Psychological Status and Recurrent Aphthous Ulceration

Article (PDF Available)inCollegium antropologicum 36(1):157-9 · March 2012with45 Reads
Source: PubMed
Abstract
Recurrent aphthous ulceration (RAU) are a disease of an unknown etiology and mediated through T-cell lymphocytes. Evidence suggests that RAU is connected with chronic bowel disease, haematinic deficiencies, AIDS, food hypersensitivity and severe stress. The aim of this study was to determine whether differences in anxiety and depression could be seen in patients with RAU during acute phase and remision period and in comparison to the healthy controls. There were 30 patients with RAU (age range 36.27 +/- 15.308) and 30 controls aged 29.83 +/- 9.082. Every participant with RAU fullfilled STAI and Beck Depression Inventory II test during acute phase and during remission period as well as controls. Statistical analysis was performed by use of descriptive statistics and t-test. There are no differences in the level of depression and stress between the two phases of the RAU (acute versus remission period) as well as in comparison to the controls. Patients with acute RAU are more anxious than patients with RAU during remission period. We might conclude that psychological disturbances do not preceed the development of RAU and that the patients with acute RAU are more anxious when compared to the condition when they do not have RAU due to the discomfort they experience.
Coll. Antropol. 36 (2012) 1: 157–159
Original scientific paper
Psychological Status and Recurrent Aphthous
Ulceration
Pavle Picek
1
, Danijel Buljan
2
, Ana Andabak Rogulj
3
, Jasmina Stipeti}-Ov~ari}ek
4
, Amir ^ati}
4
,
Stjepko Ple{tina
5
, Vanja Vu~i}evi} Boras
3
and Danica Vidovi}-Juras
3
1
Zagreb Health Center, Zagreb, Croatia
2
University of Zagreb, »Sestre milosrdnice« University Hospital Center, Department of Psychiatry, Zagreb, Croatia
3
University of Zagreb, School of Dentistry, Department of Oral Medicine, Zagreb, Croatia
4
University of Zagreb, School of Dentistry, Department of Prosthodontics, Zagreb, Croatia
5
University of Zagreb, Zagreb University Hospital Center, Department of Patophysiology, Zagreb, Croatia
ABSTRACT
Recurrent aphthous ulceration (RAU) are a disease of an unknown etiology and mediated through T-cell lymphocytes.
Evidence suggests that RAU is connected with chronic bowel disease, haematinic deficiencies, AIDS, food hypersensitiv
-
ity and severe stress. The aim of this study was to determine whether differences in anxiety and depression could be seen
in patients with RAU during acute phase and remision period and in comparison to the healthy controls. There were 30
patients with RAU (age range 36.27±15.308) and 30 controls aged 29.83±9.082. Every participant with RAU fullfilled
STAI and Beck Depression Inventory II test during acute phase and during remission period as well as controls. Statisti-
cal analysis was performed by use of descriptive statistics and t-test. There are no differences in the level of depression
and stress between the two phases of the RAU (acute versus remission period) as well as in comparison to the controls.
Patients with acute RAU are more anxious than patients with RAU during remission period. We might conclude that
psychological disturbances do not preceed the development of RAU and that the patients with acute RAU are more anx-
ious when compared to the condition when they do not have RAU due to the discomfort they experience.
Key words: recurrent aphthous ulceration, anxiety, depression
Introduction
Recurrent aphthous ulceration (RAU) is a common
oral disease appearing usually on nonkeratinized oral
mucosa, especially on the tongue, vestibulum, palate and
buccal mucosa
1
. The etiology of the disease is still not
completely understood. Many local and systemic factors
have been associated with these conditions as well as evi
-
dence of a genetic and immunopathogenic basis for RAU
1
.
RAU disease is characterized by two phases of the dis
-
ease, acute RAU when patients have ulcerations in the
mouth and remission period of RAU when patients are
free of any ulcerations. Through our clinical practice, pa
-
tients with RAU frequently report that the ulcerations
are in correlation with stressful events. McCartan et al.
2
concluded that stress may play an important role in the
pathogenesis of RAU, especially in persons who are prone
to be anxious, cause serum cortisol levels were increased
in patients with RAU together with increased anxiety
scores. Ceki}-Aramba{in et al.
