Fera Tiziana, Cascio Barbara, Angelini Guiseppe, Martini Silvia, Guidetti Carla Sategna
Dipartimento di Neuroscienze and Dipartimento di Medicina Interna, Università degli Studi di Torino, Torino, Italy.
Eur J Gastroenterol Hepatol. 2003 Dec;15(12):1287-92. doi: 10.1097/00042737-200312000-00006.
Psychiatric symptoms, common in untreated coeliac disease patients, may improve after gluten withdrawal.
To estimate the incidence of psychiatric disorders in coeliac disease patients on gluten withdrawal and to evaluate: (1) the psychological weight of a chronic disease that involves a restrictive diet and a limited life style; (2) the acceptance of the disease; (3) the effects of both disease and diet on behaviour and quality of life.
Three groups of 100 patients (coeliac disease patients, diabetic patients and healthy controls, respectively) were assessed by means of a professional semi-structured diagnostic interview based on DSM-IV criteria. This interview, together with specific psychiatric questionnaires, ruled out axis I or II psychopathological disturbances.
The modified Self-rating Depression Scale and State and Trait Anxiety Inventory Y2 scores were significantly higher in both coeliac and diabetic patients than in healthy controls. The duration of gluten restriction was related to significantly higher modified Self-rating Depression Scale scores in patients with a more recent diagnosis. Quality of life was poorer in both coeliac and diabetic patients than in healthy controls and significantly correlated with anxiety. The Illness Behaviour Questionnaire showed a high psychological and somatic perception of illness in both coeliac and diabetic patients. Its subscale scores correlated significantly with anxiety and depression symptoms.
In coeliac disease, affective disorders should be ascribed to difficulties in adjusting to the chronic nature of the disease rather than directly to the disease itself, thus giving an indication for preventive liaison psychiatric interventions.
未经治疗的乳糜泻患者常见精神症状，戒食麸质后可能改善。
评估戒食麸质的乳糜泻患者精神障碍的发生率，并评估：（1）涉及限制性饮食和有限生活方式的慢性疾病的心理负担；（2）对该疾病的接受程度；（3）疾病和饮食对行为及生活质量的影响。
分别对三组各100名患者（乳糜泻患者、糖尿病患者和健康对照者）进行基于《精神疾病诊断与统计手册》第四版（DSM-IV）标准的专业半结构化诊断访谈评估。该访谈连同特定的精神科问卷，排除了轴I或轴II精神病理障碍。
乳糜泻患者和糖尿病患者的改良自评抑郁量表以及状态-特质焦虑量表Y2得分均显著高于健康对照者。对于诊断时间更近的患者，麸质限制的持续时间与显著更高的改良自评抑郁量表得分相关。乳糜泻患者和糖尿病患者的生活质量均低于健康对照者，且与焦虑显著相关。疾病行为问卷显示，乳糜泻患者和糖尿病患者对疾病的心理和躯体感知度都很高。其分量表得分与焦虑和抑郁症状显著相关。
在乳糜泻中，情感障碍应归因于适应疾病慢性性质的困难，而非直接归因于疾病本身，从而为预防性联络精神科干预提供了依据。
