VERIFIED CONTENTAuthor: Dominika Wilk

Mental disorders very often accompany connective tissue diseases, which results both from the organic changes caused by the disease and the deterioration of the quality of life resulting from the limitations of the disease. Recognizing the source of these disorders is a key element of appropriate treatment, and thus reducing the patient's symptoms.

Causes of mental disorders in connective tissue diseases

The disease itself is one of the reasons that may determine the appearance of mental disorders in the course of connective tissue disease. It can, in the process of autoimmunity, lead to disorders of the central nervous system.

In addition, drugs used in connective tissue diseases, such as glucocorticosteroids or immunosuppressants, can have a negative effect on the mental state and the nervous system.

The very awareness of the incurability of the disease and its chronic condition may also lower the mood and lead to mood disorders, the occurrence of various fears or depression.

Connective tissue diseases which may be accompanied by mental disorders

The most common systemic connective tissue diseases in the course of which mental disorders may develop include:

  • RA, or rheumatoid arthritis
  • TU, i.e. systemic sclerosis,
  • TRU, or systemic lupus erythematosus,
  • ZS, or Sjorgen's band,
  • ZAF, or antiphospholipid syndrome,
  • UZN, i.e. systemic vasculitis,
  • those diseases of the connective tissue in which treatment with e.g. glucocorticosteroids may affect the nervous system.

Rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic, inflammatory disease of the joints and the synovial membrane of small and medium-sized joints that damages the joints. As it is a systemic disease, it can also attack other organs and tissues, leading to permanent disability and even death.

To determine if RA is present, the doctor must check whether the patient has anyrheumatoid factor (RF) antibodies and anti-citrullinic antibodies (aCCP).

In addition, it checks whether the inflammatory changes affect small or medium joints of the arms and legs, whether the lesions are symmetrical, whether they include more than, for example, 1 large joint or several small joints, whether there are rheumatoid nodules or whether radiological changes are visible type:

  • erosions,
  • osteoporosis.

If the patient reports joint pain, it is also necessary to check if there are also extra-articular symptoms, such as :

  • weight loss,
  • weakness,
  • low-grade fever,
  • vasculitis,
  • anemia,
  • interstitial pneumonia.

Due to the accompanying pain and physical disability, RA is a disease that promotes depression. Depressive states are also favored by taking glucocorticosteroids, which induce or aggravate already existing depression in the patient, and the excess of pro-inflammatory cytokines that are produced in this disease promotes mood depression.

Systemic Lupus Erythematosus

Systemic lupus erythematosus is an autoimmune connective tissue disease. It is chronic, and during its duration, many organs, joints, nervous system, kidneys, lungs, heart and skin are damaged.

People most often affected by this type of disease are women in their reproductive years. It very rarely affects men, so the proportion of female-male cases is 9: 1.

The most characteristic symptoms of this disease are: facial erythema, Raynaud's symptoms, arthritis without deformation, hypersensitivity to sunlight, alopecia, both mouth and nasopharynx ulcers approved by a doctor, pleurisy or pericarditis .

In addition, kidney disorders (proteinuria 0.5 g / d or ≥3 + rollers), neurological disorders such as convulsions or psychosis, immunological disorders, e.g. the presence of LE cells, hematological disorders, are found in this disease. (haemolytic anemia or leukopenia, lymphopenia, or thrombocytopenia), presence of antinuclear antibodies.

In lupus erythematosus, the nervous system is very often involved, and then cognitive disorders, mood changes, anxiety disorders, psychosis, or acute confusion may occur. Movement disorders, headaches, demyelinating syndrome, convulsions may also appear.

If that happens, we are dealing with neuropsychiatric lupus. U lessIn more than half of patients, psychiatric changes appear at the first signs of the disease or within the first year of lupus diagnosis.

Unfortunately, CNS involvement means that the disease usually involves more organs, and patients have a poorer quality of life than those patients whose nervous system was not attacked.

Sjorgen's team

Sjorgen's syndrome is a chronic autoimmune disease, the main symptoms of which are xerostomia (dry mouth) and xerophthalmia (dry eye).