3
reported that during the
war in Croatia in nineties prevalence of RAU increased
in patients who were known as RAU sufferers when com
-
pared to the time before war. Neville et al.
4
concluded
that RAU are more prevalent in students during the
exam period in comparison to the period when there are
no exams at the university. Gallo et al.
5
concluded that
there was a higher level of psychological stress among pa
-
tients with RAU when compared to the control group.
Furthermore, the same authors concluded that psycho
-
logical stress may play a role in the manifestation of
RAU, either being a trigger or a modifying factor, but not
a cause of the disease. Furthermore, Tang et al.
6
sug
-
157
Received for publication December 12, 2011
gested that psychosocial disorder caused by stresses of
social life events on the people with special personality
could impact the occurrence of RAU.
However, there are no data in anxiety, depression and
stress between patients with RAU during both phases of
the disease.
The aim of this study was to assess level of anxiety
and depression in patients with RAU during acute phase
and during remission period as well as in comparison to
the heathy controls.
Materials and Methods
Prior to this investigation, participants signed an in
-
formed consent according to the Helsinki II obtained
from the Ethical Committee, School of Dentistry, Univer
-
sity of Zagreb, Croatia.
There were 30 patients with RAU (age range 36.27±
15.308 yrs). Thirty controls were selected on the basis
that they were free of oral diseases and were age and sex
matched to the patients with RAU (age range 29.83±
9.082 yrs).
Patients with RAU fulfilled both psychological tests
twice, ie during acute phase and during remission period.
Controls fulfilled both test only once. First test was STAI
(State-Trait Anxiety Inventory for Adults) by which level
of anxiety is measured as a current state and as a usual
feeling of an individual. Second test measures the level of
depression (BDI-II Beck Depression Inventory II).
Statistical analysis was performed by use of descrip
-
tive statistics and t-test.
Results
There were no significant differences in anxiety trait
and state scores as well as depression scores between
control group and patients with RAU during acute phase
(Table 1).
There were significant differences in anxiety state
scores between patients with acute RAU and patients
with RAU during remission period (Table 2).
Discussion
Most of the published data upon psychological status
and RAU do report correlation between the two. How
-
ever, data upon psychological parameters during two
phases of the disease are lacking. Patients with RAU are
more anxious when compared to the healthy controls
7
.
Victoria et al.
8
found out that 69 patients with RAU have
more polymorphism of the promoter region 5-HHT
(5-HTTLPR) which is responsable for the serotonin ex-
pression in comparison to the control group. Therefore
the same authors concluded that patients with RAU tend
to be more anxious than the controls. Pedersen
9
evalu-
ated psychological stress by means of social readjustment
rating scale and visual analogue scale in the patients
with RAU during acute phase and during remission pe-
riod. However, she could not find any differences in
aforementioned scores between two phases of the dis-
ease, concluding that there is no association between
psychologic life stress and recurrences of RAU. The re
-
sults of Pedersen
9
are in contrast to our results as we
found significant differences in anxiety state scores in
patients with acute RAU when compared to the patients
with RAU during remission period. Albanidou-Farmaki
et al.
10
found that anxiety as a trait and as a state could
play a role in patients with RAU as they reported signifi
-
cant differences between patients with RAU and con
-
trols. Therefore, they suggested that stress might be in
-
volved in the pathogenesis of RAU. The results of Alba
-
nidou-Farmaki et al.
10
are in not in concordance with our
results as we found that anxiety as a trait does not im
-
pact RAU disease. Soto-Araya et al.
11
reported that anxi
-
ety and stress were significantly connected with RAU,
unlike depression. Richter et al.
12
reported that RAU
were significantly in correlation with anxiety but of
-
course authors speculate that RAU are not caused by
anxiety but rather that RAU are in correlation with anxi
-
ety which is in concordance with our results.
We could not find any significant differences in de
-
pression scores between patients with RAU during acute
phase and remission period and controls. Therefore, we
might conclude that depression does not a play a signifi
-
cant role in patients with RAU.
