Examining the Relationship Between Behçet's Disease and Depression, Anxiety, and Sexual Dysfunctions. / Behçet Hastaligi ile Depresyon, Anksiyete ve Cinsel Islev Bozukluklari Arasindaki Iliskinin Incelenmesi.

OBJECTIVE: People with Behçet's Disease, as many individuals with chronic diseases, often face depression, anxiety, poor quality of life and sexual problems. In this study, it was aimed to evaluate depression, anxiety, and sexual dysfuntions in people with Behcet's Disease. METHOD: A total of 100 participants, 50 patients (29 female) and 50 healthy volunteers (28 female), participated in the study. Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Female Sexual Function Index (FSFI), and International Index of Erectile Function (IIEF) were administered to the participants. RESULTS: Depression and sexual dysfunctions were significantly related with Behçet's Disease. In our study, all female participants with Behçet's Disease had problems in sexual functions. Erectile dysfunction was more frequent in participants with Behcet's. The results also showed that there is a significant relationship between depression and orgasmic function (p=0.004), sexual desire (p=0.028), sexual satisfaction (p=0.023), and general satisfaction (p=0.028). There was a significant difference between people with Behçet's Disease (10.54±6.45) and healthy group (7.36 ±6.13) in depression scores (p=0.009). Patients with systemic involvement and those with mucocutaneous involvement were found to be similar in terms of BDI and BAI scores (p>0.05). CONCLUSION: Behçet's Disease was found to be a risk factor for depression and sexual dysfunctions.

Sexual dysfunction among female patients with rheumatic diseases.

To demonstrate the burden of sexual dysfunction (SD) among females with rheumatic diseases, we conducted a cross-sectional comparative study in patients with systemic sclerosis (SSc), systemic lupus erythematosus (SLE), and Behçet's syndrome (BS) along with suitable healthy controls (HCs). Age-matched female patients with SSc (n = 50), SLE (n = 49), and BS (n = 54), along with 52 female HCs were included in this study between April and October, 2021. Sociodemographic features were recorded, and psychometric tests, i.e., female sexual function index (FSFI), Beck depression inventory (BDI), body cathexis scale, and marital adjustment test (MAT) were performed. Scale scores were compared, and binary logistic regression was used to identify predictors for SD in the whole group. The total FSFI and body cathexis scores among the patient groups were significantly lower than those of the HCs (p < 0.001). Depression was significantly more frequent in the patient groups. MAT scores did not differ significantly between the study groups. Patients with SSc had the worst scores in each psychometric index, including MAT. Decreased body cathexis score [OR 0.974, 95% CI (0.957-0.991), p = 0.003] and low MAT score [OR 0.937, 95% CI (0.896-0.980), p = 0.005], and being diagnosed with SSc [OR 6.6, 95% CI (1.975-22.498), p = 0.002], SLE [OR 2.7, 95% CI (0.998-7.753), p = 0.050], and BS [OR 2.8, 95% CI (1.100-7.359), p = 0.031], were identified as independent predictors for SD. Body cathexis seems to be the most important independent predictor for SD, and the burden of SD appears heavier in patients with SSc, probably due to poor body image satisfaction.

Treatment Adherence Effect on the Visual Acuity of Behçet's Uveitis Patients.

