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Ohsawa I, Onuki A, Oka F, Matsuoka Y, Makita Y, Kobayashi T, Kanaguchi Y, Nakamura Y, Suzuki Y, Goto Y, Gotoh H. Rapidly progressive cognitive impairment resulting in heavy psychosocial burden in a patient with Fabry disease undergoing hemodialysis: a case report. BMC Nephrol 2024; 25:188. [PMID: 38831308 PMCID: PMC11149238 DOI: 10.1186/s12882-024-03624-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 05/28/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Long-term enzyme replacement therapy (ERT) may improve prognosis in the patients with Fabry disease (FD), however, detail psychosocial burden has not been focused on long life expectancy. We experienced a male case of FD under ERT, he was placed on hemodialysis and presented rapidly progressive cognitive function. CASE PRESENTATION A 51-year-old male patient with FD has been receiving ERT from age of 38 years. Hemodialysis was initiated at the age of 47 years. The patient experienced several attacks of cerebral infarction, and brain images demonstrated wide-spread asymptomatic ischemic lesions. His behavior became problematic at the age of 51 years. He often exhibited restlessness during hemodialysis sessions and failure to communicate effectively. The patient experienced impairment of attention and executive function, topographical disorientation, and amnesia. Consequently, it was necessary for medical staff and family members to monitor his behavior for safe extracorporeal circulation and daily life activities. Annual standardized neuropsychiatric testing revealed worsening of cognitive performance. CONCLUSIONS Despite treating with long-term ERT, it is necessary to determine the psychosocial burden derived from the progression of cognitive impairment in patients with FD undergoing hemodialysis.
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Affiliation(s)
- Isao Ohsawa
- Department of Nephrology, Internal Medicine, Saiyu Soka Hospital, 1-7-22, Matsubara, Soka City, Saitama, 340-0041, Japan.
- Department of Rehabilitation, Saiyu Soka Hospital, Soka City, Saitama, Japan.
| | - Akiko Onuki
- Department of Rehabilitation, Saiyu Soka Hospital, Soka City, Saitama, Japan
| | - Fumie Oka
- Department of Rehabilitation, Saiyu Soka Hospital, Soka City, Saitama, Japan
- Department of Psychiatry, Japanese Red Cross Medical Center, Shibuya-Ku, Tokyo, Japan
| | - Yoshiyuki Matsuoka
- Department of Neurosurgery, Saiyu Soka Hospital, Soka City, Saitama, Japan
| | - Yuko Makita
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Bunkyo-Ku, Tokyo, Japan
| | - Takashi Kobayashi
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Bunkyo-Ku, Tokyo, Japan
| | - Yasuhiko Kanaguchi
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Bunkyo-Ku, Tokyo, Japan
| | - Yuya Nakamura
- Department of Nephrology, Internal Medicine, Saiyu Soka Hospital, 1-7-22, Matsubara, Soka City, Saitama, 340-0041, Japan
| | - Yusuke Suzuki
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Bunkyo-Ku, Tokyo, Japan
| | - Yoshikazu Goto
- Department of Neurosurgery, Saiyu Soka Hospital, Soka City, Saitama, Japan
| | - Hiromichi Gotoh
- Department of Nephrology, Internal Medicine, Saiyu Soka Hospital, 1-7-22, Matsubara, Soka City, Saitama, 340-0041, Japan
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Jovanovic A, Miller-Hodges E, Castriota F, Takyar S, Howitt H, Ayodele O. A systematic literature review on the health-related quality of life and economic burden of Fabry disease. Orphanet J Rare Dis 2024; 19:181. [PMID: 38689282 PMCID: PMC11062018 DOI: 10.1186/s13023-024-03131-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/03/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Fabry disease (FD) is a rare lysosomal storage disease associated with glycolipid accumulation that impacts multiple physiological systems. We conducted a systematic literature review (SLR) to characterize the humanistic (quality of life [QoL]) and economic burden of FD. METHODS Searches were conducted in the Embase, MEDLINE®, and MEDLINE® In-Process databases from inception to January 19, 2022. Conference abstracts of specified congresses were manually searched. Additional searches were performed in the Cochrane and ProQuest databases for the humanistic SLR and the National Health Service Economic Evaluations Database for the economic SLR. Studies of patients with FD of any sex, race, and age, and published in the English language were included. There was no restriction on intervention or comparator. For the humanistic SLR, studies that reported utility data, database/registry-based studies, questionnaires/surveys, and cohort studies were included. For the economic SLR, studies reporting economic evaluations