Mental disorders in patients with cystic fibrosis

Cover Page

Cite item

Full Text

Abstract

   Introduction. Cystic fibrosis (CF) is a genetic disease that leads to dysfunction of internal organs and significantly increases the risk of respiratory infections. According to the N. P. Bochkov Medical and Genetic Research Center, 1 out of 9,000 newborns suffers from CF. Chronic disease has a negative impact on mental health and can contribute to the development
of anxiety and depressive disorders, as well as accentuated traits and personality disorders.

   Aim. To summarize the currently available data on mental disorders in patients with CF, as well as to summarize current recommendations regarding the management of patients with this disease.

   Materials and methods. Articles were searched in Google Scholar databases, eLIBRARY.ru, Elsevier, PubMed from 2014 to 2024 by key words in Russian and English in accordance with the purpose of the study.

   Results. It has been established that mental health problems are associated with worse compliance to the treatment, as well as difficulties with self-organization and self-care. Some hypotheses that explain the pathogenesis of mental disorders have been provided. The key characteristics of course and clinical presentation of mental disorders in this group of patients have been described. Some potential recommendations for the treatment are provided, taking into the account the specificities of the metabolism of psychotropic drugs in people with CF. The tactics of management, including the creation of a multidisciplinary team that would consist of a doctor of somatic profile, psychiatrist and a psychologist. A strategy for development of this aspect of medical care for patients with CF has also been proposed.

   Conclusion. Drawing the attention of the scientific community to the problem of mental disorders in patients with CF will allow the introduction of methods for monitoring mental status and early detection of symptoms, and will also entail the creation of multidisciplinary teams, including a psychiatrist and a medical psychologist.

About the authors

A. A. Klimenko

L.A. Vorohobov City Clinical Hospital № 67, Moscow Healthcare Department; Federal Brain and Neurotechnology Center, Federal Medical and Biological Agency of Russia

Author for correspondence.
Email: alexaless@yandex.ru
ORCID iD: 0009-0000-0769-201X