PURPOSE: This study aimed to explore the relationship between treatment adherence, visual acuity, quality of life (QoL), depression, and anxiety levels in individuals with Behçet's uveitis (BU). METHODS: A total of 55 BU patients and 55 healthy controls completed sociodemographic questionnaires, the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), World Health Organization Quality of Life Questionnaire-BREF version (WHOQOL-BREF), Self-reported Questionnaire About Treatment Compliance, and the Morisky Medication Adherence Scale (MMAS). The scores obtained from these scales were analyzed to assess the relationship between treatment adherence, visual acuity, QoL, depression, and anxiety levels. RESULTS: The results revealed that 36 (65.4%) of the 55 BU patients exhibited depressive symptoms, while 45 (81.8%) of them experienced symptoms of anxiety. Patients with BU demonstrated significantly higher BAI and BDI scores compared to the healthy control group (p < 0.001). Furthermore, the patient group reported lower mean scores across multiple domains of the WHOQOL-BREF questionnaire, including general health, psychological health, social relationships, and environment (p < 0.05). Moreover, a significant association was observed between low treatment adherence and lower values of best-corrected visual acuity (BCVA) (p < 0.05), as well as a higher frequency of uveitis attacks (p = 0.005). CONCLUSION: Poor treatment adherence in BU patients has a negative effect on final visual acuity outcomes. Moreover, BU patients experience lower QoL and higher rates of depression and anxiety compared to the healthy control group. These findings highlight the importance of addressing treatment adherence and psychological well-being in the management of BU.

The mediator role of treatment response on oral health related quality of life in Behçet's syndrome.

BACKGROUND: The aim of the study was to analyse the effects of Treatment Response with oral ulcers on oral health related quality of life in Behçet's syndrome (BS). MATERIAL AND METHODS: In the cross-sectional study, 339 BS patients (F/M: 179/160, mean age: 36,13±9,81 years) were included. Data were collected by clinical examinations and patient reported outcome measures (PROMs) regarding Oral Health Impact Profile-14 (OHIP-14) questionnaire and self-reported Treatment Responses coded by a 5-point Likert-type scale (1: symptoms were cured- 5: symptoms were worsened). Moderated Mediation analysis (MA) was used to understand how oral ulcer activity (independent variable; X) influenced OHIP-14 score (outcome variables, Y) through self-reported Treatment Response (M1) and age (M2) as possible mediator variables (M) and disease course (mucocutaneous and musculuskeletal involvement vs. major organ involvement) as a possible moderator variable (W) on these relationships. RESULTS: In Moderated MA, OHIP-14 score (Y) was mediated by the presence of oral ulcer (X) (p=0.0000), the negative Treatment Response (M1) (p=0.0001) and being young (M2) (p=0.0053) with mucocutaneous involvement (W)(p=0.0039). CONCLUSIONS: Self-reported Treatment Response as an underestimated issue has a Mediator role in relation to oral ulceration on oral health related quality of life in the framework of patient empowerment strategies. Therefore, study results give clues to assist physicians and dentists for better understanding of patients' perspective.

Evaluation of the Psychoeducation Program Given to Behcet's Patients in the Context of the Roy Adaptation Model.

The physical, social, and psychological effects of Behcet's disease necessitate the person's adaptation in many areas. This study was conducted to examine the effect of psychoeducation provided to people living with Behcet's disease in the context of the Roy adaptation model on illness adjustment, dyadic adjustment, self-esteem, and psychiatric symptoms. The study was quasi-experimental. The study was with 70 patients with Behcet's disease: 35 patients were in the intervention group and the same number in the control group. The data of the study were collected using the Adaptation to Chronic Illness Scale, Dyadic Adjustment Scale, Rosenberg Self-Esteem Scale, and Brief Symptom Inventory. A seven-session psychoeducation program was provided to the intervention group. After the psychoeducation program, adaptation to illness increased significantly and psychiatric symptoms decreased significantly in the intervention group compared with the control group (P < .05).

The impact of Behçet's disease on intimate relationships in women: A qualitative study.

