Date Published: November 1, 2018
Publisher: Public Library of Science
Author(s): Maciej Bieliński, Natalia Lesiewska, Joanna Bielińska, Ariel Liebert, Artur Mieczkowski, Paulina Sopońska-Brzoszczyk, Bartosz Brzoszczyk, Maria Kłopocka, Alina Borkowska, Marco Innamorati.
Psychiatric disorders are significantly common complications among patients suffering from inflammatory bowel diseases (IBD). Affective temperament is a concept of core personality traits, which can decribe the vulnerability to mood disorders, therefore its evaluation might convey useful information about patients’ mental status in autoimmune disorders. The aim of the study was to evaluate the affective temperament in patients with Crohn’s disease (CD) and ulcerative colitis (UC) as characteristic features of these diseases, but also in the clinical course and the severity of anxiety and depression.Due to our knowledge this is the first study of this kind. The study enrolled 130 patients with IBD, including 68 with CD and 62 with UC. We used TEMPS-A to evaluate affective temperament and HADS scales to assess the intensity of depressive and anxiety symptoms. Harvey Bradshaw scale, Crohn’s Disease Activity Index (CDAI) and Mayo Score were used to evaluate clinical severity of the diseases. We observed significantly higher prevalence of depressive, cyclothymic and anxiety temperaments in CD patients compared to the control group. Harvey Bradshaw scale, CDAI and Mayo Self Report showed statistically significant outcomes, including significant positive correlations with depressive, cyclothymic and anxiety subscales of TEMPS-A, and negative correlation with the hyperthymic temperament in CD subjects. Our findings indicate significant differences between CD and UC due to temperament traits, and suggest distinct pathogenesis of mood disorders in IBD.
Inflammatory Bowel Disease (IBD), such us Crohn’s Disease (CD) and Ulcerative Collitis (UC) are chronic and relapsing gastrointestinal disorders with crucial implications. This issue requires greater attention provided that the number of patients with IBD is still significantly increasing, especially in the western industrialized countries. The occurence rate of IBD in adult Europeans can reach even 140 per 100,000 inhabitants .
The initial analysis of affective temperament showed that patients with CD have significantly more depressive (p = 0.018, d-Cohen = 0.51), cyclothymic (p = 0.026, d-Cohen = 0.32) and irritable (p = 0.029, d-Cohen = 0.27) dimensions in relation to patients with UC (Table 2). Similar analyzes were carried out regarding the subgroup results of patients with CD and UC to the results of the control group matched according to gender, age and level of education to the patients groups (Table 3). The results indicated higher prevalence of depressive (p = 0.0004, d-Cohen = 0.43), cyclothymic ((p = 0.0001, d-Cohen = 0.27) and anxiety (p = 0.001, d-Cohen = 0.52) temperaments among CD patients compared to the control group. In contrast, patients with UC were only characterized by a significantly lower scores of irritability in TEMPS-A.
Temperament displays the relatively stable biological and genetic basis of personality which can putatively affect the risk of psychiatric comorbidities . Mood disorders are very prevalent among IBD patients and by their intensity create two-dimensional dependencies with the clinical course. Hence TEMPS-A, as a simple tool, can be very useful in assessing patient’s morbidity to psychiatric disorders . To our knowledge, this is the first study scrutinizing affective temperament in patients suffering from CD and UC.
In conclusions, to our knowledge, this is the first study evaluating the affective temperament via TEMPS-A in both CD and UC patients. The results of our study indicate significant differences between CD and UC due to temperament traits, and suggest distinct pathogenesis of mood disorders in IBD. Our findings show strong association between cyclothymic, depressive and anxious temperament and CD group in comparison to control groups. Also these temperaments positively correlated with subjective scales assessing the activity of UC and CD, and the number of loose stools in regard to CD scales. We have observed negative correlation of hyperthymic temperament in this regard, showing it’s putatively protective effect on the disease course. We suggest that the mechanisms responsible for such findings are related to genetic polymorphisms and changes in serotoninergic neurotransmission, however more studies are needed to prove this association. TEMPS-A constitutes the simple tool, which could be utilized in the assessment of the vulnerability to psychiatric disorders and prognostic evaluation in IBD patients. Our results also indicate that analysis of affective temperament may contribute to genetic studies in identifying genes responsible for the development of affective disorders in IBD population. Creating more homogenous groups of patients regarding clinical manifestation and genetic profile, might results in administration of individualized and better adjusted treatment strategies against mood disorders in both CD and UC patients.