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Unrecognised psychopathology in patients with difficult asthma: major mental and personality disorders

  • Lonneke C.J. Prins (a1), Maarten J.M. van Son (a2), Anton R.J. van Keimpema (a3), Jan-Willem G. Meijer (a4), Martina E.F. Bühring (a5) and Victor J.M. Pop (a1)...
Abstract
Background

Difficult asthma is a severe subgroup of asthma in which the main feature is uncontrollability of symptoms. Psychopathology is suggested to be prominent in patients with difficult asthma and considered important in its treatment; however, the evidence is scarce.

Aims

To describe psychopathology in difficult asthma, both major mental and personality disorders, based on diagnostic interviews.

Method

This study was conducted in a specialised asthma care centre. A total of 51 patients with difficult asthma were diagnosed at the start of the treatment programme using two structured clinical interviews for both major mental (SCID-I) and personality disorders (SCID-II) according to DSM-IV-TR.

Results

About 55% of the patients with difficult asthma had a psychiatric disorder of which 89% was undiagnosed and untreated before being interviewed. About 49% had a minimum of one major mental disorder of which the cluster of anxiety disorders was the most common cluster of major mental disorders, followed by somatoform disorders. About 20% were diagnosed with a personality disorder. Of the 10 patients with a personality disorder, 9 had an obsessive-compulsive personality disorder.