OBJECTIVE: Behçet's disease is a rare and incurable condition where the body's immune system attacks healthy tissue. Behçet's can cause blood clots and ulcerations to form in every organ and system in the body, including deep and painful genital ulceration. The psychological impact of the disease on intimacy and relationships is unexplored. This study aimed to explore how the disease impacts on female patients' intimate partner relationships. METHODS: Participants were seven female, UK patients with Behçet's disease who were in committed relationships. In depth, semi-structured interviews lasting approximately 80 minutes were conducted via video conferencing about participants' sexual functioning and intimate relationships. Data was analysed using Interpretative Phenomenological Analysis. RESULTS: Patients' sexual relationships and intimacy were impacted by issues due to lack of knowledge of symptoms (misdiagnosis of herpes), issues due to symptoms (genital manifestations, painful sex, exhaustion), difficulties communicating with medical professionals, medication, partner support, and support from fellow Behçet's patients. DISCUSSION: Female Behçet's patients are at risk of developing psychological problems with intimacy due to symptoms, lack of knowledge of symptoms, and negative impacts of medication. Intimacy needs to be discussed in medical consultations so these issues can be addressed before a lack of intimacy negatively impacts relationships.

The Patients' Beliefs Regarding the Role of Food, Mucosal Trauma, Menstruation, and Psychological Stress in the Recurrence of Behçet's Disease Symptoms.

Behçet's disease is a systemic vasculitis. Mucocutaneous involvement is the most prominent finding, but triggering factors are not well-known. We decided to assess the beliefs of patients with Behçet's disease regarding the potential role of food, mucosal injury, menstruation, and stress in the appearance of symptoms. In this cross-sectional study, 60 patients with Behçet's disease who fulfilled the International Study Group criteria for Behçet's disease and referred to the outpatient Behçet's clinic of Motahari, affiliated to Shiraz University of Medical Sciences, were included. A questionnaire was designed by the research team consisting of the rheumatologist involved in the study, two dietitians, and a psychiatrist. The patients were interviewed face-to-face to fill in the questionnaire. The assessed variables were all food categories, menstruation, psychological stress, and oral mucosal injury as the potential triggers of symptoms onset. The most common foods reported as triggers for oral ulcers were eggplant (78.3%), melon (68.3%), walnut (68.2%), and cantaloupe (66.7%). Walnut was reported by three patients (5%) as the most common trigger for genital ulcers. Nervous tension (83%) and annoying arguments (45%) were the two most common psychological stress triggers for oral ulcers. Seven patients (11.7%) reported tooth brushing, as the trigger for oral ulcers. The irregular menstrual cycle was a trigger for oral ulcers in only two patients. Food items such as eggplant, walnut and melon were common self-reported triggers for mucocutaneous lesions in patients with Behçet's disease. Nervous tension and annoying arguments were also common psychological triggers for oral aphthous ulcers.

The impact of coping strategies in behcet's disease: A case-control study.

BACKGROUND: Behcet's disease (BD) is a chronic, systemic inflammatory disease characterized with higher prevalence of psychiatric disorders, particularly major depression. This study aimed to determine the relationship between the psychological coping strategies with the disease and depression, anxiety, quality of life and disease activity in patients with BD. METHODS: Fifty Behcet's patients and 38 control subjects were compared by using Behcet's disease current activity form (BDCAF), quality of life instrument (QOL), structured clinical interview for DSM-IV axis I disorders (SCID-I), ways of coping questionnaire (WCQ), Beck depression inventory (BDI), and Beck anxiety inventory (BAI). RESULTS: In terms of coping, self-controlling and positive reappraisal scores were lower in BD patients than controls while escape-avoidance was negatively correlated with age in patients. Confrontive coping, accepting responsibility, and escape-avoidance scores were positively correlated with BDI and BAI. Confrontive coping, accepting responsibility, and planful problem solving were positively correlated with QOL score. Multiple linear regression analysis indicated that confrontative coping was the major predictive factor for QOL and BDI scores. CONCLUSIONS: Excessive use of confrontive coping, accepting responsibility, and escape-avoidance strategies seems to increase depression and anxiety in Behcet's patients. Besides, among those strategies, confrontive coping is significantly associated with depression and quality of life in BD patients that should be considered in therapeutic approaches. Our results highlighted that Behcet's patients have different coping strategies than healthy controls that may impair the psychological adjustment process.

Identification of physical and psychosocial problems based on symptoms in patients with Behçet's disease.

