Clinical health psychology and autoimmune disorders

[4 abstracts]

1. Ego-control and ego-resiliency in systemic autoimmune disorders  
Gyöngyösiné Kiss E., Czirják L., Hargitai R., Nagy L., Paksi E.
First author's affiliation: University of Pécs, Institute of Psychology, Pécs, Hungary

The aim of our scientific project at the Institute of Psychology with collaboration of the Dept. of Immunology and Rheumatology is a complex clinical and health psychological approach of patients suffered in different systemic autoimmune diseases. One part of the research deals with the connection of ego-resiliency and distress in systemic autoimmune diseases. Earlier psychodynamic studies dealt with the role of aggression and ego-control in different, inflamed chronic illnesses (Alexander, 1948; Müller, 1961; Cobb, 1968; Beck, 1974). In modern personality psychology ego-control refers to the inhibition/expression of impulse and ego-resiliency to the dynamic capacity to contextually modify one’s level of ego-control in response to situational affordances (Block, 1950, 2002; Block, 1951; Block & Block, 1980). Highly ego-resilient individuals are characteristically able to modify their level of control, either up or down, as may be appropriate or necessary according to the situational context. Individuals with a low level of ego-resiliency are more restricted to the same level of impulse containment or expression regardless of situational demands (Letzring, Block, Funder, 2004). In our research it was proposed that we would find higher trait anxiety and lower ego-resiliency in systemic autoimmune patients compared to the healthy subjects. We examined patients with systemic sclerosis (SSC, N = 100), rheumatoid arthritis (RA, N = 20), systemic lupus erythematosus (SLE, N = 50) and compared to a healthy sample as controls (N = 100). We measured ego-resiliency with the short version of Wagnild and Youngs’ questionnaire (1993) made by Neill and Dias (2001) (RS15), and examined the degree of anxiety by the Hospital anxiety and depression scale (HADS; Zigmond and Snaith, 1983). The results can be useful for clinicians, doctors, nurses and the patients’ close relatives as well.

2. Anxiety and depression in patients with autoimmune disorders  
Hargitai R., Czirják L., Gyöngyösi Kiss E., Nagy L., Paksi E.
First author's affiliation: University of Pécs, Institute of Psychology, Pécs, Hungary

Psychiatric symptoms are common to many autoimmune disorders. Patients often will have mood disorders, anxiety, cognitive deficits, delirium, and psychosis. These symptoms may reflect the direct or indirect effect of the autoimmune disorder. The presentation aims to examine the degree of depression and anxiety in patients with autoimmune disorders. Subjects were selected on a database from the Immunology and Rheumatology Clinic of University of Pécs. During the recruitment period September 2007 to May 2008, 170 female patients who attended were asked to participate in the study. As diagnostic assessment instruments two standardized questionnaires, The Centers for epidemiological studies of depression scale (CES-D; Radloff, 1977) and the Hospital anxiety and depression scale (HADS; Zigmond and Snaith, 1983) were used to examine the degree of depression and anxiety in patients with systemic scleroderma (SSC, N = 100), with rheumatoid arthritis (RA; N = 20) and with systemic lupus erythematosus (SLE, N = 50). In age and qualification matched healthy female were used as controls (N = 100). CES-D and HADS are well suited for the population of autoimmune patients because these do not rely on somatic indices of depression, thus differentiating themselves from other depression inventories. The CES-D and HADS have high internal consistency for medical and healthy control populations. The patients with autoimmune disorders had significantly higher scoring rate for clinical anxiety (28%) and for clinical depression (49%) compared with control group (p<0.05). These results indicate that autoimmune patients often have mood disorders, which may affect their quality of life. Accurately recognizing the psychiatric component and generating a differential diagnosis is a complex task for the treating physician. Treatment of the psychiatric component to the disorder is essential.

3. Psychopathological symptoms in patients with autoimmune disorders  
Nagy L., Czirják L., Gyöngyösiné Kiss E., Hargitai R., Paksi E.
First author's affiliation: University of Pecs, Pecs, Hungary

In many respects, the Minnesota multiphasic personality inventory (MMPI-2) is a widely used measure of psychopathology and internationally accepted comprehensive instrument for the assessment of individual differences in personality psychology (Butcher, 2006). Because of its clinical utility, the MMPI often is present in existing data sets, and its broad coverage of symptomatology makes it a frequent choice when several personality/psychopathology measure is obtained. The presentation aims to examine the degree of psychopathological symptoms in patients with autoimmune disorders. Subjects were selected on a database from the Immunology and rheumatology clinic of University of Pécs. During the recruitment period September 2007 to May 2008, 170 female patients who attended were asked to participate in the study. The sample consists of patients with systemic scleroderma (SSC, N = 100), with rheumatoid arthritis (RA; N = 20) and with systemic lupus erythematosus (SLE, N = 50). In age and qualification matched healthy female were used as controls (N = 100). As diagnostic assessment instrument we used the booklet form of the MMPI-2 Hungarian translated 567-item version. As a group, patients with autoimmune disorders respond somewhat differently in MMPI measures than healthy adults on 6 of the 10 basic clinical scales. In aggregate they tend to have higher scores on the Hypochondriasis, Hysteria, Depression, and Social introversion scales and lower scores on the Psychopathic deviate and Hypomania scales. But there are huge differences among the SSC, RA and SLE patients. More details, the results of the content scales and their implications will be discussed in our presentation.

4. Temperament and character in scleroderma and lupus erythematosus  
Csókási K., Hargitai R., Gyöngyösiné Kiss E., Nagy L., Paksi E., Czirják L.
First author's affiliation: Pécsi Tudományegyetem, University of Pécs, Pécs, Hungary

The personality of patients with systemic autoimmune diseases is rarely examined. In our study we investigated 50 women with systemic sclerosis and the same amount of women with systemic lupus erythematosus. The control group consisted of 50 healthy women. The applied psychological instrument was The Temperament and character inventory (TCI), which is based on Cloninger’s personality-theory. It considers not only the influence of the social environment and learning, but also the biological and genetic factors in the process of personality-development. According to our results the patients with systemic autoimmune diseases presented significantly higher scores on harm avoidance and significantly lower on novelty seeking. Summing up the results, it can be said, that the most important difference among the healthy and the two patient groups appears in the temperament factors – for example obsessive-compulsive temperament was reported by more than half of the women with scleroderma.