Tesi di specializzazione (5 anni)
Autoimmunity, allergy and bipolarity: an "humoral" perspective.
MEDICINA CLINICA E SPERIMENTALE
Corso di studi
relatore Dott. Perugi, Giulio
- Autoimmune disorders
- Bipolar Disorder
Data inizio appello
Data di rilascio
Objective: Increasing evidence suggests that inflammation and autoimmunity may play an important role in the pathogenesis of bipolar disorder. High prevalence of allergic and autoimmune diseases has been found in patients with bipolar disorder (BD). The aim of the present study is to explore clinical correlates of allergic and autoimmune diseases in a large sample of bipolar patients. <br>Method: The study sample comprised 347 patients who met DSM-IV-TR criteria for BD I (n=207, 59.7%), BD II or Cyclothymic Disorder (n=140, 40.3). Diagnostic information was collected by means of the Structured Clinical Interview for DSM-IV Axis I Disorders– Clinical Version (SCID-I), and information about personal and family history were collected by the Semi-Structured Interview for Mood Disorder-Revised (SIMD-R). Standardized procedure was used to assess the diagnosis of GMC, which was considered present only if a specific therapy to treat the condition was prescribed by a specialist or a general practitioner. In order to explore possible relationships between physical comorbidity and clinical features of BD, we compared patients with (AutD) and without (No-AutD) Autoimmune Diseases and patients with (AllD) and without (No-AllD) Allergic Diseases. <br>Results: The reported AutD were: LES, Reumatoid Arthritis, Sjögren’s Syndrome, Graves-Basedow Disease, Psoriasis, Vitiligo, Hashimoto Thyroditis, Inflammatory Bowel Diseases (IBD), Alopecia Areata, Fibromyalgia. The reported AllD were: Asthma Bronchiale, Urticaria, Allergic Rhinoconjunctivitis, Atopic Dermatitis, Other Allergies. In the group comparisons, lower mean age, higher score of GAF, lifetime comorbid panic disorder, generalized anxiety disorder, borderline personality disorder, absence of lifetime comorbid alcool and irritable and anxious temperament were statistically associated with the presence of comorbid AllD; while female gender, higher number of hospitalizations, bipolar disorder type II and absence of bipolar type I, absence of congruous psychotic features, presence of atypical features and lower presence of melancholic features, BPRS item 2, 7, 17, and lifetime comorbid bulimia, higher use of SSRI and absence of antisocial personality disorder were statistically associated with the presence of comorbid AutD. <br>Limitations: Possible referral and selection bias; retrospective, non-blind, cross-sectional evaluation. <br>Conclusion: The clinical correlates of different sub-groups of AllD and AutD suggest different interpretations. The presence of AllD seems to be correlated with a higher comorbid anxious, mood reactivity and instability, while comorbid AutD seems to correlate with a specific clinical subtype of BD, characterized by atypical features, lifetime comorbid bulimia and higher number of hospitalizations. If the link with autoimmune-allergic diathesis will be confirmed, it could provide an interesting new paradigm for the study of the “systemic” nature of mood disorders and a promising target for future treatment options. <br>
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