or assessing the cost of illness and resource use were included. RESULTS Of the 1363 records identified in the humanistic search, 36 studies were included. The most commonly used QoL assessments were the 36-item Short-Form Health Survey (n = 16), EQ-5D questionnaire descriptive system or visual analog scale (n = 9), and the Brief Pain Inventory (n = 8). Reduced QoL was reported in patients with FD compared with healthy populations across multiple domains, including pain, physical functioning, and depressive symptoms. Multiple variables-including sex, age, disease severity, and treatment status-impacted QoL. Of the 711 records identified in the economic burden search, 18 studies were included. FD was associated with high cost and healthcare resource use. Contributors to the cost burden included enzyme replacement therapy, healthcare, and social care. In the seven studies that reported health utility values, lower utility scores were generally associated with more complications (including cardiac, renal, and cerebrovascular morbidities) and with classical disease in males. CONCLUSION FD remains associated with a high cost and healthcare resource use burden, and reduced QoL compared with healthy populations. Integrating information from QoL and economic assessments may help to identify interventions that are likely to be of most value to patients with FD.
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Affiliation(s)
- Ana Jovanovic
- The Mark Holland Metabolic Unit, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Eve Miller-Hodges
- Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
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Fabry Disease and Central Nervous System Involvement: From Big to Small, from Brain to Synapse. Int J Mol Sci 2023; 24:ijms24065246. [PMID: 36982318 PMCID: PMC10049671 DOI: 10.3390/ijms24065246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/05/2023] [Accepted: 03/07/2023] [Indexed: 03/12/2023] Open
Abstract
Fabry disease (FD) is an X-linked lysosomal storage disorder (LSD) secondary to mutations in the GLA gene that causes dysfunctional activity of lysosomal hydrolase α-galactosidase A and results in the accumulation of globotriaosylceramide (Gb3) and globotriaosylsphingosine (lyso-Gb3). The endothelial accumulation of these substrates results in injury to multiple organs, mainly the kidney, heart, brain and peripheral nervous system. The literature on FD and central nervous system involvement is scarce when focusing on alterations beyond cerebrovascular disease and is nearly absent in regard to synaptic dysfunction. In spite of that, reports have provided evidence for the CNS’ clinical implications in FD, including Parkinson’s disease, neuropsychiatric disorders and executive dysfunction. We aim to review these topics based on the current available scientific literature.
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Andonian C, Beckmann J, Mayer O, Ewert P, Freiberger A, Huber M, Kaemmerer H, Kurschat C, Lagler F, Nagdyman N, Pieper L, Regenbogen C, Freilinger S. Quality of life in patients with Fabry's disease: a cross-sectional study of 86 adults. Cardiovasc Diagn Ther 2022; 12:426-435. [PMID: 36033224 PMCID: PMC9412216 DOI: 10.21037/cdt-22-215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/18/2022] [Indexed: 11/29/2022]
Abstract
Background Fabry disease (FD) is a multi-organ disorder associated with severe physical and psychological impairments, particularly in adulthood. To date, comprehensive data on the psychological burden of FD are lacking. The present study assessed quality of life (QOL) in a representative cohort of adults with FD. Methods Patient-reported outcome measures were retrospectively analyzed in 86 adults with FD (49.6±16.6 years; 62.8% female) and compared to adults with congenital heart defects (ACHD) which is another lifelong disease and affliction. QOL was assessed using the European Quality of Life 5 Dimensions 5 Levels questionnaire (EQ-5D-5L). Results Subjects affected by FD reported an overall reduced QOL (EQ-VAS: 71.8±20.0). Most frequently reported complaints occurred within the dimensions pain/discomfort (69.7%), daily activities (48.9%) and anxiety/depression (45.4%). Compared to ACHD, individuals with FD scored significantly lower in the areas of pain/discomfort, usual activities and mobility (all P<0.05). Older age and female sex were particularly associated with diminished QOL (P=0.05). Conclusions Patients with FD are at high risk for impaired QOL. They require additional support to cope with disease-related challenges. Increased attention should be directed towards improving their subjective well-being to potentially increase their QOL and long-term health outcomes.
