Psychiatric Co-Morbidity Affects the Symptoms of Fibromyalgia

Zusammenfassung

Fragestellung: Es wurde untersucht, inwiefern bei Fibromyalgie die Ausprägung der Symptomatik (u. a. Schmerzintensität, Müdigkeit, Schlafstörungen) durch eine psychiatrische Komorbidität beeinflusst wird. Material und Methode: 100 konsekutiv aufgenommene Patientinnen im Alter von 30 - 60 Jahren (MW: 38,5) mit Fibromyalgie (Klassifizierung nach ACR-Kriterien) wurden in die Studie aufgenommen. Zunächst erfolgte die Selbsteinschätzung der Intensität von Schmerz, Müdigkeit und Schlafstörungen anhand einer 5-poligen Skala. Weiterhin wurde erhoben: Symptom Check List (SCL-90), Beck Depression Inventory (BDI) und Toronto Alexithymia Scale (TAS). Die Patientinnen wurden anschließend anhand von DSM-IV-Kriterien (Diagnostic and Statistical Manual of Mental Disorders) in fünf Gruppen nach Schweregrad unterteilt. Diese wurden jeweils mit der Ausprägung der Fibromyalgiesymptome verglichen. Ergebnisse: Zwischen den Gruppen bestanden keine auffälligen Differenzen bezüglich Alter, Erkrankungsdauer und Anzahl der Tenderpoints. Folgende psychiatrische Störungen wurden ermittelt: 31 depressive Störungen, 24 Angststörungen, 8 somatoforme Störungen, 1 Impulskontrollstörung. 36 Patientinnen waren psychiatrisch unauffällig. Schmerzintensität, Schlafstörungen und Müdigkeit zeigten sich signifikant erhöht bei Patienten mit somatoformen Störungen. Ein ähnliches Bild zeigte sich bei den Patientinnen mit Angststörungen, jeweils im Vergleich zur Gruppe ohne psychiatrische Diagnose. Schlussfolgerung: Die klinische Symptomatik bei Fibromyalgie ist signifikant ausgeprägter bei Patientinnen mit gleichzeitig bestehender psychiatrischer Diagnose.

Abstract

Purpose: To investigate the effect of co-morbid psychiatric disorders on clinical symptoms of fibromyalgia syndrome such as pain intensity, fatigue, sleep disturbances, and patients' global assessment. Materials and Methods: One hundred consecutive female patients who were diagnosed with fibromyalgia syndrome according to American College of Rheumatology (ACR) criteria were included in the study. The patients were asked to assess the intensity of their pain, fatigue and sleep disturbances. They were also requested to fill in Symptom Check List (SCL-90 R), Beck Depression Inventory (BDI), Toronto Alexithymia Scale (TAS). The patients were divided into 5 groups using Diagnostic and Statistical Manual of Mental Disorders (DSM IV) criteria. The groups were compared according to symptoms of the patients. Results: There was no significant difference among the groups in terms of age, disease duration, total tender point counts. Thirty-one patients were diagnosed as having depressive disorders, 24 anxiety disorders, 8 somatoform disorders, 1 impulse control disorder, 36 no psychiatric diagnosis. Pain intensity, sleep disturbance, and fatigue complaints are significantly more severe among patients with somatoform disorder as compared to patients with no diagnosis. Pain intensity in the anxiety disorder group, and sleep disturbance in the depressive disorder group were also found significantly more severe than in the group with no psychiatric diagnosis. Conclusion: Clinical symptoms were significantly more severe in patients with any psychiatric diagnosis. This indicates that co-morbid psychiatric disorders in patients with fibromyalgia modify the self-assessment of clinical symptoms such as pain, sleep disturbances and fatigue.

Schlüsselwörter

Fibromyalgie - Schmerz - Schlafstörungen - Erschöpfung - Somatisierung - Depression - Angst

Key words

Fibromyalgia - pain - sleep disturbance - fatigue - somatization - depression - anxiety

