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.

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

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

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