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Affiliation(s)
- Caroline Andonian
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany.,Department of Sport and Health Sciences, Chair of Sport Psychology, Technical University Munich, Munich, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University Hospital Rechts der Isar, Technical University Munich, Munich, Germany
| | - Jürgen Beckmann
- Department of Sport and Health Sciences, Chair of Sport Psychology, Technical University Munich, Munich, Germany.,School of Human Movement and Nutrition Sciences, University of Queensland, Queensland, Australia.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - Oliver Mayer
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Annika Freiberger
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Maximilian Huber
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Harald Kaemmerer
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Christine Kurschat
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Florian Lagler
- Institute for Hereditary Metabolic Diseases, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Nicole Nagdyman
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Lars Pieper
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Claudia Regenbogen
- Department of Nephrology, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, Germany
| | - Sebastian Freilinger
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany.,Department of Sport and Health Sciences, Chair of Preventive Pediatrics, Technical University of Munich, Munich, Germany
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Mroczek M, Maniscalco I, Sendel M, Baron R, Seifritz E, Nowak A. Neuropsychiatric Symptoms and Their Association With Sex, Age, and Enzyme Replacement Therapy in Fabry Disease: A Systematic Review. Front Psychiatry 2022; 13:829128. [PMID: 35370863 PMCID: PMC8967288 DOI: 10.3389/fpsyt.2022.829128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/16/2022] [Indexed: 11/13/2022] Open
Abstract
Patients suffering from Fabry disease (FD) have an increased risk of developing neuropsychiatric symptoms (NPS), mostly impairment in cognitive performance and depression. Single cases of psychosis have been reported, however, their association with FD can be coincidental. Furthermore, deficits in social functioning and adaptation as well as specific coping styles in FD patients were observed. Recent studies focused on a longitudinal course of the disease and identified risk factors associated with specific NPS. Since 2001, enzyme replacement therapy (ERT) has been available and in preliminary studies seems to improve cognitive impairment and adaptive skills. In this systematic review, we analyze the available literature on the NPS in FD and investigate if there are any differences in their distribution between males and females, children/adolescents and adults, and individuals treated with ERT and untreated. We discuss the role of the psychological, environmental, and molecular alterations and their correlation to psychiatric manifestations in FD. Finally, we would like to increase awareness of the spectrum of NPS in FD.
