Elsevier

Japanese Journal of Ophthalmology

Volume 47, Issue 1, January–February 2003, Pages 85-92
Japanese Journal of Ophthalmology

Clinical investigations
Health-related Quality of Life in Behçet Patients with Ocular Involvement

https://doi.org/10.1016/S0021-5155(02)00647-0Get rights and content

Abstract

Purpose: Health-related quality of life (HRQOL) is an important outcome factor in chronic diseases such as Behçet syndrome. We aimed to investigate the relation of HRQOL to the duration of illness, mental state, and visual acuity of patients with Behçet syndrome.

Methods: We conducted a cross-sectional clinical trial of 45 consecutive Behçet patients with ocular involvement. The control group consisted of an age-, sex-, and education-matched group of 45 healthy individuals. All patients and the controls had been given a complete ophthalmic examination. In addition, they completed a questionnaire comprising the SF-36 Health Survey, Beck Depression Inventory, and Beck Anxiety Inventory. Eight multiple regression analyses were carried out in the patient group to determine whether total anxiety scores, total depression scores, duration of the disease, and visual acuity predicted the dependent variable SF-36 subscales.

Results: Using the analysis of variance statistical method, comparisons of the patient and the control groups for depression, anxiety, and the subscales of the SF-36 Health Survey indicated a statistical significance for this battery of tests.

Conclusions: Behçet patients with ocular involvement are susceptible to anxiety and depression when compared to age and sex matched controls. It is important for the ophthalmologist to know that changes in the mental state of his patient may trigger a new ocular attack, and to be aware that these changes may play a critical role in the management and preventive measures for Behçet syndrome.

Introduction

Behçet syndrome is a generalized occlusive vasculitis of unknown etiology described by the Turkish physician Hulusi Behçet in 1937.1 It is characterized by three components: iridocyclitis (historically with hypopyon), aphthous lesions in the mouth, and ulceration of the genitalia. It is more common in some geographic areas (Japan, eastern Mediterranean, the Middle East) with higher prevalence rates. The disease occurs most frequently in younger adults. Behçet syndrome is a chronic disorder that may lead to blindness if ischemic optic neuropathy and retinopathy are not adequately treated. Central nervous system symptoms such as stroke, palsy, and a confused state may develop in 10–49% of patients, and are the first symptoms of the disease in 5% of patients. A variety of other signs including polyarthritis, vascular conditions (blood vessel occlusions and aneurysms), epididymis, gastrointestinal, pulmonary and heart lesions may also occur.2, 3

Chronic diseases such as Behçet syndrome may lead to temporary or permanent functional disabilities and may cause some psychiatric disorders. In their earlier paper, Wells and associates4 described the prevalence of psychiatric disorders in persons with or without chronic medical conditions. In their study they found that 1) there was a strong overall association between psychiatric disorders and chronic medical conditions, and 2) that persons with any recent chronic medical condition had a high prevalence, relative to those without any chronic medical condition, of lifetime substance use disorders and recent mood and anxiety disorders.4 On the other hand, research on the psychiatric aspects of Behçet syndrome, and health-related quality of life has been surprisingly limited in the literature; the psychiatric aspects of Behçet syndrome have been peripherally mentioned in many reviews and case reports, but few papers deal with this aspect exclusively. According to previous studies, patients with Behçet syndrome usually relate to others in a “passive and overtly compliant manner,” and are characterized by a dependent life style, intermittent periods of overt mood disorder, poor psychosexual adjustment, and marked somatization.5, 6, 7, 8 In the Koptagel et al study,9 the psychiatric investigation of 55 patients with Behçet syndrome through a psychoanalytically oriented interview and the application of the Rorschach test revealed that psychosocial stress factors were predominant prior to the onset of the disease. The personality structures of the patients, according to the Rorschach findings, were pathological with a weak ego, regressive tendencies, disturbed body image, high anxiety, difficulties in social adaptation and in evaluation of realities, as well as inadequate expression of and difficulty in coping with emotions. Orsucci10 maintained that psychosomatic patterns of thinking might be paramount in these patients, but indicated that psychosocial events may play an interesting and complex role in the chronicity of the syndrome. He showed that the relapsing cycle of the syndrome had some interesting connections with important life events, important changes in emotion, and modifications in patterns of thinking.

Health-related quality of life (HRQOL) is an important outcome factor in chronic diseases such as Behçet syndrome. HRQOL may decline due to the prolonged duration of the illness, medication, and disability, or because of the depressive mood state in chronic diseases.11, 12 We were not able to locate any HRQOL studies on the ocular involvement of Behçet syndrome through our computer-based search in PubMed. In this study our objective was to investigate the relation of HRQOL with duration of illness, mental state, and the visual acuity of patients having the ocular findings of Behçet syndrome.

Section snippets

Subjects

The study group consisted of 45 consecutive patients with Behçet syndrome seen at the Uveitis and Behçet Syndrome Clinic at SSK Ankara Eye Center and Eye Bank, between December 2000 and June 2001. All patients had Behçet syndrome with ocular involvement and their vision was affected to some degree by their illness. The diagnoses of the patients were made in accordance with the diagnostic criteria of the “International Study Group for Behçet Disease.” Nine women (20%) and 36 men (80%) were

Results

Mean duration of the Behçet syndrome was 63.04 ± 47.48 months (range, 1–180 months); and mean duration of ocular involvement was 50.09 ± 37.94 (range, 1–180 months) for the patient group. None of the patients had a psychiatric disorder or was taking medicine for a psychiatric illness at the time of the study. Mean best corrected visual acuity was 0.62 ± 0.43 (range, 0.001–1) for the better eye of the patients and 1.00 (range, 1.0–1.0) for the controls. None of the patients had a history of

Discussion

The male to female ratio for Behçet syndrome is even in both northern Europe and Japan but increases significantly (1.5–5:1) in certain Mediterranean countries and the Middle East.21 The male to female ratio was 5 to 1 in our patient group; and it reflects the natural distribution of the disease between men and women in our region for Behçet syndrome. When comparisons were done, total anxiety scores differed with statistical significance; there was a trend but the difference did not reach

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