Psychological features of adult patients with langerhans cell histiocytosis.

Emmanuelle Bugnet,Cédric Lemogne,Nishant Gupta,Sylvie Chevret,Abdellatif Tazi,Gwenaël Lorillon,Sayena Arbabzadeh-Bouchez,Sherief Ghozy

doi:10.1371/journal.pone.0246604

Abstract

BackgroundThe prevalence of psychological symptoms and the co-occurrence of substance abuse disorders in adult patients with Langerhans cell histiocytosis (LCH) has not been previously explored. We aimed to use validated scales to evaluate depression and anxiety symptoms experienced by adult LCH patients.MethodsIn this cross-sectional study, all consecutive adult LCH patients seen at our national reference center between January 2012 and January 2013 were asked to complete the following instruments: the Hospital Anxiety and Depression scale (HADS); Barratt Impulsiveness Scale, Version 10 (BIS-10); and Cannabis Use Disorders Identification Test (CUDIT). Self-reported scores on these scales were used to determine the point prevalence of clinically significant psychological symptoms and substance use disorders in LCH patients. Patient profiles in terms of psychological features were assessed by principal component analysis including the HADS and BIS-10 instruments values, followed by hierarchical clustering. Fisher exact tests and Wilcoxon tests were used to examine the associations between disease-related parameters and high levels of anxiety and impulsivity.ResultsSeventy-one adult LCH patients, mainly with pulmonary LCH (PLCH), completed the evaluations. Clinically significant anxiety and depression symptoms were reported by 22 (31%) and 4 (6%) subjects, respectively. Impulsivity was detected in 14% (10/71) of the patients. Seventeen percent (12/71) of the patients used cannabis on a regular basis, with 50% of these individuals (6/12) exhibiting scores consistent with cannabis use disorder. Three derived clusters of patients were identified in the principal component analysis; these patient clusters differed in successful weaning from tobacco at the time of evaluation (p = 0.03). In univariate analyses, isolated PLCH and the use of psychotropic treatments were statistically associated with clinically significant anxiety symptoms.ConclusionsHigh levels of anxiety and impulsivity are common in adult patients with LCH. The consequences of these symptoms for the management of LCH patients warrant further evaluation.

Highlights

High levels of anxiety and impulsivity are common in adult patients with Langerhans cell histiocytosis (LCH)
Langerhans cell histiocytosis (LCH) is an inflammatory myeloid neoplasm driven by the abnormal accumulation of specialized dendritic cells carrying pathogenic activating mutations in the mitogen activating protein (MAP) kinase pathway [1,2,3]
Studies with a confirmed histologic diagnosis highlighted the rarity of the disease, which accounted for 3 to 5% of adult patients with diffuse infiltrative lung diseases [5,6]. These reports most probably underestimated the true prevalence of Pulmonary LCH (PLCH), as with the wide use of chest high resolution computed tomography (HRCT) in the evaluation of patients, lung biopsy is not performed in all cases of PLCH [4]

Summary

Introduction

Langerhans cell histiocytosis (LCH) is an inflammatory myeloid neoplasm driven by the abnormal accumulation of specialized dendritic cells carrying pathogenic activating mutations in the mitogen activating protein (MAP) kinase pathway [1,2,3]. Studies with a confirmed histologic diagnosis highlighted the rarity of the disease, which accounted for 3 to 5% of adult patients with diffuse infiltrative lung diseases [5,6]. These reports most probably underestimated the true prevalence of PLCH, as with the wide use of chest high resolution computed tomography (HRCT) in the evaluation of patients, lung biopsy is not performed in all cases of PLCH [4]. The prevalence of psychological symptoms and the co-occurrence of substance abuse disorders in adult patients with Langerhans cell histiocytosis (LCH) has not been previously explored. We aimed to use validated scales to evaluate depression and anxiety symptoms experienced by adult LCH patients.

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Methods

Results

Conclusion