Conclusions

This study demonstrates that more than half of patients with difficult asthma had a psychiatric disorder of which 89% was unrecognised. This study highlights the importance of offering patients with difficult asthma a psychiatric diagnostic interview and/or a psychiatric consultation as part of their routine medical examination and provision of appropriate psychiatric treatment. Moreover, it highlights the urgency of further research into the role of psychopathology in the development of difficult asthma.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Lonneke C.J. Prins, Department of Medical and Clinical Psychology, Centre of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands. Email: lcjprins@gmail.com
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Preventon. 2012. http://www.ginasthma.org/guideline. (Accessed February 2014).
2 Centers for Disease Control and Prevention (CDC). Asthma in the US growing every year. 2011. http://www.cdc.gov/VitalSigns/Asthma/index.html (Accessed February 2014).
3 Chung, KF, Wenzel, SE, Brozek, JP, Bush, A, Castro, M, Sterk, PJ, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J 2014; 43: 343–73.
4 Barnes, PJ, Woolcock, AJ. Difficult Asthma. Eur Respir J 1998; 12: 1209–18.
5 Chipps, BE, Zeiger, RS, Borish, L, Wenzel, SE, Yegin, A, Hayden, ML, et al. Key findings and clinical implications from The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study. J Allergy Clin Immunol 2012; 130: 332–42.
6 Chung, KF, Godard, P, Adelroth, E, Ayres, J, Barnes, P, Bel, E, et al. Difficult/therapy-resistant asthma: the need for an integrated approach to define clinical phenotypes, evaluate risk factors, understand pathophysiology and find novel therapies: ERS Task Force on Difficult/Therapy-Resistant Asthma. Eur Respir J 1999; 13: 1198–208.
7 American Thoracic Society. Proceedings of the ATS workshop on refractory asthma: current understanding, recommendations, and unanswered questions. Am J Respir Crit Care Med 2000; 162: 2341–51.
8 Gendo, K, Lodewick, MJ. Asthma economics: focusing on therapies that improve costly outcomes. Curr Opin Pulm Med 2005; 11: 4350.
9 Lavoie, KL, Bacon, SL, Barone, S, Cartier, A, Ditto, B, Labreque, M. What is worse for asthma control and quality of life: depressive disorder, anxiety disorder, or both? Chest 2006; 130: 1039–47.
10 Kessler, RC, Chiu, WT, Demler, O, Walters, EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Arch Gen Psychiatry 2005; 62: 617–27.
11 Heaney, LG, Conway, E, Kelly, C, Gamble, J. Prevalence of psychiatric morbidity in a difficult asthma population: relationship to asthma outcome. Respir Med 2005; 99: 1152–9.
12 Heaney, LG, Conway, E, Kelly, C, Johnston, BT, English, C, Stevenson, M, et al. Predictors of therapy resistant asthma: outcome of a systematic evaluation protocol. Thorax 2003; 58: 561–6.
13 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. (4th edn, text revision). American Psychiatric Association, 2000.
14 Amelink, M, Hashimoto, S, Spinhoven, P, Pasma, HR, Sterk, PJ, Bel, EH, et al. Anxiety, depression and personality traits in severe, prednisone-dependent asthma. Respir Med 2014; 108: 438–44.
15 Van Ranst, D, Otten, H, Meijer, JW, Van 't Hul, A. Outcome of pulmonary rehabilitation in COPD patients with severely impaired health status. Int J Chron Obstruct Pulmon Dis 2011; 6: 647–57.
16 Rijssenbeek-Nouwens, LH, Fieten, KB, Bron, AO, Hashimoto, S, Bel, EH, Weersink, EJ. High-altitude treatment in atopic and nonatopic patients with severe asthma. Eur Respir J 2012; 40: 1374–80.
17 First, MB, Gibbon, M, Spitzer, RL, Williams, JBW. User's Guide for the Structured Clinical Interview for the DSM-IV Axis I disorders-Research Version. Biometrics Research Department, New DYork State Psychiatric Institute, 1996.
18 First, MB, Gibbon, M, Spitzer, RL, Williams, JBW, Benjamin, LS. Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). American Psychiatric Press, 1997.
19 Ten Brinke, A, Ouwerkerk, ME, Zwinderman, AH, Spinhoven, P, Bel, EH. Psycho-pathology in patients with severe asthma is associated with increased health care utilization. Am J Respir Crit Care Med 2001; 163: 1093–6.
20 Ten Brinke, A, Ouwerkerk, ME, Bel, EH, Spinhoven, P. Similar psychological characteristics in mild and severe asthma. J Psychosom Res 2001; 50: 710.
21 Lavoie, KL, Cartier, A, Labrecque, M, Bacon, SL, Lemière, C, Malo, JL, et al. Are psychiatric disorders associated with worse asthma control and quality of life in asthma patients? Respir Med 2005; 99: 1249–57.
22 deGraaf, R, ten Have, M, Van Dorsselaer, S. De Psychische Gezondheid van de Nederlandse Bevolking. NEMESIS-2: Opzet en Eerste Resultaten. Trimbos-instituut, 2010.
23 Lenzenweger, MF, Lane, MC, Loranger, AW, Kessler, RC. DSM-IV personality disorders in the National Comorbidity Survey Replication. Biol Psych 2007; 62: 553–64.
24 de Jong, A, van der Brink, W, Ormel, J (eds). Handbook Psychiatrische Epidemiologie. Elsevier / De Tijdstroom, 1999.
25 Jorm, AF. Mental health literacy: public knowledge and beliefs about mental disorders. Br J Psychiatry 2000; 177: 396401.
26 Warrington, TP, Bostwick, JM. Psychiatric adverse effects of corticosteroids. Mayo Clin Proc 2006; 81: 1361e7.
27 Hyland, ME, Whalley, B, Jones, RC, Masoli, M. A qualitative study of the impact of severe asthma and its treatment showing that treatment burden is neglected in existing asthma assessment scales. Qual Life Res 2015; 24: 631–9.
28 Alonso, J, de Jonge, P, Lim, CC, Aguilar-Gaxiola, S, Bruffaerts, R, Caldas-de-Almeida, JM, et al. Association between mental disorders and subsequent adult onset asthma. J Psychiatr Res 2014; 59: 179–88.
29 Spitzer, RL, Kroenke, K, Linzer, M, Hahn, SR, Williams, JB, deGruy, FV III, et al. Health-related quality of life in primary care patients with mental disorders: results from the PRIME-MD 1000 study. JAMA 1995; 274: 1511–7.
30 Heaney, LG, Menzies-Gow, A. Difficult Asthma. Jaypee Brothers, 2013.
31 Wampold, BE. The Great Psychotherapy Debate: Models, Methods, and Findings. Lawrence Erlbaum Associates Publishers, 2001.
32 Mikkelsen, RL, Middelboe, T, Pisinger, C, Stage, KB. Anxiety and depression in patients with chronic obstructive pulmonary disease (COPD). A review. Nordic J Psychiatry 2004; 58: 6570.
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Unrecognised psychopathology in patients with difficult asthma: major mental and personality disorders

  • Lonneke C.J. Prins (a1), Maarten J.M. van Son (a2), Anton R.J. van Keimpema (a3), Jan-Willem G. Meijer (a4), Martina E.F. Bühring (a5) and Victor J.M. Pop (a1)...
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