The purpose of this study was to use the International Classification of Functioning, Disability and Health (ICF) to identify physical and psychosocial problems associated with symptoms of Behçet's disease (BD) in Japanese patients. Thirty patients with BD were interviewed in a pilot study using the "ICF Checklist", and a team of medical experts selected categories related to physical and psychosocial aspects of BD. To identify specific physical and psychosocial problems of Japanese patients with BD, 100 new patients were interviewed using the selected categories. Among the 128 categories in the original ICF Checklist, 80 categories were identified as impaired, and another 12 ICF categories were added based on expert discussion of patients input. The number of problem categories was significantly greater in patients with BD with eye involvement and fatigue (eye involvement, 25.7 categories; fatigue, 25.2 categories; both P < 0.001). Specifically, patients with eye involvement had more difficulties with problems in daily life, such as writing (odds ratio 4.2), understanding such nonverbal messages as gestures and facial expressions (13.7), moving (5.7), walking in intense sunlight and bright light (17.6), and patients with fatigue had more difficulties with climate problems such as symptoms getting worse at the turn of the seasons or on cold days (2.5), compared to those without these symptoms. This study demonstrated that support focusing not only on physical symptoms but on other aspects of life as well is necessary for patients with BD, particularly patients with eye involvement and fatigue.

Sexual dysfunction in Behçet's syndrome.

Behçet's syndrome (BS) is an autoimmune, rare, and severe multisystemic inflammatory disease characterized by recurrent oral aphthous ulcers, genital ulcers, skin lesions, and both anterior and posterior uveitis; articular, vascular, gastroenteric and neurological involvement may also occur. The multi-organ involvement and the wide range of clinical spectrum make the diagnosis of BS challenging. As other systemic chronic diseases, BS can affect all aspects of patients' life, including sexual dysfunction (SD). So far, SD has been deeply studied among patients affected by many rheumatic diseases; however, little is known about the prevalence and the characteristics of SD among BS patients. The present work was aimed at providing a systematic literature review of the literature published on SD and BS. We carried out a systematic search in PubMed and Scopus based on controlled terms (MeSH) and keywords to identify literature data on SD in BS. The systematic search was independently performed by two clinicians based on the controlled medical subject heading terms for Behcet syndrome and SD. Systematic database search identified 32 records. Screening by title and abstract was then conducted and a total of 10 articles were eligible for full text assessment, five studies explored SD in male patients with BS, 3 studies in females and 2 works reported data on both genders. Globally, the systematic literature review results have underlined that SD seems frequent in BS patients. Both female and male patients experienced a significant correlation between SD and depression. The studies investigating sexuality in BS seem to demonstrate that in these patients SD may be mainly related to depression rather than to active organic manifestations.

Longitudinal Study Investigating the Relationship between Disease Activity and Psychological Status of Patients with Behçet's Disease.

PURPOSE: To compare longitudinal changes in disease activity with quality of life and psychological status in patients with Behçet's disease (BD). METHODS: Patients attending a National Centre of Excellence for BD over a two-year period had disease activity including clinician and patient perception of disease documented and completed a number of validated quality of life and psychological questionnaires. Some representative case-studies were examined in detail. RESULTS: 102 patients were included. Disease activity weakly correlated with quality of life and psychological health. Clinician and patient perceptions strongly correlated with each other. Case-study analyses showed diverse, and sometimes incongruous, responses between, and in, individual patients. CONCLUSION: Changes in disease activity account for only a small proportion of changes in psychological status with intra-individual variation playing a large role. There is a complex relationship between psychological status and disease activity that cannot be explained by changes in disease activity alone.

Illness Perception Mediates the Relationship Between the Severity of Symptoms and Perceived Health Status in Patients With Behçet Disease.