Aleksandr Anatolyevich Klimenko

123423; 2 / 44 Salyama Adillya St.; 117997; 1 Ostrovityanova St.; Moscow

Russian Federation

A. Yu. Aleksandrova

M. V. Lomonosov Moscow State University

ORCID iD: 0009-0003-5105-6784

Faculty of Fundamental Medicine

119192; 27 Lomonosovskiy Avenue; Moscow

Russian Federation

References

  1. Quittner A.L., Abbott J., Georgiopoulos A.M. et al. International Committee on Mental Health; EPOS Trial Study Group. International Committee on Mental Health in Cystic Fibrosis: Cystic Fibrosis Foundation and European Cystic Fibrosis Society consensus statements for screening and treating depression and anxiety. Thorax 2016;71(1):26–34. doi: 10.1136/thoraxjnl-2015-207488
  2. VanElzakker M.B., Tillman E.M., Yonker L.M. et al. Neuropsychiatric adverse effects from CFTR modulators deserve a serious research effort. Curr Opin Pulm Med 2023;29(6):603–9. doi: 10.1097/MCP.0000000000001014
  3. Elgudin L., Kishan S., Howe D. Depression in children and adolescent with cystic fibrosis: case studies. Int J Psychiatry Med 2004;34(4):391–7. doi: 10.2190/N7DL-L6PE-MKYH-4910
  4. Nieddu E. Cystic fibrosis: CFTR modulators and their mechanism of action. Curr Pharm Des 2013;19(19):3474–5. doi: 10.2174/13816128113199990322
  5. The register of patients with cystic fibrosis in the Russian Federation for 2021. Edited by S.A. Krasovsky, M.A. Starikova, A.Y. Voronkova еt al. St. Petersburg: Charitable Foundation “Islands”, 2023. (In Russ.).
  6. Schechter M.S., Ostrenga J.S., Fink A.K. et al. Decreased survival in cystic fibrosis patients with a positive screen for depression. J Cyst Fibros 2021;20(1):120–6. doi: 10.1016/j.jcf.2020.07.020
  7. Amerio A., Sibilla F., Pescini R. et al. Mental health and cystic fibrosis: time to move from secondary prevention to predictive medicine. Pediatr Pulmonol 2020;55(9):2204–6. doi: 10.1002/ppul.24928
  8. Fidika A., Herle M., Goldbeck L. Symptoms of depression impact the course of lung function in adolescents and adults with cystic fibrosis. BMC Pulm Med 2014;14:205. doi: 10.1186/1471-2466-14-205
  9. Cystic Fibrosis Foundation Patient Registry. Annual data report 2021. Bethesda, Maryland. Available at: https://www.cff.org/sites/default/files/2021-11/Patient-Registry-Annual-Data-Report.pdf
  10. Quittner A.L., Goldbeck L., Abbot J. et al. Prevalence of depression and anxiety in patients with cystic fibrosis and parent caregivers: results of The International Depression Epidemiological Study across nine countries. Thorax 2014;69(12):1090–7. doi: 10.1136/thoraxjnl-2014-205983
  11. Pearson D.A., Pumariega A.J., Seilheimer D.K. The development of psychiatric symptomatology in patients with cystic fibrosis. J Am Acad Child Adolesc Psychiatry 1991;30(2):290–7. doi: 10.1097/00004583-199103000-00019
  12. Bathgate C.J., Hjelm M., Filigno S.S. et al. Management of mental health in cystic fibrosis. Clin Chest Med 2022;43(4):791–810. doi: 10.1016/j.ccm.2022.06.014
  13. Talwalkar J.S., Koff J.L., Lee H.B. et al. Cystic fibrosis transmembrane regulator modulators: implications for the management of depression and anxiety in cystic fibrosis. Psychosomatics 2017;58(4):343–54. doi: 10.1016/j.psym.2017.04.001
  14. Bathgate C.J., Muther E., Georgiopoulos A.M. et al. Positive and negative impacts of elexacaftor/tezacaftor/ivacaftor: Healthcare providers’ observations across US centers. Pediatr Pulmonol 2023;58(9):2469–77. doi: 10.1002/ppul.26527
  15. Dagenais R.V.E., Su V.C.H., Quon B.S. Real-world safety of CFTR modulators in the treatment of cystic fibrosis : a systematic review. J Clin Med 2020;10(1):23. doi: 10.3390/jcm10010023
  16. Heo S., Young D. C., Safirstein J. et al. Mental status changes during elexacaftor/tezacaftor/ivacaftor therapy. J Cyst Fibros 2022;21(2):339–43. doi: 10.1016/j.jcf.2021.10.002
  17. McKinzie C.J., Goralski J.L., Noah T.L. et al. Worsening anxiety and depression after initiation of lumacaftor/ivacaftor combination therapy in adolescent females with cystic fibrosis. J Cyst Fibros 2017;16(4):525–7. doi: 10.1016/j.jcf.2017.05.008
  18. Piehler L., Thalemann R., Lehmann C. et al. Effects of elexacaftor/tezacaftor/ivacaftor therapy on mental health of patients with cystic fibrosis. Front Pharmacol 2023;14(1):1179208. doi: 10.3389/fphar.2023.1179208
  19. Baroud E., Chaudhary N., Georgiopoulos A.M. Management of neuropsychiatric symptoms in adults treated with elexacaftor/tezacaftor/ivacaftor. Pediatr Pulmonol 2023;58(7):1920–30. doi: 10.1002/ppul.26412
  20. Reyes-Martinez S., Segura-Real L., Gomez-Garcia A.P. et al. Neuroinflammation, microbiota-gut-brain axis, and depression: the vicious circle. J Integr Neurosci 2023;22(3):65. doi: 10.31083/j.jin2203065
