Orthostatic intolerance in Behcet's disease

Behçet's Disease with Severe Autonomic Disorders Developing after Herpes Zoster

A 58-year-old Japanese woman with herpes zoster developed Behçet's disease (BD) with symptoms including orthostatic intolerance as an autonomic disorder. Multiple immune-suppressive therapies and a β-blocker successfully controlled both the disease activity of BD and the autonomic disorders. A cytokine multiplex analysis of her serum revealed the elevation of proinflammatory cytokines [interleukin (IL)-1, IL-6, IL-12, tumor necrosis factor alfa (TNFα), and interferon gamma (IFN-γ)] and a low IL-10 concentration. IL-10 production is reported to be important for defense against herpes zoster virus (VZV). Insufficient IL-10 production is reported in BD. The reactivation of VZV with this cytokine profile suggests that BD will develop with various symptoms, including severe autonomic disorders.

Epidemiology and management of neuropsychiatric disorders in Behçet's syndrome

Behçet's syndrome (BS) is a systemic, chronic, relapsing vasculitis, typically characterized by recurrent orogenital ulcers, ocular inflammation and skin manifestations; articular, vascular, gastroenteric and neurological involvement may also occur. Besides the other clinical features of BS, it seems relatively frequent that patients with BS develop a neurobehavioural syndrome, characterized by euphoria, bipolar disorders and paranoid attitudes, loss of insight/disinhibition, and indifference to their disease, defined as 'neuro-psycho-BS'. To date, the pathogenetic mechanism underlying neuro-psycho-BS has not been determined. It may be secondary to organic neurological involvement, or it may be related to poor quality of life and the relapsing course of the disease. Another engaging theory suggests that it could be related to the frequent observation of psychiatric symptoms during relapses or, in some cases, in the phases preceding reactivation of the disease; these elements suggest that psychiatric disorders in BS could represent a crucial element, whether a psychiatric subset or a distinct clinical feature of the disease. Moreover, it has been reported that cognitive impairment in BS can be seen with or without central nervous system involvement. Globally, psychiatric symptoms have been described as being multifaceted, ranging from anxiety disorders to depressive-bipolar disorders or to psychotic ones. In addition, some psychological characteristics of BS patients seem to predispose them to maladaptive stress management, which may lead to stress-related disorders, including anxiety and depression. Therefore, the aims of this review are to explore the epidemiology of neuro-psycho-BS by evaluating the relationship between the stress system and the multifaceted psychiatric manifestations in BS, and to summarize the therapeutic strategy used.

The impact of personality on quality of life and disease activity in patients with Behcet's disease: a pilot study

BACKGROUND

The aim of this study was to examine the personality characteristics of patients with Behcet's Disease (BD) using the Temperament and Character Inventory (TCI) compared with healthy control subjects and to investigate the relationship between the temperament and character properties and quality of life, disease activity, depression and anxiety in Behcet's patients.

METHODS

A total of 46 BD patients and 40 healthy subjects were included in the study. All patients and controls were determined using the TCI, Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders Clinical Version for Axis I disorders (SCID-CV), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Quality of life (QOL) Instrument for Skin Disorders and Behcet Disease Current Activity Form (BDCAF).

RESULTS

BD patients demonstrated significantly lower Reward Dependence than healthy controls. Among the subscales; Explarotory Excitability, Shyness with Strangers, Attachment, Spiritual Acceptance were lower and Self-Acceptance was higher in patients compared to control subjects. Decreased quality of life and increased disease activity of the patients were correlated with increased anxiety and depression. Responsibility, Self-Forgetfulness and Transpersonal Identification were associated with quality of life while Responsibility was the major factor effecting QOL. Disease activity was not found related with TCI properties.

CONCLUSION

Temperament and Character traits of BD patients were different from healthy group that might be due to many factors like genetics, biological or socio-cultural differences. BD patients were demonstrated as materialistic, self-contained, self-confident, cold, detached, and reserved although they are not shy. Considering the different personality traits of BD patients in psychotherapeutic approaches, may have a positive impact on QOL and comorbid major depressive disorder.

The subclinic autonomic dysfunction in patients with Behçet disease: an electrophysiological study

Studies that have evaluated autonomic nervous system (ANS) function in Behçet disease (BD) are rare and have indicated conflicting results with different degrees of involvement. The aim of this study was to investigate ANS function by using electrophysiological tests in patients with BD and to determine the relationship between the disease activity parameters and the indicators of autonomic activity. We included 70 BD patients and 50 healthy controls. Demographic characteristics including age, sex, and disease duration were recorded. A detailed neurological examination was performed, and clinical autonomic symptoms were recorded. The Behçet Disease Current Activity Form (BDCAF) was used to determine the disease activity. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were determined for laboratory activity. The electrophysiological assessments of ANS function were performed by sympathetic skin response (SSR) and R-R interval variation (RRIV) tests. The mean values of sympathetic (SSR latency and amplitude) and parasympathetic (RRIV at rest [R%] and deep breathing [D%], D% - R%, and D%/R%) parameters were compared, and any correlations between ANS parameters and clinical disease characteristics were determined. Seventy BD patients (23 males, 47 females) with a mean age of 41.2 ± 10.01 years and 50 control subjects (18 males, 32 females) with a mean age of 39.5 ± 8.94 years were included in the study. All the subjects were totally symptom free with respect to ANS involvement, and the subjects in both groups had normal neurological examination findings. The demographic characteristics were similar between the groups. The mean latency of SSR was increased (1.4 ± 0.4 vs 0.7 ± 0.8), and R% (0.3 ± 0.3 vs 0.5 ± 0.4) and D% (0.3 ± 0.3 vs 0.6 ± 0.5) values were decreased in BD patients compared to control subjects. No correlation was found between BDCAF scores and ANS variables. However, there was a significant correlation between SSR latency and ESR and CRP values (p < 0.01, r = -0.25, r = -0.31, respectively) in the patient group, indicating a more sympathetic dysautonomia in patients with active laboratory parameters. In conclusion, our study indicates a subclinical sympathetic and parasympathetic autonomic dysfunction in patients with BD, which may be related with disease activity. As the early recognition of abnormalities in ANS may be very important in order to prevent excessive morbidity, simple electrophysiological methods are suggested to identify Behçet patients at high risk for symptomatic dysautonomia.