OBJECTIVE: The aim of this study was to investigate the relationship between psychological representations of illness, perceived health status, and self-assessment of symptom severity in patients with Behçet disease, a rare long-term incurable condition with unclear etiology. METHODS: Using cross-sectional survey design, data on self-administered questionnaires on illness perception, health status, symptoms severity, and demographic characteristics were collected from 273 patients with Behçet disease (age range, 18-65 years). The data were subjected to mediation analysis to test whether cognitive and emotional components of illness perception mediate the relationship between the severity of symptoms and heath status. RESULTS: The results support our hypotheses that cognitive components of illness perception (perceived consequences and identity of the illness) mediate the link between symptom activity and pain, whereas emotional components of the illness (emotional representations about the illness) mediate the relationship between disease activity and perceived energy level. CONCLUSIONS: The robustness of these mediation effects suggests potential directions for clinical psychologists and health care practitioners in developing support programs. We supplement our study with Open Access database containing information about type of medication, comorbid mood disorder, and detailed measurement of the severity of BD symptoms for sharing and accumulating multidisciplinary knowledge aiming to support the development of interventions. Addressing psychological aspects of BD will help to manage complex patients effectively.

A Systematic Review of Neurocognitive Functioning in Behçet's Disease.

Behçet's disease (BD) is a vascular, inflammatory multisystem disorder with neuro-Behçet's (NBD) diagnosed in a subset of patients with neurological manifestations. The objective of this review was to determine whether neurocognitive dysfunction is observed in BD, in which neurocognitive domains, and whether there are differences in rates of dysfunction observed between BD and NBD groups. Studies of any methodology were included that reported results from standardized neurocognitive assessment measures in participants with BD or NBD. Twelve group comparison studies met the criteria for inclusion in the review (totalling 284 BD and 157 NBD participants), as well as 17 case study/series papers (11 BD, 35 NBD). Issues with blinding, incomplete data reporting and selective reporting bias were found across the group and case study/series papers, as well as inadequate statistical adjustment for multiple comparisons in the group studies, and the lack of the use of appropriate norms or adjustment for premorbid ability in the case series/studies papers. These quality issues impacted on the conclusions that could be drawn from the current literature. Neurocognitive dysfunction was found in NBD compared to health controls (HC) in a higher proportion of results across studies, than in comparisons between BD and HC groups. The domains in which neurocognitive attenuation was most often reported were visual spatial ability, working memory and acquired knowledge, with more than 25% of these results showing significantly lower functioning in both the BD and NBD groups compared to HC. More than 25% of the processing speed and long-term memory encoding and retrieval results were also lower for the NBD group, compared to HC. Group comparisons between NBD and multiple sclerosis participants indicated few significant differences in neurocognitive test results. The majority of case study/series participants were found to have some degree of attenuated neurocognitive functioning, as defined by case study/series authors.

Comparison of nitric oxide level in Behçet's disease patients with or without psychiatric comorbidity.

Both Behçet's disease (BD) and major depressive disorder (MDD) are diseases associated with nitric oxide (NO). We hypothesized that the comorbidity of MDD affects the levels of NO in BD. In this study, we investigate whether there was a difference in NO levels among BD patients with accompanying MDD, BD patients with no depressive symptoms and healthy control group. There was a significant difference in NO levels among BD and control group (P < 0.05). Also, there was a significant difference between the BD group with MDD and BD group without psychiatric comorbidity in terms of NO levels (P < 0.05). This study is interesting as it demonstrates that accompanying psychiatric comorbidity puts an additional NO burden on the shoulders of BD patients.

Patients' experiences with Behçet's syndrome: structured interviews among patients with different types of organ involvement.

