, R=,748; p=,001, R=,652); Fatigue was negatively correlated with vitality (p=,000, R=-,767).

20 DISCUSSION AND CONCLUSIONS

21 Fatigue was highly prevalent in SLE patients (95,8%), in line with previous reports; Cleanthous S., et al, 2012 Although SLE patients complained of higher levels of fatigue, no differences were found between SLE and depressed patients regarding the presence of clinical fatigue ; Remarkable levels of fatigue have also been identified in physically healthy depressed patients; The association of fatigue with psychological suffering in both entities could explain the detected similarities in FSS scores.

22 Fatigue in SLE related to: Physical burden of the disease Role limitations due to physical health problems Physical functioning Emotional stressors Anxiety Depression Quality of sleep Emotional suffering from a chronic and disabling disease? Secondary to CNS damaging/disease s pathophysiology?

23 Fatigue has been highly correlated with depression in patients with rheumatologic diseases, such as SLE; Arnold L.M., 2008 In the present study, the prevalence of poor sleepers among patients with SLE was higher than previously described in literature; Abad, V.C., et al, 2008 Mutual impairment? Sleep plays an important role on immune system, invigorating and energizing host defense mechanisms in experimental models. Palma B.D., et al, 2006

24 Social and labour implications Clinical implications Fatigue in SLE Economic implications

25 ACKNOWLEDGMENTS SLE patients; Depressed patients; Rheumatology Service HSJ Miguel Bernardes; Georgina Terroso; Lúcia Costa.

26 Thank you

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