Temperament and character in relapsing-remitting multiple sclerosis: the association with clinical factors and psychiatric disorders

Yıl 2022, Cilt: 47 Sayı: 3, 1339 - 1349, 30.09.2022

Ozge Kılıc , Rabia Gökçen Gözübatık Çelik , Murat Emul , Sabahattin Saip , Ayse Altintas , Aksel Siva

https://doi.org/10.17826/cumj.1147756

Cited By: 1

Öz

Purpose: Despite its implications for quality of life, temperament, and character in multiple sclerosis are underexplored. We aimed to explore temperament and character traits, their association with clinical characteristics, and explore the factors that impact depression in patients with relapsing-remitting multiple sclerosis (RRMS).
Material and Methods: This cross-sectional study enrolled 67 patients (male/female=12/55) (median age=30 (18-53)) and 50 age-and gender-matched healthy controls (HCs) (male/female=16/34) (median age= 26.5 (18-60)) using a convenience sampling method. Temperament and Character Inventory, Beck Depression and Beck Anxiety Inventories, and Structured Clinical Interview for DSM-Axis I Disorders-SCID-I were applied.
Results: In the patient group there were 45 MS patients with no psychiatric comorbidity (MSN) and 22 MS patients with psychiatric comorbidity (MSP). Higher self-forgetfulness was observed in the MSP group compared with MSN and HC groups. MSP and MSN demonstrated higher total harm avoidance than HCs. MSP group showed lower total self-directedness compared with HCs. While EDSS, duration of disease, or the number of relapses did not impact depression scores; higher anxiety (Β=0.416) and lower purposefulness (Β=-1.565) significantly impacted them (R2=.50, F=32.459).
Conclusion: Temperament and character differences were observed in patients with and without psychiatric comorbidity. Higher anxiety levels and the difficulty to establish and attain meaningful goals may relate to higher depression levels. Future studies with larger samples examining coping, health behaviors, and resilience as potential mediators or moderators between self-forgetfulness and psychiatric disorders may aid in defining interventions for psychiatric disorders. Adequate treatment of anxiety symptoms and addressing purposefulness are potential targets for planning behavioral interventions.

Anahtar Kelimeler

multiple sclerosis, temperament and character, depression, anxiety, personality

Destekleyen Kurum

The authors declared that this study has received no financial support.

Proje Numarası

-

Teşekkür

-

Tekrarlayan ve düzelen multipl sklerozda mizaç ve karakter: klinik faktörler ve psikiyatrik bozukluklarla ilişkisi

Öz

Amaç: Yaşam kalitesi üzerindeki etkilerine rağmen, multipl sklerozda mizaç ve karakter yeterince araştırılmamıştır. Mizaç ve karakter boyutlarını, i, bunların klinik özelliklerle ilişkisini ve depresyon şiddetini etkileyen faktörleri tekrarlayan ve düzelen multiple skleroz (TDMS) hastalarında incelemeyi amaçladık.
Gereç ve Yöntem: Bu kesitsel çalışmaya, elverişli örnekleme yöntemiyle 67 hasta (erkek/kadın=12/55) (medyan yaş=30 (18-53)) ve yaş ve cinsiyet açısından eşleştirilmiş 50 sağlıklı kontrol (SK) (erkek/kadın=16/34) (medyan yaş= 26.5 (18-60)) alındı. Mizaç ve Karakter Envanteri, Beck Depresyon ve Beck Anksiyete Envanterleri, DSM-Eksen I Bozuklukları için Yapılandırılmış Klinik Görüşme uygulandı.
Bulgular: Hasta grubu içinde, psikiyatrik komorbiditesi olan 45 (MSP), psikiyatrik komorbiditesi olmayan (MSO) 22 hasta bulunuyordu. MSP grubu, MSO grubuna ve SK’lere göre daha yüksek kendilik kaybı gösterdi. MSP grubu ve MSO grubu toplam zarardan kaçınma puanları SK’lere kıyasla yüksekti. Toplam kendini yönetme puanları MSP grubunda SK’lerden düşüktü. EDSS, hastalık süresi, toplam nüks sayısı depresyon şiddetini etkilemezken; yüksek anksiyete (Β=0,416) ve düşük amaçlılık düzeyleri (Β=-1,565) depresyon düzeyini anlamlı derecede etkilemekteydi (R2=0.50, F=32.459).
Sonuç: Komorbid psikiyatrik bozukluğu olan ve olmayan hastalar arasında mizaç ve karakter özellikleri açısından farklılıklar gözlendi. Artmış anksiyete düzeyleri; anlamlı hedefler belirleme ve bunlara ulaşmada güçlük, artmış depresyon düzeyleriyle ilişkili olabilir. Gelecek çalışmalar, daha geniş örneklemlerde, baş etme, sağlık davranışları ve dayanıklılığın kendilik kaybı ve psikiyatrik bozukluklar arasındaki aracı ve düzenleyici rolünü inceleyerek, psikiyatrik bozukluklara yönelik müdahalelerin tanımlanmasına yardımcı olabilir. Anksiyete belirtilerinin etkin tedavisi ve yaşam amaçlarının ele alınması, davranışsal müdahalelerin planlanması için olası hedeflerdir.

