Assessment of Congenital Vascular and Organ Anomalies in Subjects With Thalidomide Embryopathy Using Non-Contrast Magnetic Resonance Angiography

Psychische Gesundheit von Contergan-geschädigten Menschen

Hintergrund

Sechs Jahrzehnte nach der pränatalen pharmakogenen Schädigung durch Thalidomid prägen vielfältige biopsychosoziale Folgeschädigungen das klinische Bild von Menschen mit Contergan-Behinderungen.

Fragestellung

Wie lässt sich das erst in der zweiten Lebenshälfte sichtbar gewordene hohe Ausmaß psychischer Störungen näher verstehen?

Material und Methode

Literaturüberblick zum aktuellen Stand der empirischen Forschung mit Diskussion weiterführender Fragen.

Ergebnisse

Menschen mit thalidomidinduzierten Schwerstbehinderungen zeigten jahrzehntelang bemerkenswerte Kompensationsleistungen. Ein sehr hoher Bildungsstatus sowie eine gute berufliche und soziale Integration wurden über viele Jahre erreicht. In der jüngeren Vergangenheit ist es jedoch zur zunehmenden sozialen Desintegration gekommen. Erstmals wurde eine hohe Rate psychischer Störungen, bei gleichzeitig bestehenden Barrieren im Zugang zur psychotherapeutischen Versorgung, beschrieben.

Schlussfolgerung

Das große Vorkommen psychischer Störungen im Alter kann einerseits als durch multidimensionale, teilweise bereits pränatal erworbene Traumatisierungen verursacht, andererseits als eine lange Zeit zugunsten einer Monostigmatisierung bestehende selektive Nichtwahrnehmung des Psychischen verstanden werden. Nicht nur für die Betroffenen ist es wichtig, dass der Fall Contergan im kollektiven Gedächtnis erinnert wird.

[Chronic Pain in People Impaired by Thalidomide Embryopathy: An Explorative Analysis of Prevalence, Pain Parameters and Biopsychosocial Factors]

OBJECTIVE

The aim of the study was to show the frequency, localisation, intensity, quality and degree of chronic pain in people with thalidomide-induced congenital defects (thalidomide embryopathy) and to investigate the association with biopsychosocial factors more closely.

METHODS

A group of 202 people from North Rhine-Westphalia with thalidomide embryopathy were studied for the first time both physically for the pattern of the original damage and also psychiatrically in a structured diagnostic interview (SCID I & SCID II). The results were combined with a standardized pain interview (MPSS) and questionnaires on further pain-related (SF-36, painDETECT) and sociodemographic variables and analysed. In the analysis 167 completed datasets were included.

RESULTS

The prevalence of pain in the sample population was 94%. The majority (107, 54.0%) already showed an advanced stage of chronicity in the MPSS: 63 subjects with Stage II (37.7%) and 44 with Stage III (26.3%). In 74 subjects (44.3%) the PainDetect score showed a possible or neuropathic pain component. The factors that most reliably influenced the chronicity of pain proved to be hip pain (p<0.001) and also mental health disorders (p=0.001), above major depression (p<0.001) and also somatic symptom disorders and substance-related disorders (p=0.001 in each case). Social variables proved non-significant here (p=0.094 for living alone, p=0.122 for unemployment, p=0.167 for lack of college education), as did the care situation (p=0.191 for care dependency) and the underlying pattern of organ damage (p=0.229 for damage to hearing, p=0.764 for dysmelia).

CONCLUSIONS

People with thalidomide defects frequently suffer from a separate pain disorder which can be seen as secondary thalidomide-induced damage and which requires specialized and personalized multimodal pain management.

A nationwide survey regarding the life situations of patients with thalidomide embryopathy in Japan, 2018: First report

Background

Clinical studies on the effects of thalidomide‐induced damage on thalidomide victims as they age have only recently started to be conducted, but no studies have examined socioeconomic differences in terms of healthcare and social status between thalidomiders and the age‐matched general population in Japan. Therefore, we carried out a nationwide survey focusing on the life situations of thalidomiders.

Method

Questionnaires were sent to 274 thalidomiders in Japan. The questionnaire items basically matched those of the Comprehensive Survey of Living Conditions (CSLC) in the general population conducted by the Japanese Government. The results were compared with those of the CSLC for individuals aged 55–59 years, which was the cohort most similar in age to the average thalidomider living in Japan.

Results

More thalidomiders rated their health condition as relatively bad or bad compared with the general population (20.2% vs. 13.3%, respectively). A much higher percentage of thalidomiders reported having some health or physical problem caused by a disease or injury (68.8% vs. 32.6%, respectively), and thalidomiders reported visiting medical and healthcare‐related facilities more frequently. A higher proportion of thalidomiders (9.2%) were unemployed, and thalidomiders tended to feel higher levels of worry and stress, especially in terms of the future.

Conclusions

The results of this nationwide survey of the life situations of thalidomiders in Japan clarified their health conditions and the related associations with socioeconomic status. These findings could be expected to help improve the provision of medical and healthcare, welfare measures, and financial support for thalidomiders in the near future.