Dryness of the mucous membranes is the result of the involvement of the organs and mucous membranes in the autoimmune process, e.g. the salivary glands in the oral cavity, and the lacrimal glands in the eye.

In addition, the disease can damage the glands of the external secretion: pancreas, gastrointestinal tract, glands of the bronchial tree. On the other hand, organs can be affected, for example, by the vascular system, nervous system, lungs, etc.

Sjorgen's syndrome can damage the central nervous system, including damage to the hemispheres of the brain, the cerebellum, the brainstem, and the spinal cord. As a result of this damage, the patient may suffer from speech disorders, sensory and movement disorders, as well as neuropsychiatric disorders.

The mental disorders resulting from Sjorgen's syndrome include, first of all, anxiety, depressive, cognitive, somatization and dissociative disorders. In addition, there may be progressive dementia, dysphoria, and hysterical personality disorders.

Systemic sclerosis

Scleroderma is a severe, systemic autoimmune disease characterized by inflammation and fibrosis, changes in blood vessels and activation of the immune system.

Depending on the area of ​​the body affected by this disease, we can divide it into local and systemic scleroderma. In systemic scleroderma, changes may affect the skin, and only the distal parts of the body (they reach only e.g. the knees or elbows), and the organs become affected after many years.

In another embodiment, skin lesions affect almost the entire body, and organs are occupied by the disease process after only a few years.

Sometimes this disease occurs without skin lesions, but with organ involvement, which is a very rare case or has a limited form, and its symptoms are reduced to:

  • esophagus involvement,
  • telangiectasia,
  • hardening of the skin only on the fingers,
  • the appearance of Raynaud's symptoms.

In systemic scleroderma we can deal with mental disorders,mainly: anxiety, cognitive or behavioral disorders, as impaired blood circulation may affect microcirculation in the brain.

In addition, skin lesions and increased disability resulting from the disease make patients more prone to developing depression and experiencing more related anxiety.

Antiphospholipid syndrome

Antiphospholipid syndrome is an autoimmune disease characterized by episodes of arterial thrombosis and / or venous thromboembolism.

A characteristic feature of the disease are obstetric problems appearing in the disease process, e.g. habitual miscarriages before the 10th week of pregnancy, as well as the occurrence of anti-cardiolipin antibodies in the IgG or IgM class, the presence of which at a moderate or high level is found 2 times within 6 weeks.

In addition, the lupus anticoagulant appears in the antiphospholipid syndrome, which is confirmed by at least two tests during 6 weeks.

Psychiatric disorders in the antiphospholipid syndrome may result either from circulatory disorders and blood clots, which worsens the blood supply to the brain tissue, or be a consequence of antiphospholipid antibodies circulating in the body.

Methods of treating mental disorders in connective tissue diseases

The treatment method is different depending on what causes mental disorders in connective tissue diseases. If the cause is due to the medications being used, the doctor may try to change them to other medications that will not adversely affect the patient's nervous system. However, this is not always possible.

When disorders appear as a natural consequence of the disease, the improvement of the patient's mental state is possible, for example, when appropriate treatment is applied and the patient is in remission.

When a sick person's poor mental state is only a consequence of the awareness of their own disability, which is related to the disease, and the inability to return to the old way of life, then psychotherapy will be the most helpful.

It is sometimes difficult to separate mental disorders caused by illness from those caused by drugs. This is especially complex in systemic lupus erythematosus, however, a good physician should detect changes in a patient's behavior after administration of specific medications. He should also analyze to what extent they influence his mood or different behavior.

One clue is that if psychosis appears at the very first symptoms of SLE and is accompanied by the presence of antibodies againstthe ribosomal protein P, the source here will be the disease itself. However, when the patient received the drug and mental disorders appeared or worsened only after pharmacotherapy, they should be combined with drugs and, if possible, try to change them to other drugs.

The positive thing is that the treatment of connective tissue diseases usually consists of many therapeutic aspects, which additionally has a positive effect on the patient's psyche. For example, in rheumatoid arthritis, treatment includes both drug and physical therapy, rehabilitation treatment, and psychotherapy.

Category:

Psychiatry