OBSESSIVE COMPULSIVE PERSONALITY AND FATIGUE IN PATIENTS WITH ANXIETY AND MOOD DISORDERS

Abstract

Introduction Prior analysis has demonstrated executive dysfunction as a cardinal feature of fatigue in a post myocardial infarction population [1]. Executive problems have also been demonstrated in a group of subjects with obsessive compulsive personality disorder (OCPD) [2]. Traits of OCPD are commonly associated with depression, which has fatigue as an intrinsic element; however, so far no study has investigated the possibility of a specific association between fatigue and OCPD. Aim To investigate whether measures of fatigue and OCPD were associated, in a sample of patients with anxiety and mood disorders (AMD) demonstrating high levels of fatigue. Material and Methods A cross-sectional study of patients with AMD attending a Stress Disorders Clinic. Socio-demographic and clinical information including diagnosis (as defined by The Mini International Neuropsychiatric Interview), medication use, body mass index, and history of smoking were collected. The severity of OCPD traits was evaluated using the observer-rated Compulsive Personality Assessment Scale (CPAS) [2]. The Multidimensional Fatigue Inventory (MFI-20) was used to assess general, physical and mental fatigue, reduced activity and motivation. The Beck Depression Inventory-II (BDI-II) and the Hamilton Depression Rating Scale (HAM-D) were employed to measure subjective and objective symptoms of depression, while the Hamilton Anxiety Rating Scale (HAM-A) measured anxiety symptoms. Two-tailed Student’s t-test or Fisher’s χ2 test were applied to compare socio-demographic, clinical, fatigue, anxiety and depression characteristics in AMD patients with and without OCPD. Binary logistic regression analyses were performed to test associations between OCPD and fatigue, while controlling for possible confounders. Results Sixty-seven patients participated, 49 (73.1 %) females with a mean age of 39±13. In this group, 14 (20.9%) patients had one mood disorder, 17 (25.4%) had one anxiety disorder, and the remaining 36 (53.7%) patients suffered simultaneously from AMD. Nine patients (13.4%) fulfilled operational criteria for OCPD. The OCPD group had higher subjective depression scores on the BDI-II relative to patients without OCPD (35.1±14.1 vs. 23.5±11.1; p = 0.007). However, scores on the HAM-D and HAM-A scales did not show any difference between groups (p’s > 0.05). Measures of physical and mental fatigue were higher among OCPD patients than non-OCPD (respectively, 81.9±22.8 vs. 62.5±25.8, p = 0.037; 88.9±13.5 vs. 65.7±27.6, p = 0.017). Controlling for potential confounders i.e. depression scores (BDI-II), age, gender, medication use and reduced motivation, the association between mental fatigue and OCPD remained significant and was associated with a 1.072-fold increase (95% confidence, 1.002 to 1.147, p = 0.045) in risk for OCPD. There was no longer a significant effect of physical fatigue on OCPD. Conclusions Mental fatigue in patients with AMD is associated with OCPD traits even when depression and reduced motivation symptoms are taken into account. Thus, mental fatigue might represent a previously under-explored marker of OCPD. Further investigation of mental fatigue in diverse groups of patients is needed to confirm this finding.