Influence of Personality, Resilience and Life Conditions on Depression and Anxiety in 104 Patients Having Survived Acute Autoimmune Thrombotic Thrombocytopenic Purpura

Abstract

Autoimmune thrombotic thrombocytopenic purpura (iTTP) is a life-threatening, relapsing disease in which an acquired deficiency of the enzyme ADAMTS13 leads to generalised microvascular thrombosis. Survivors have a high prevalence of depression and impaired cognitive function. The aim of this study was to determine whether life circumstances and personality have an influence on the development and severity of depression and anxiety in iTTP patients and how they impact the quality of life. With validated questionnaires, we examined the prevalence of depression and anxiety symptoms in 104 iTTP patients, as well as parameters of subjective cognitive deficits, quality of life, attitude to life and resilience. iTTP patients had significantly more depressive symptoms (p < 0.001), a tendency to have anxiety disorders (p = 0.035) and a significantly worse cognitive performance (p = 0.008) compared to the controls. Sex, age, physical activity and partnership status had no significant influence on depression, whereas the number of comorbidities did. Lower scores of resilience, attitude to life and quality of life were reported by patients compared to controls. iTTP patients had a high prevalence of depression and anxiety, as well as a more negative attitude to life and low resilience. Resilience correlated negatively with the severity of the depression. Furthermore, quality of life and cognitive performance were significantly reduced.

TTP: From empiricism for an enigmatic disease to targeted molecular therapies

“…Improving relevant clinical outcomes for rare‐disease patients and addressing patient concerns is coming into focus 135,136 . iTTP is known to be followed by several sequelae in the central nervous system 137 with chronic fatigue, headache, cognitive impairment, reduced work productivity, depression, anxiety, 136–139 post‐traumatic stress disorder 140 and a lower QoL 136,138,141 . Current treatments do not prevent these long‐term outcomes, yet these are the ones patients complain about the most, although concern profiles are slightly different between cTTP and iTTP 142 .…”

“… 135 , 136 iTTP is known to be followed by several sequelae in the central nervous system 137 with chronic fatigue, headache, cognitive impairment, reduced work productivity, depression, anxiety, 136 , 137 , 138 , 139 post‐traumatic stress disorder 140 and a lower QoL. 136 , 138 , 141 Current treatments do not prevent these long‐term outcomes, yet these are the ones patients complain about the most, although concern profiles are slightly different between cTTP and iTTP. 142 So far, the mechanisms behind the cognitive impairment observed are not yet fully defined, but likely involve ADAMTS13.…”

Special Issue: “The Latest Clinical Advances in Thrombocytopenia”

“…We observe that a number of these papers are already viewed at a high rate and even cited, supporting the value of this article series. For this issue, we acquired one original research article [1] and 13 reviews [2][3][4][5][6][7][8][9][10][11][12][13][14] that are shortly introduced below.…”

“…Falter, Böschen, Schepers, Beutel, Lackner, Scharrer, and Lämmle report their final analysis on a questionnaire study from 2015 and 2016 into neurocognitive and mental sequelae on 104 adult patients having survived at least one acute episode of autoimmune thrombotic thrombocytopenic purpura (iTTP) at the University Medical Center in Mainz or having consulted with this center [1]. Data on depressive symptoms and cognitive deficits in this cohort obtained in 2013 and 2014 had already been published before.…”

“…Recombinant ADAMTS13 as a replacement for patients with cTTP is under investigation. Regular follow-up of iTTP and cTTP patients is imperative to minimize long-term sequelae (see also the article by Falter et al [1] mentioned above).…”