Anahtar Kelimeler

multiple skleroz, mizaç ve karakter, depresyon, anksiyete, kişilik

Proje Numarası

-

Kaynakça

• 1. Alonso A, Hernán MA. Temporal trends in the incidence of multiple sclerosis: a systematic review. Neurology 2008;71:129-35.
• 2. Tutuncu M, Tang J, Zeid NA, Kale N, Crusan DJ, Atkinson EJ et al. Onset of progressive phase is an age-dependent clinical milestone in multiple sclerosis. Mult Scler 2013;19:188-98.
• 3. Hyphantis TN, Christou K, Kontoudaki S, Mantas C, Papamichael G, Goulia P et al. Disability status, disease parameters, efense styles, and ego strength associated with psychiatric complications of multiple sclerosis. Int J Psychiatry Med 2008;38:307-27.
• 4. Marrie RA, Reingold S, Cohen J, Stuve O, Trojano M, Sorensen PS et al. The incidence and prevalence of psychiatric disorders in multiple sclerosis: a systematic review. Mult Scler 2015;21:305-17.
• 5. D'Alisa S, Miscio G, Baudo S, Simone A, Tesio L, Mauro A. Depression is the main determinant of quality of life in multiple sclerosis: a classification-regression (CART) study. Disabil Rehabil 2006;28:307-14.
• 6. Oner OG, Totuk O, Dogan İG, Çelik D, Demir S. Evaluation of neuropsychiatric symptoms in patients with multiple sclerosis. Cukurova Medical Journal 2022;47:208-18.
• 7. Boeschoten RE, Braamse AMJ, Beekman ATF, Cuijpers P, van Oppen P, Dekker J et al. Prevalence of depression and anxiety in multiple sclerosis: a systematic review and meta-analysis. J Neurol Sci 2017;372:331-41.
• 8. Lima AB, Paes RA, Alvarenga RM. Personality factors in recently diagnosed multiple sclerosis patients: a preliminary investigation with the NEO-FFI scale. Arq Neuropsiquiatr 2015;73:200-4.
• 9. Zarbo IR, Minacapelli E, Falautano M, Demontis S, Carpentras G, Pugliatti M. Personality traits predict perceived health-related quality of life in persons with multiple sclerosis. Mult Scler 2016;22:551-8.
• 10. Salhofer-Polanyi S, Friedrich F, Loffler S, Rommer PS, Gleiss A, Engelmaier R et al. Health-related quality of life in multiple sclerosis: temperament outweighs EDSS. BMC Psychiatry 2018;18:143.
• 11. Dietmaier JM, von dem Knesebeck O, Heesen C, Kofahl C. Personality and its association with self-management in multiple sclerosis. Mult Scler Relat Disord 2022;61:103752.
• 12. Gazioglu S, Cakmak VA, Ozkorumak E, Usta NC, Ates C, Boz C. Personality traits of patients with multiple sclerosis and their relationship with clinical characteristics. J Nerv Ment Dis 2014;202:408-11.
• 13. Kuloglu M, Saglam S, Korkmaz S, Saglam S, Gurok MG, Ustun SK et al. Temperament and character traits and alexithymia in patients with multiple sclerosis/Multipl skleroz hastalarinda mizac karakter ozellikleri ve aleksitimi duzeyi. Noro Psikiyatr Ars 2013;50:34-40.
• 14. Christodoulou C, Deluca J, Johnson SK, Lange G, Gaudino EA, Natelson BH. Examination of Cloninger's basic dimensions of personality in fatiguing illness: chronic fatigue syndrome and multiple sclerosis. J Psychosom Res 1999;47:597-607.
• 15. Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 2011;69:292-302.
• 16. Cloninger CR. The temperament and character inventory-revised. St Louis, MO: Center for Psychobiology of Personality, Washington University 1999;
• 17. Köse S, Sayar K, Kalelioglu Ü, Aydin N, Ak I, Kirpinar I et al. Turkish version of the temperament and character Inventory (TCI): reliability, validity, and factorial structure. Bulletin of Clin Psychopharmacology 2004;14:107-31.
• 18. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Archives of general psychiatry 1961;4:561-71.
• 19. Hisli N. A reliability and validity study of beck depression inventory in a university student sample. J Psychol 1989;7:3-13.
• 20. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 1988;56:893.
• 21. Ulusoy M, Sahin NH, Erkmen H. The beck anxiety inventory: psychometric properties. J Cogn Psychother 1998;12:163-72.
• 22. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-98.
• 23. Güngen C, Ertan T, Eker E, Yaşar R, Engin F. Standardize mini mental test’in Türk toplumunda hafif demans tanısında geçerlik ve güvenilirliği. Turk Psikiyatri Derg 2002;13:273-81.