OBJECTIVES: Behçet's syndrome (BS) is a multisystem variable-vessel vasculitis with significant life impact. The aim of this study was to explore the perspectives of patients with BS with different types of organ involvement. METHODS: Semi-structured qualitative interviews were conducted with 20 patients with BS with different types of organ involvement. Interviews were audio-recorded, transcribed, and translated into English. A Grounded Theory approach was employed in thematic analysis of translated interviews. RESULTS: Interviews with participants yielded four themes, including symptoms (skin problems, pain, vision problems, fatigue/sleep disturbances, and gastrointestinal/weight loss), impact on function (impact on speech and vision, mobility, energy for tasks, adaptations, and self-care), psychological impact (emotions and emotional management techniques), and social impact (ability to socialize generally and impact on familial relationships). CONCLUSIONS: Patients with BS identified several domains, including physical functioning, psychological state, and social identity that are significantly modulated by the symptoms of BS. Those are inter-related with physical symptoms, reflecting the multi-system character of BS, and impair patients' function impacting on psychological and social identities. This work advances an understanding of BS, and will be useful in developing patient-oriented outcome measures for use in studying BS.

Evaluation of treatment adherence in patients with Behçet's disease: its relation to disease manifestations, patients' beliefs about medications, and quality of life.

INTRODUCTION/OBJECTIVES: Despite its importance, adherence to treatment has not been sufficiently studied in Behçet's disease (BD). The aim of this study was to evaluate medication adherence in BD using the Compliance Questionnaire of Rheumatology (CQR) and factors potentially affecting it. METHOD: This cross-sectional study included 67 consecutive BD patients including 57 (85%) males with a mean age of 35.1 ± 9.27 years and mean disease duration of 129 ± 91 months. The cumulative clinical manifestations, the Behçet's Disease Current Activity Form (BDCAF) score, and the Vasculitis Damage Index (VDI) were recorded. The CQR, Socioeconomic Status Questionnaire for Health Research in Egypt (SES), the Beliefs about Medication Questionnaire (BMQ), and the Short Form 36 (SF-36) quality of life assessment questionnaire were administered to the patients. Linear regression analysis was done to determine independent predictors of CQR. RESULTS: The mean BDCAF score was 3.27 ± 3.54 and the VDI was 3.36 ± 2.21. The mean CQR score was 69.2 ± 11.79. The CQR score varied significantly among different health sources (p = 0.02), with no relationship detected with other sociodemographic characteristics, nor with clinical characteristics or the SF-36. Among the investigated medications' complexities, severity of side effects showed significantly different CQR scores (p = 0.004), and a weak positive correlation between medications' numbers and the CQR was detected. Predictors for higher CQR scores included the necessity beliefs score of the BMQ (ß = 1.1, p < 0.001); whereas, predictors for lower CQR scores were the harm and concern BMQ subscales ((ß = - 1.5, p = 0.004) and (ß = - 0.72, p = 0.032), respectively). CONCLUSIONS: Beliefs about medications were the only predictor for adherence in our cohort.

Neurological manifestations of Behçet's disease: Case report and literature review. / Manifestaciones neurológicas de la enfermedad de Behçet: descripción de un caso y revisión de la literatura.

Neurological involvement in Behçet's disease is rare, especially at the onset. It can present in the form of parenchymal changes or as damage to the vascular structures in its nonparenchymal form. The coexistence of both kinds of manifestations in the same patient is exceptional. We report the case of a 32-year-old patient with a history of deep venous thrombosis, who was being treated for holocranial headache, apathy, and oral and genital ulcers. Brain magnetic resonance imaging showed hyperintense lesions in the basal ganglia and white matter, and the vascular study evidenced venous thrombosis of the left transverse sinus. After confirming the diagnosis of Behçet's disease with parenchymal and nonparenchymal cerebral involvement, immunosuppressive and corticosteroid therapy was started, resulting in the remission of the symptoms.

An evaluation of depression, anxiety and fatigue in patients with Behçet's disease.

