| Sažetak | U ovoj disertaciji po principu prospektivne kohortne studije istraživala se moguća povezanost između parodontnog statusa osoba oboljelih od shizofrenije i slabljenja kvalitete remisije, što se pratilo tijekom šest mjeseci nakon otpusta iz bolnice.
U istraživanje je uključeno 67 ispitanika s dijagnosticiranom shizofrenijom otpuštenih iz bolnice u stanju remisije. Prilikom otpusta svim ispitanicima određivali su se parodontološki parametri: indeks krvareće papile, aproksimalni plak indeks, dubina sondiranja, recesija gingive i gubitak kliničkog pričvrstka. Također su se pri otpustu svim ispitanicima mjerile razine proupalnih citokina TNFα i IL-6. Psihički status ispitanika procijenjen je ljestvicom pozitivnih i negativnih simptoma (PANSS) u tri navrata: prilikom otpusta, nakon tri mjeseca i nakon šest mjeseci.
Nakon prilagodbe za potencijalne zbunjujuće varijable, pokazano je da je indeks krvareće papile pri otpustu iz bolnice bio značajno inverzno povezan s težinom generalnih psihotičnih simptoma, a aproksimalni plak indeks s težinom negativnih simptoma. Tri mjeseca nakon postizanja remisije indeks krvareće papile bio je povezan s relativnom promjenom autističnih psihotičnih simptoma, a dubina parodontnih džepova s promjenom ukupne težine psihotičnih simptoma. Šest mjeseci nakon otpusta iz bolnice nijedan indikator stanja parodonta registriran pri otpustu nije bio statistički značajno povezan s promjenom težine psihotičnih simptoma. U ovoj disertaciji proupalni citokini TNFα i IL-6 nisu bili povezani s parametrima parodontnog zdravlja niti je utvrđen njihov medijacijski učinak na povezanost parodontnih indeksa i smanjenja psihotičnih simptoma.
Ova je disertacija još jedno istraživanje koje ističe vaţnost oralnog zdravlja osoba oboljelih od shizofrenije, zbog mogućeg utjecaja parodontitisa na tijek bolesti i težinu simptoma, kao i utjecaja shizofrenije na oralno zdravlje i kvalitetu života. |
| Sažetak (engleski) | Background and objectives
Several studies have indicated a correlation between periodontal disease and schizophrenia, as well as a poorer periodontal status in patients with schizophrenia. However, only few studies have analyzed the correlation between periodontal diseases and the etiopathogenesis of schizophrenia. Both, periodontal disease and schizophrenia, are linked with elevated levels of proinflammatory cytokines and numerous immunological mechanisms. Our aim was to test the hypothesis: Periodontal disease at discharge from hospital due to remission of schizophrenia is associated with worsening of the quality of remission as determined six months after, regardless of other clinical, demographic and vital parameters.
Methods
The study was conducted on a consecutive sample of 67 patients with schizophrenia, both male and female, aged between 30 and 65, discharged after matching remission criteria. Periodontal indices such as papilla bleeding index (PBI), approximal plaque index (API), probing depth (PD), loss of attachment (LA) and gingival recession (REC) were evaluated at the time of discharge. At the same time, blood levels of proinflammatory cytokines TNFα and IL-6 were determined. Positive and negative syndrome scale (PANSS) total score was consequently assessed at hospital discharge, after three, and again after six months. Clinical Global Impression Scale (CGI-S and CGI-I), Beck's Depression Inventory (BDI-II), Oral Health Impact Profile (OHIP-49), Global Assesssment of Functioning (GAF), Heinrich-Carpenter Quality of Life scale (QLS), sociodemographic and vital clinical parameters were also assessed.
Results
After adjusting the potential confounders, baseline PBI was significantly inversely correlated with severity of general psychotic symptoms, and API was significantly correlated with severity of negative symptoms. Three months after discharge, baseline PBI was
significantly correlated with relative change in autistic psychotic symptoms, and PD with change in severity of psychotic symptoms. Six months after discharge none of the selected parameters of periodontal status were significantly correlated with changes in the severity of psychotic symptoms. Both proinflammatory cytokines, IL-6 or TNFα, had no correlation with periodontal health parameters. However, we have not identified a mediation effect of selected cytokines in the correlation between periodontal indices and the alleviation of psychotic symptoms.
Conclusions
According to our study, the worsening of the quality of remission could be best described by the parsimonious diagnostic model, which takes into consideration the profession and annual income of the participants, as well as their antipsychotic therapy at the time of hospital discharge. |