• 24. Molloy DW, Alemayehu E, Roberts R. Reliability of a standardized mini-mental state examination compared with the traditional mini-mental state examination. Am J Psychiatry 1991;148:102-05.
• 25. First M, Spitzer R, Gibbon M, Williams J. Structured clinical interview for DSM-IV axis I disorders-Clinical version. New York State Psychiatric Institute, Biometrics Research Department 1997.
• 26. Öztürkçügil A, Aydemir Ö, Yıldız MDA, Köroğlu E. DSM-IV Eksen I Bozuklukları için yapılandırılmış klinik görüşmenin (SCID-I) Türkçeye uyarlanması ve güvenilirlik çalışması. İlaç ve Tedavi Dergisi. 1999;12:233-6.
• 27. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 1983;33:1444-44.
• 28. Faul F, Erdfelder E, Buchner A, Lang A-G. Statistical power analyses using G* power 3.1: tests for correlation and regression analyses. Behav Res Methods 2009;41:1149-60.
• 29. Cloninger CR, Svrakic DM, Przybeck TR. A psychobiological model of temperament and character. Archives of general psychiatry 1993;50:975-90.
• 30. Mattei A, Revis J, Giovanni A. Personality traits inventory in patients with vocal nodules. Eur Arch Otorhinolaryngol 2017;274:1911-17.
• 31. Yang JH, Rhee SJ, Park CHK, Kim MJ, Shin D, Lee JW et al. Self-transcendence mediates the relationship between early trauma and fatal methods of suicide attempts. J Korean Med Sci 2021;36:e39
• 32. Zaninotto L, Solmi M, Toffanin T, Veronese N, Cloninger CR, Correll CU. A meta-analysis of temperament and character dimensions in patients with mood disorders: comparison to healthy controls and unaffected siblings. J Affect Disord 2016; 194:84-97.
• 33. Marrie RA, Fisk JD, Tremlett H, Wolfson C, Warren S, Tennakoon A et al. Differences in the burden of psychiatric comorbidity in MS vs the general population. Neurology 2015; 85:1972-9.
• 34. Schwartz ES, Chapman BP, Duberstein PR, Weinstock-Guttman B, Benedict RH. The NEO-FFI in multiple sclerosis: internal consistency, factorial validity, and correspondence between self and informant reports. Assessment 2011;18:39-49.
• 35. Roy S, Schwartz CE, Duberstein P, Dwyer MG, Zivadinov R, Bergsland N et al. Synergistic effects of reserve and adaptive personality in multiple sclerosis. J Int Neuropsychol Soc 2016;22:920-27.
• 36. Fazekas C, Khalil M, Enzinger C, Matzer F, Fuchs S, Fazekas F. No impact of adult attachment and temperament on clinical variability in patients with clinically isolated syndrome and early multiple sclerosis. Clin Neurol Neurosurg 2013;115:293-7.
• 37. Rintala A, Matcham F, Radaelli M, Locafaro G, Simblett S, Barattieri di San Pietro C et al. Emotional outcomes in clinically isolated syndrome and early phase multiple sclerosis: a systematic review and meta-analysis. J Psychosom Res 2019;124:109761.
• 38. Koffman J, Penfold C, Cottrell L, Farsides B, Evans CJ, Burman R et al. "I wanna live and not think about the future" what place for advance care planning for people living with severe multiple sclerosis and their families? a qualitative study. PLoS One 2022;17:e0265861.
• 39. Bonavita S, Tedeschi G, Gallo A. Morphostructural MRI abnormalities related to neuropsychiatric disorders associated to multiple sclerosis. Mult Scler Int 2013;102454.
• 40. Johansson V, Lundholm C, Hillert J, Masterman T, Lichtenstein P, Landén M et al. Multiple sclerosis and psychiatric disorders: comorbidity and sibling risk in a nationwide Swedish cohort. Mult Scler 2014;20:1881-91.
• 41. Heesen C, Gold S, Huitinga I, Reul J. Stress and hypothalamic–pituitary–adrenal axis function in experimental autoimmune encephalomyelitis and multiple sclerosis—a review. Psychoneuroendocrinology 2007;32:604-18.
• 42. Zhang T, Tremlett H, Leung S, Zhu F, Kingwell E, Fisk JD et al. Examining the effects of comorbidities on disease-modifying therapy use in multiple sclerosis. Neurology 2016;86:1287-95.
• 43. Korostil M, Feinstein A. Anxiety disorders and their clinical correlates in multiple sclerosis patients. Mult Scler 2007;13:67-72.
• 26. 26. Öztürkçügil A, Aydemir Ö, Yıldız MDA, Köroğlu E. DSM-IV Eksen I Bozuklukları için yapılandırılmış klinik görüşmenin (SCID-I) Türkçeye uyarlanması ve güvenilirlik çalışması. İlaç ve Tedavi Dergisi. 1999;12:233-6.