OBJECTIVES: Behçet's disease (BD) is a type of systemic vasculitis and inflammatory disease of unknown etiology, which is associated with fatigue and lower quality of life (QoL). The aim of this study was to assess the relationship between Behçet's Disease Current Activity Form (BDCAF) and Behçet's Disease Quality of Life (BDQoL), depression, anxiety and fatigue in Behçet's disease. METHODS: We conducted a cross-sectional study of 155 BD patients and 107 healthy subjects in a single center over a 1 year period. All participants completed the Multidimensional Assessment of Fatigue (MAF) questionnaire, and the Hospital Anxiety and Depression (HADS) scale. Disease activity in the BD patients was assessed using the BDCAF, and the physician's global assessment (PGA). BD patients also completed the BDQoL questionnaire. RESULTS: There was no significant difference in age and gender between the groups. BD patients had significantly higher HADS-anxiety (HADS-A), HADS-depression (HADS-D) and MAF scores than the healthy control group (P < 0.05). BD patients with active disease had significantly higher MAF and HADS-A scores compared to inactive BD patients (P < 0.05). MAF scores showed positive correlations with HADS-A, HADS-D, BDCAF and BDQoL. CONCLUSIONS: Fatigue and anxiety are common in clinically active BD patients compared with healthy control subjects and inactive BD patients.

Does illness perception associate with disease symptoms in Behçet's disease?

This study aims to assess the relationship between illness perception and disease course and symptoms in Behçet disease (BD). One hundred ten consecutive BD patients (F/M 50/60, mean age 38.5 ± 9.88 years) and 57 patients with Psoriasis as a disease control group (F/M 28/29, mean age 48.12 ± 15.52) are included in this cross-sectional study. Illness perception is evaluated using a revised version of the Illness Perception Questionnaire (IPQ-R). In IPQ-R, the identity score reflecting the number of symptoms is higher in BD patients with musculoskeletal involvement than the others (6.77 ± 2.91 vs. 5.08 ± 3.3, respectively, p = 0.007). The consequences score for musculoskeletal involvement (19.52 ± 7.03) and timeline (acute/chronic) score for eye involvement (26.67 ± 4.32) are also higher compared to patients without them (16.37 ± 5.82 and 22.09 ± 8.68) (p = 0.011 and p = 0.038), reflecting negative beliefs about the illness. The score of psychological attribution is higher in patients with psoriasis than BD (p = 0.039), whereas the other subgroup scores are lower in patients with psoriasis compared to those of BD (p < 0.05). This study provides a patient's perspective in the disease management process of BD using the IPQ-R questionnaire. A patient's own personal beliefs and emotional responses to their symptoms might affect the outcome measures, especially with musculoskeletal symptoms and eye involvement in BD. However, psychological attribution is found to be a prominent issue in psoriasis.

Behçet's syndrome and psychiatric involvement: is it a primary or secondary feature of the disease?

OBJECTIVES: The primary aim of the study was to determine the frequency of psychiatric disorders in Behçet's syndrome (BS) patients, both with and without neurological involvement. The secondary aims were: to investigate a possible association between disease activity/organ involvement/demographic data and psychiatric profile in BS patients, and to compare the distribution of psychiatric disorders in BS patients compared to patients with other chronic diseases. METHODS: One hundred and sixteen BS patients were studied; in addition, two groups of patients affected by systemic lupus erythematosus and chronic arterial hypertension were included in the study as disease control groups. The end-point was represented by the assessment of disease activity, performed by the evaluation of: the presence/absence of manifestations, BDCAF and clinician's overall perception of disease activity. Psychiatric comorbidity was evaluated according to the DSMIV-TR criteria. RESULTS: The frequency of bipolar disorders resulted significantly higher in BS than in disease controls. The presence of bipolar disorders in BS patients does not seem to be related to the presence of neurological involvement in the history of the disease. Notably, a significant correlation was found between BS disease activity and mood disorders, also in the follow-up. CONCLUSIONS: The study demonstrated a high frequency of psychiatric disorders in BS patients, peculiarly represented by bipolar disorders. The presence of this involvement, independently from the organ involvement, and strictly related to the disease activity, seems to suggest that neuro-psycho-BS may represent an intrinsic aspect of BS.