Clinical psychiatry Familial Mediterranean Fever and psychiatric disorders: three case reports

FMF is a genetic disease charactarized by recurrent febrile episodes and inşammation of serous membranes. It affects mainly ethnic groups living around the Mediterranean basin. It is transmitted through autosomal recessive form of inheritance and the gene responsible for FMF (MEFV) has been mapped to the short arm of chromosome 16. The disease is characterized by typical recurrent fever and polyserositis episodes such as peritonitis, arthritis, and pleuritis. Less frequently, pericarditis, orchiepidydimitis, myozitis and menengitis episodes can be seen. The episodes often last for 12-72 hours. Amyloidosis is the most common complication of FMF in which the treatment is colchicine. Exacerbation may be facilitated by emotional stress, mentsruation and hard physical exercises. In this case report, three FMF patients, who have comorbid psychiatric diseases are presented and their treatments are discussed. One case had anxiety disorder comorbid with major depression; the other two cases had schizophrenia. FMF comorbid with psychiatric diseases are uncommon. It was found that unclear prognosis in chronic diseases as in FMF, unpredictable health status and chronic pain increased the risk of other problems. FMF presenting with unpredictable abdominal pain mostly, chest pain, arthritis and skin rashes cause anxiety and feelings of helplessness. Also side effect of colchisine as depression has been known before. That’s why organic reasons should be thoroughly examined; any existence of chronic diseases should be questioned. Since chronic diseases may trigger psychiatric diseases, multidisciplinary approach is recommended for such patients. We think that FMF comorbid with schizophrenia has poor diagnosis. Anhedonia and autism in schizophrenia may delay the recognition of FMF symptoms and the ongoing amyloid deposition may secretly cause renal failure and the worsening of prognosis. Moreover one more drug would be added on to lifelong psychiatric medication treatment. Treatment rejection and/or incoherence are very common in schizophrenic patients. Colchicine can be the target of treatment rejection, too.