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Affiliation(s)
- Magdalena Mroczek
- Department of Neurology and Neurophysiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Ignazio Maniscalco
- Department of Geriatric Psychiatry, Psychiatric Hospital of University of Zurich, Zurich, Switzerland
| | - Manon Sendel
- Department of Neurology, Division of Neurological Pain Research and Therapy, University Clinic Schleswig-Holstein, Kiel, Germany
| | - Ralf Baron
- Department of Neurology, Division of Neurological Pain Research and Therapy, University Clinic Schleswig-Holstein, Kiel, Germany
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital of University of Zurich, Zurich, Switzerland
| | - Albina Nowak
- Department of Internal Medicine, Psychiatric Hospital of the University of Zurich, Zurich, Switzerland.,Department of Endocrinology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland
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Pihlstrøm HK, Weedon‐Fekjær MS, Bjerkely BL, von der Lippe C, Ørstavik K, Mathisen P, Heimdal K, Jenssen TG, Dahle DO, Solberg OK, Sigurdardottir S. Health-related quality of life in Norwegian adults with Fabry disease: Disease severity, pain, fatigue and psychological distress. JIMD Rep 2021; 62:56-69. [PMID: 34765399 PMCID: PMC8574186 DOI: 10.1002/jmd2.12240] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/24/2021] [Accepted: 06/29/2021] [Indexed: 12/25/2022] Open
Abstract
Health-related quality of life (HRQOL) is reduced in Fabry disease (FD) and associated with clinical disease manifestations, but few have used Fabry-specific severity scores to study how disease burden interferes with quality of life. We investigated how the Fabry DS3, consisting of four somatic domains and one patient-reported item, associates with HRQOL, while also evaluating fatigue, pain and psychological distress as possible predictors. Thirty-six adults with FD completed the Short-form Health Survey (SF-36), the hospital anxiety and depression scale (HADS), the brief pain inventory (BPI) and reported fatigue on a visual analog scale. Clinical data were collected from the last multidisciplinary hospital visit. Using correlation and hierarchical linear regression analyses, we examined associations between demographic, clinical and self-reported predictors and the SF-36 physical (PCS) and mental (MCS) component summary scores. Males scored lower than the general population in all SF-36 domains (P < .05). General health and social functioning were reduced in females. Before including self-reported symptom scores, DS3 showed associations with PCS (P = .009). Our fully adjusted model explained 66% of the variation in PCS, where education (P = .040) and fatigue (P = .002) retained significance. With HADS depression score (P = .001) as the sole significant factor, our regression model explained 56% of the variation in MCS. The DS3 score has implications for HRQOL in FD. Low education and fatigue represent major barriers to physical well-being, while depression strongly influences mental quality of life. Fatigue should be recognized as an important endpoint in future FD trials. Increased efforts to diagnose and treat affective disorders are warranted.
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Affiliation(s)
- Hege Kampen Pihlstrøm
- Department of Surgery, Inflammation Medicine and Transplantation, Section of NephrologyOslo University Hospital, Rikshospitalet HFOsloNorway
| | | | | | | | - Kristin Ørstavik
- Department of Neurology, Section for Rare Neuromuscular disordersOslo University Hospital, Rikshospitalet HFOsloNorway
| | - Per Mathisen
- Department of CardiologyOslo University Hospital, Rikshospitalet HFOsloNorway
| | - Ketil Heimdal
- Department of Medical GeneticsOslo University Hospital, Rikshospitalet HFOsloNorway
| | - Trond Geir Jenssen
- Department of Surgery, Inflammation Medicine and Transplantation, Section of NephrologyOslo University Hospital, Rikshospitalet HFOsloNorway
- Institute of Clinical Medicine, Faculty of Medicine, University of OsloOsloNorway
| | - Dag Olav Dahle
- Department of Surgery, Inflammation Medicine and Transplantation, Section of NephrologyOslo University Hospital, Rikshospitalet HFOsloNorway
| | - Olga Karin Solberg
- Centre for Rare Disorders, Oslo University Hospital, Rikshospitalet HFOsloNorway
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Ali N, Caceres A, Hall EW, Laney D. Attention Deficits and ADHD Symptoms in Adults with Fabry Disease-A Pilot Investigation. J Clin Med 2021; 10:jcm10153367. [PMID: 34362157 PMCID: PMC8347978 DOI: 10.3390/jcm10153367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 07/23/2021] [Accepted: 07/24/2021] [Indexed: 11/16/2022] Open
Abstract
The present pilot study examines subjective reported symptoms of attention-deficit/hyperactivity (AD/H) in adults with Fabry disease (FD) in comparison with existing normative control data. Existing data from 69 adults with FD via the Achenbach System of Empirically Based Assessment Adult Self-Report questionnaire were analyzed. The results demonstrated a higher prevalence of AD/H symptoms in adults with FD than in the general United States population, with a roughly equal endorsement of Inattention/Attention Deficit symptoms (AD), Hyperactivity-Impulsivity (H-I) symptoms, and Combined Inattention/hyperactivity-impulsivity (C) symptoms. No gender differences were observed. While all subjects endorsing H-I symptoms fell into the symptomatic range on the AD/H scale, only two-thirds of subjects endorsing AD did so. This suggests that attention difficulties with FD are not solely explained by ADHD. Adults with FD who endorsed the AD, H-I, and C symptoms were also more likely to report mean adaptive functioning difficulties. These findings support the growing literature regarding attention difficulties in adults with FD, as well as suggesting a previously unrecognized risk of AD/H symptoms. Future research involving the objective assessment of ADHD in adults with FD is recommended. When serving adults with FD clinically, healthcare professionals should address multiple areas of care, including physical, psychological, and cognitive arenas.