  21. Yaltonskiy V.M., Abrosimov I.N. Coping behavior in adults with cystic fibrosis. Nacional’nyj psihologicheskij zhurnal = National Journal of Psychology 2014;(3):60–5. (In Russ.). doi: 10.11621/npj.2014.0307
  22. Arslan M., Chalmers S., Rentfrow K. et al. Suicide attempts in adolescents with cystic fibrosis on Elexacaftor / Tezacaftor / Ivacaftor therapy. J Cyst Fibros 2023;22(3):427–30. doi: 10.1016/j.jcf.2023.01.015
  23. Akiskal H.S., Mallya G. Criteria for the “soft” bipolar spectrum: treatment implications. Psychopharmacol Bull 1987;23(1):68–73. doi: 10.3928/0048-5713-19861101-15
  24. Akiskal K.K., Akiskal H.S. The theoretical underpinnings of affective temperaments: implications for evolutionary foundations of bipolar disorder and human nature. J Affect Disord 2005;85(1–2):231–9. doi: 10.1016/j.jad.2004.08.002
  25. Serafini G., Geoffroy P.A., Aguglia A. et al. Irritable temperament and lifetime psychotic symptoms as predictors of anxiety symptoms in bipolar disorder. Nord J Psychiatry 2018;72(1):63–71. doi: 10.1080/08039488.2017.1385851
  26. Amerio A., Magnani L., Castellani C. et al. The expression of affective temperaments in cystic fibrosis patients: psychopathological associations and possible neurobiological mechanisms. Brain Sci 2023;13(4):619. doi: 10.3390/brainsci13040619
  27. Vazquez G.H., Tondo L., Mazzarini L. et al. Affective temperaments in general population : a review and combined analysis from national studies. J Affect Disord 2012;139(1):18–22. doi: 10.1016/j.jad.2011.06.032
  28. Niehammer U., Straßburg S., Sutharsan S. et al. How personality influences health outcomes and quality of life in adult patients with cystic fibrosis. BMC Pulm Med 2023;23(1):190. doi: 10.1186/s12890-023-02463-y
  29. Abrosimov I.N. Coping with a chronic illness as a predictor of psychological adaptation. Lichnost’ v menyayushchemsya mire: zdorov’e, adaptaciya, razvitie. Personality in a changing world: health, adaptation, development 2020;8(2):192–200. (In Russ.). doi: 10.23888/humj20202192-200
  30. Darukhanavala A., Merjaneh L., Mason K. et al. Eating disorders and body image in cystic fibrosis. J Clin Transl Endocrinol 2021;26(100280):1–8. doi: 10.1016/j.jcte.2021.100280
  31. Bryon M., Shearer J., Davies H. Eating disorders and disturbance in children and adolescents with cystic fibrosis. Children’s Health Care 2008;37(1);67–77. doi: 10.1080/02739610701766909
  32. Petropoulou A., Bakounaki G., Grammatikopoulou M.G. et al. Eating disorders and disordered eating behaviors in cystic fibrosis: a neglected issue. Children (Basel) 2022;9(6):915. doi: 10.3390/children9060915
  33. Bailey J., Krick S., Fontaine K.R. The changing landscape of nutrition in cystic fibrosis: the emergence of overweight and obesity. Nutrients 2022;14(6);1216. doi: 10.3390/nu14061216
  34. Power H.A., Shivak S.M., Kim J. et al. A systematic review of attention-deficit / hyperactivity disorder in people living with cystic fibrosis. Pediatr Pulmonol 2024;59(4):825–33. doi: 10.1002/ppul.26843.10.1002/ppul.26843
  35. Cohen-Cymberknoh M., Dimand I., Tanny T. et al. The association between Attention-Deficit-Hyperactivity-Disorder (ADHD) symptoms and disease severity in people with Cystic Fibrosis (pwCF). J Cyst Fibros 2023;22(4):772–6. doi: 10.1016/j.jcf.2023.04.004
  36. Molitor S.J., Fidler A.L., Sinisterra M. et al. Associations between symptoms of ADHD/ODD and health outcomes in youth with cystic fibrosis. Pediatr Pulmonol 2024;59(3):809–12. doi: 10.1002/ppul.26811
  37. Vaziri S., McGarry M.E., Huang C.Y. et al. Time to be blunt: substance use in cystic fibrosis. Pediatr Pulmonol 2024;59(4): 1015–27. doi: 10.1002/ppul.26880.10.1002/ppul.26880
  38. Richards C.J., Friedman D., Pinsky H. et al. Alcohol and opiate misuse in adults with cystic fibrosis. Pediatr Pulmonol 2023;58(9):2535–42. doi: 10.1002/ppul.26541
  39. Lowery E.M., Afshar M., West N. et al. Self-reported alcohol use in the cystic fibrosis community. J Cyst Fibros 2020;19(1):84–90. doi: 10.1016/j.jcf.2019.06.004
  40. Maléth J., Balázs A., Pallagi P. et al. Alcohol disrupts levels and function of the cystic fibrosis transmembrane conductance regulator to promote development of pancreatitis. Gastroenterology 2015;148(2):427–39. doi: 10.1053/j.gastro.2014.11.002
  41. Villarreal-Zegarra D., Barrera-Begazo J., Otazu-Alfaro S. et al. Sensitivity and specificity of the Patient Health Questionnaire (PHQ-9, PHQ-8, PHQ-2) and General Anxiety Disorder scale (GAD-7, GAD-2) for depression and anxiety diagnosis: a cross-sectional study in a Peruvian hospital population. BMJ Open 2023;13(9):e076193. doi: 10.1136/bmjopen-2023-076193

Supplementary files

Supplementary Files
Action
1. JATS XML

Copyright (c)



СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 36931 от  21.07.2009.