P. Picek et al.: Psychological Status and Recurrent Aphthous Ulceration, Coll. Antropol. 36 (2012) 1: 157–159
158
TABLE 2
DESCRIPTIVE STATISTICS OF THE RESULTS ON THE ANXIETY
STATE INVENTORY (STAI-S), ON THE ANXIETY TRAIT
INVENTORY (STAI-T) AND ON THE BECK DEPRESSION
INVENTORY (BDI-II) BETWEEN PATIENTS WITH ACUTE RAU
AND THE SAME PATIENTS WITH RAU DURING REMISSION
PERIOD
NXSD
STAI-S Acute phase RAU 30 38.47 8.978
Remisssion 30 35.50 7.999
STAI-T Acute phase RAU 30 38.43 9.391
Remission 30 38.53 9.965
BDI-II Acute phase RAU 27 8.63 6.840
Remission 27 7.63 6.968
TABLE 1
TESTED DIFFERENCES IN MEDIAN VALUES OF THE RESULTS
ON THE ANXIETY STATE INVENTORY (STAI-S), ON THE
ANXIETY TRAIT INVENTORY (STAI-T) AND ON THE BECK
DEPRESSION INVENTORY (BDI-II) BETWEEN PATIENTS WITH
ACUTE RAU AND CONTROL GROUP
Levens variance test t-test
Fp tdfp
STAI-S 0.849 0.361 –0.656 58 0.514
STAI-T 0.029 0.865 –0.701 58 0.486
BDI II 0.106 0.746 –1.351 54 0.182
Patients with acute RAU are more anxious than pa
-
tients with RAU during remission period and controls,
suggesting that anxiety is not their trait but a conse
-
quence of a RAU disease which has impact on their abil
-
ity to eat and speak.
Aknowledgements
The authors wish to thank prof. Dora Bratu{a in her
excellence when analyzing psychological tests. This study
was supported by the grant of Ministry of Science, Re
-
public of Croatia, project number 065-0650445-0485.
REFERENCES
1. BROZOVI] S, VU^I]EVI]-BORAS V, BUKOVI] D, Coll Antropol,
25 (2001) 633. 2. McCARTAN BE, LAMEY PJ, WALLACE AM, J Oral
Pathol Med, 25 (1996) 357. 3. CEKI]-ARAMBA[IN A, MALER G, TO
-
PI] B, MRAVAK-STIPETI] M, Acta Stomatol Croat, 31 (1997) 35. 4.
NEVILLE BW, DAMM DD, ALEN CM, BOUQUOT JE, Oral and Maxillo
-
facial Pathology (WB Saunders Co., Philadelphia, 2002). 5. GALLO
CDB, MIMURA MAM, SUGAYA NN, Clinics, 64 (2009) 645. 6. TANG
L, MA L, LIU N, Hua Xi Kou Qiang Yi Xue Za Zhi, 19 (2001) 102. 7.
BUAJEEB W, LAOHAPAND P, VONGSAVAN N, KRAIVAPHAN P,J
Dent Assoc Thai, 40 (1990) 253. 8.VICTORIA JM, CORREIA-SILVA
JDEF, PIMENTA FJ, K ALAPOTHAKIS E, GOMEZ RS, J Oral Pathol Med,
34 (2005) 494. 9. PEDERSEN AJ, Oral Pathol Med, 18 (1989) 119.
10. ALBANIDOU-FARMAKI E, POULOPOULOS AK, EPIVATIANOS A,
FARMAKIS K, KARAMOUZIS M, ANTONIADES D, Tohoku J Exp Med,
214 (2008) 291. 11. SOTO ARAYA M, ROJAS ALCAYAGA G, ESGUEP
A, Med Oral, 9 (2004) 1. 12. RICHTER I, VIDAS I, TUR^INOVI] P,
Acta Stomatol Croat, 37 (2003) 27.