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Affiliation(s)
- Nadia Ali
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA 30322, USA;
- Correspondence:
| | | | - Eric W. Hall
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
| | - Dawn Laney
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA 30322, USA;
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Chertcoff A, Cejas LL, Marchesoni C, Reisin R. Depression: The Hidden Problem in Fabry Disease. A Review. JOURNAL OF INBORN ERRORS OF METABOLISM AND SCREENING 2021. [DOI: 10.1590/2326-4594-jiems-2021-0015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Körver S, Geurtsen GJ, Hollak CEM, van Schaik IN, Longo MGF, Lima MR, Dijkgraaf MGW, Langeveld M. Cognitive functioning and depressive symptoms in Fabry disease: A follow-up study. J Inherit Metab Dis 2020; 43:1070-1081. [PMID: 32510623 PMCID: PMC7540266 DOI: 10.1002/jimd.12271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/19/2020] [Accepted: 06/04/2020] [Indexed: 12/13/2022]
Abstract
Patients with Fabry disease (FD) have a high prevalence of depressive symptoms and can suffer from cognitive impairment, negatively affecting their life. The course of cognitive functioning and depressive symptoms in FD is unknown. The aim of this prospective cohort study was to describe changes in cognitive functioning and depressive symptoms and to identify related variables in patients with FD over 1 year. Assessments were conducted twice, using a neuropsychological test battery and the Centre of Epidemiological Studies Depression scale (CESD). Eighty-one patients were included of which 76 patients (94%) completed both assessments (age: 44 years, 34% men, 75% classical phenotype). A significant decrease in cognitive functioning was found in four patients (5%), with patients regressing from excellent to average/good. Changes were not related to sex, phenotype, stroke, IQ or CESD scores. CESD scores ≥16 were present in 29 patients (38%) at baseline. Using the reliable change index a decrease in CESD scores was found in six patients (8%). Decreased CESD scores were independently related to employing a positive and problem solving coping style and increased CESD scores to an avoiding and brooding coping style and worsening health perception. We found no major changes in cognitive functioning in patients with FD during 1 year follow-up making it an unsuitable outcome in FD treatment trials. Considering the high prevalence of persistent depressive symptoms, assessment of depressive symptoms should be part of routine follow-up. Altering coping styles and health perception may improve psychological well-being in FD.
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Affiliation(s)
- Simon Körver
- Department of Endocrinology and MetabolismAmsterdam UMC, Location AMC, University of AmsterdamAmsterdamThe Netherlands
| | - Gert J. Geurtsen
- Department of Medical PsychologyAmsterdam UMC, Location AMC, University of Amsterdam, Amsterdam NeuroscienceAmsterdamThe Netherlands
| | - Carla E. M. Hollak
- Department of Endocrinology and MetabolismAmsterdam UMC, Location AMC, University of AmsterdamAmsterdamThe Netherlands
| | - Ivo N. van Schaik
- Department of Neurology, Amsterdam UMC, Location AMCUniversity of AmsterdamAmsterdamThe Netherlands
- Spaarne GasthuisHaarlemThe Netherlands
| | - Maria G. F. Longo
- Department of RadiologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Marjana R. Lima
- Department of RadiologyHospital Moinhos de VentoPorto AlegreBrazil
| | - Marcel G. W. Dijkgraaf
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, Location AMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Mirjam Langeveld
- Department of Endocrinology and MetabolismAmsterdam UMC, Location AMC, University of AmsterdamAmsterdamThe Netherlands
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