References

• 1 Bradley L A, Alarcon G S. Fibromyalgia. In: Koopman WJ (ed) Arthritis and Allied Conditions - A Textbook of Rheumatology, 14 ed. Philadelphia, Baltimore, New York; Lippincott Williams & Wilkins Publishers 2001: 1811-1844
• 2 Lavin M M, Hermosillo A G. Autonomic nervous system dysfunction may explain the multisystem features of fibromyalgia.  Seminars in arthritis and rheumatism. 2000;  29 197-199
• 3 Neeck G. Neuroendocrine and hormonal perturbations and relations to the serotonergic system in fibromyalgia patients.  Scand J Rheumatol. 2000;  29, Suppl 113 8-12
• 4 Epstein S A, Kay G, Clauw D. et al . Psychiatric Disorders in patients with fibromyalgia: A multicenter investigation.  Psychosomatics. 1999;  40 57-63
• 5 Wolfe F, Smythe H A, Yunus M B. et al . The American Collage of Rheumatology 1990 criteria for the classification of fibromyalgia: Report of the Multicenter Criteria Committee.  Arthritis & Rheumatism. 1990;  33 160-172
• 6 Derogatis L R, Lipman R S, Covi L. SCL-90: an outpatient psychiatric rating scale-preliminary report.  Psychopharmacology Bulletin. 1973;  9 (1) 13-28
• 7 Bagby R M, Taylor G J, Ryan D. Toronto Alexithymia Scale: relationship with personality and psychopathology measures.  Psychotherapy and Psychosomatics. 1986;  45 (4) 207-215
• 8 Beck A T, Ward C H, Mendelson M. et al . An inventory for measuring depression.  Archives of General Psychiatry. 1961;  4 561-571
• 9 American Psychiatric Association .Diagnostic and Statistical Manual of Mental Disorders, 4^th ed. Washington DC; American Psychiatric Press 1994
• 10 Pett M A. Nonparametric statistics for health care research. Statistics for small samples and unusual distributions. Thousand Oaks; CA Sage Publications Inc 1997
• 11 Okufuji A, Turk D C, Sherman J J. Evaluation of the relationship between depression and fibromyalgia syndrome: Why aren't all patients depressed?.  Journal of Rheumatology. 2000;  27 212-219
• 12 Martinez J E, Feraz M B, Fontana A M. et al . Psychological aspects of Brazilian women with fibromyalgia.  Journal of Psychosomatic Research. 1995;  39 167-174
• 13 Aaron L A, Bradley L A, Alarcon G S. et al . Psychiatric diagnoses in patients with fibromyalgia are related to health care-seeking behaviour rather than to illness.  Arthritis & Rheumatism. 1996;  39 436-445
• 14 Ahles T A, Khan S A, Yunus M B. et al . Psychiatric status of patients with primary fibromyalgia, patients with rheumatoid arthritis, and subjects without pain: A blind comparison of DSM-III diagnoses.  The American Journal of Psychiatry. 1991;  148 1721-1726
• 15 Hudson J I, Hudson M S, Pliner L F. et al . Fibromyalgia and major affective disorder: A controlled Phenomenology and family history study.  The American Journal of Psychiatry. 1985;  142 441-446
• 16 Kirmayer L J, Robbins M J, Kapusta M A. Somatization and depression in fibromyalgia.  The American Journal of Psychiatry. 1988;  145 950-954
• 17 Wolfe F, Hawley D J. Evidence of disordered symptom appraisal in fibromyalgia: Increased rates of reported comorbidity and comorbidity severity.  Clinical Experimental Rheumatology. 1999;  17 297-303
• 18 Menefe L A, Cohen J MM, Anderson W R. et al . Sleep disturbance and non-malignant chronic pain: a comprehensive review of the literature.  Pain Medicine. 2000;  1 156-172
• 19 Krag Norregaard J, Larsen J K. et al . A blinded controlled evaluation of anxiety and depressive symptoms in patients with fibromyalgia as measured by standardized psychometric interview scales.  Acta Psychiatr Scand. 1994;  89 370-375
• 20 Walker E A, Keegan D, Gardner G. et al . Psychosocial factors in fibromyalgia compared with rheumatoid arthritis.  Psychosom Med. 1997;  59 565-571
• 21 Kurtze N, Svebak S. Fatigue and patterns of pain in fibromyalgia: Correlation with anxiety, depression and co-morbidity in female county sample.  British Journal of Medical Psychology. 2001;  74 523-537
• 22 Çeliker R, Borman P, Oktem F. et al . Psychological disturbance in fibromyalgia: relation to pain severity.  Clinical Rheumatology. 1997;  16 179-184
• 23 Clark S, Campell S M, Forehand M E. et al . Clinical characteristics of fibrositis.  Arthritis Rheum. 1985;  28 132-137