V. Vu~i}evi} Boras
University of Zagreb, School of Dentistry, Department of Oral Medicine, Gunduli}eva 5, 10000 Zagreb, Croatia
e-mail: boras@sfzg.hr
PSIHOLO[KI STATUS I REKURENTNE AFTOZNE ULCERACIJE
SA@ETAK
Rekurentne aftozne ulceracije (RAU) su bolesti nepoznate etiologije posredovane T-limfocitima. Dokazi upu}uju na
to da su povezane s kroni~nim bolestima crijeva, hematolo{kim deficitima, AIDS-om, preosjetljivo{}u na odre|enu vrstu
hrane te jakim stresom. Cilj je ovog istra`ivanja bio ustanoviti je li postoje razlike u anksioznosti i depresiji izme|u
bolesnika s akutnim RAU u odnosu na fazu remisije RAUiuusporedbi sa kontrolnom skupinom. U istra`ivanju je
sudjelovalo 30 bolesnika a RAU (raspon dobi 36,27±15,308) i 30 kontrolnih ispitanika (raspon dobi 29,83±9,082). Svaki
ispitanik je ispunio STAI i Beck Depression Inventory II test za vrijeme akutne faze i za vrijeme remisije kao i ispitanici
kontrolne skupine. Statisti~ka analiza je napravljena uz upotrebu deskriptivne statistike i t-testa. Nije bilo razlika u
stupnju depresije i stresa u bolesnika s RAU izme|u dvije faze bolesti (akutna faza u odnosu na remisiju) kao i u
usporedbi s kontrolnim ispitanicima. Bolesnici s akutnim RAU su bili znakovito vi{e anksiozni u odnosu na osobe s
RAU u fazi remisije. Mo`emo zaklju~iti kako psiholo{ki poreme}aji ne prethode nastanku RAU, ve} da su uslijed akutne
faze RAU i nelagode koja tu fazu bolesti prati oboljeli vi{e anksiozni u odnosu na stanje kada nemaju RAU.
P. Picek et al.: Psychological Status and Recurrent Aphthous Ulceration, Coll. Antropol. 36 (2012) 1: 157–159
159
    • "Picek et al., found no significant differences in the anxiety treatment and state scores, or the depression scores, of the control group and patients with RAU during the acute phase. In contrast, there were significant differences in the anxiety state scores between the control group and the patients with acute RAU and patients with RAU during the remission period [12]. Soto-Araya et al. reported that anxiety and stress were significantly connected with RAU, unlike depression [16]. "
    Full-text · Article · Jan 2016 · Evidence-based dentistry
  • [Show abstract] [Hide abstract] ABSTRACT: Editorial Although Salivary Alpha Amylase (SAA) has been investigated during past thirty years as a biomarker of stress, still remains certain doubt regarding its utility. Additionally, there has been a lot of debate whether SAA reflects sympathetic activity solely, however, recent data suggested that this is unlikely due to the parasympathetic activity which innervates salivary glands whose product is SAA [1]. Another interesting issue regarding SAA is whether SAA could serve as a biomarker of chronic stress as it has been usually investigated in acute stress. Most of the studies performed investigated SAA as a biomarker of acute stress, i.e. while watching fearful video, participating in the "Fear Challenge Course", during exams, jumping from plane, however, data are lacking regarding SAAas a biomarker in chronic stress sufferers [2]. Furthermore, the results of the published studies could have been biased by the certain contributing factors such as other SAA activity, SAA interaction with bacteria, salivary flow rate, method of saliva collection, systemic diseases and medications that patients took. Also, smoking leads to the decreased SAA levels, whereas, caffeine and exercise are known to increase SAA levels [3].
    Full-text · Article · Jan 2012
  • [Show abstract] [Hide abstract] ABSTRACT: DesignRandomised controlled trial (RCT).InterventionOne hundred and sixty patients participating in a RCT in which they were randomised to multivitamins (n=81) or placebo (n=79) completed ulcer diaries and a weekly telephone survey by calling an automated interactive voice response (IVR) system. Stressful events were quantified using the validated Recent Life Changes Questionnaire (RLCQ) and were classified as mental or physical stressors.Outcome measureOnset and duration of RAS episodesResultsStressful life events were significantly associated with the onset of RAS episodes (P < 0.001), but not with the duration of the RAS episodes. Experiencing a stressful life event increased the odds of an RAS episode by almost three times (OR = 2.72; 95% CI = 2.04-3.62). When controlled for each other, mental stressors had a larger effect (OR = 3.46, 95% CI = 2.54- 4.72) than physical stressors (OR = 1.44; 95% CI = 1.04- 1.99) on the occurrence of RAS episodes. RAS episodes did not occur more frequently or last longer with increasing stress severity.Conclusions In patients with a history of RAS, stressful events may mediate changes involved in the initiation of new RAS episodes. Mental stressors are more strongly associated with RAS episodes than physical stressors.
    Full-text · Article · Mar 2013
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