背景:精神病合并症在多发性硬化症(MS)中很常见,并且在水通道蛋白-4-抗体视神经脊髓炎谱系障碍(AQP4-AbNMOSD)和髓磷脂少突胶质细胞糖蛋白-抗体相关疾病(MOGAD)中得到越来越多的认可。然而,目前尚不清楚这些精神合并症是否早于神经系统诊断或经典神经系统症状,这些症状通常用于确定这些中枢神经系统炎症性脱髓鞘疾病的发作.我们试图:(1)评估在正式MS之前和之后精神病医生诊断的精神疾病的频率和发生率,AQP4-AbNMOSD,和MOGAD诊断,和(2)确定与MS患者首次临床就诊时预先存在的精神病发病率和抑郁严重程度相关的潜在因素。
方法:对MS进行了回顾性观察研究,AQP4-AbNMOSD,以及在新加坡国家神经科学研究所(NNI)看到的MOGAD患者。在神经系统诊断之前和之后,确定了精神病医生诊断为精神疾病的个体。人口统计,临床资料,收集并分析首次就诊时的患者健康问卷(PHQ)-9评分。
结果:三百九十九名患者(249名MS,102AQP4-AbNMOSD,包括48个MOGAD)。较高比例的MS患者(13/249,5.2%)在神经系统诊断前患有精神疾病,相比AQP4-AbNMOSD(1/102,1.0%)和MOGAD(0/48,0.0%)(p=0.054)。在MS患者中,单因素Logistic回归显示,年龄,性别,种族,MS亚型,初始MRI病变负荷,从典型的MS症状发作到MS诊断之间的间隔与先前存在的精神疾病无关。MS患者首次咨询时的平均PHQ-9评分为4.4(无/最小抑郁的截止值≤4);单变量线性回归中没有临床因素可预测较高的PHQ-9评分。神经系统诊断后出现精神疾病的MS患者比例(29/236,12.2%)与AQP4-AbNMOSD(9/101,8.9%)无差异(p>0.999),而这显著高于MOGAD(0/48,0.0%)(p=0.021)。神经系统诊断后精神疾病的发病率,计入后续时间,MS和AQP4-AbNMOSD之间也相似(发生率比1.2;95%置信区间0.54-2.8;p=0.689)。
结论:与AQP4-AbNMOSD和MOGAD相比,MS诊断前存在显著的精神负担。NMOSD诊断后精神病合并症的频率增加值得进一步研究以研究该现象的决定因素。
BACKGROUND: Psychiatric comorbidities are common in Multiple Sclerosis (MS) and are increasingly recognised in Aquaporin-4-Antibody Neuromyelitis Optica Spectrum Disorders (AQP4-Ab NMOSD) and Myelin Oligodendrocyte Glycoprotein-Antibody Associated Disease (MOGAD). However, it is unclear if these psychiatric comorbidities predate neurological diagnosis or classical neurological symptoms that are conventionally used to establish the onset of these central nervous system inflammatory demyelinating diseases. We sought to: (1) assess the frequency and incidence of psychiatrist-diagnosed psychiatric disorders before and after formal MS, AQP4-Ab NMOSD, and MOGAD diagnosis, and (2) identify potential factors associated with the presence of pre-existing psychiatric morbidity and depression severity at the first clinical visit for MS patients.
METHODS: A retrospective observational study was performed on MS, AQP4-Ab NMOSD, and MOGAD patients seen at the National Neuroscience Institute (NNI) Singapore. Individuals with psychiatrist-diagnosed psychiatric disorders before and after neurological diagnosis were identified. Demographic, clinical data, and Patient Health Questionnaire (PHQ)-9 score at first clinic visit were collected and analysed.
RESULTS: Three hundred and ninety-nine patients (249 MS, 102 AQP4-Ab NMOSD, 48 MOGAD) were included. A higher proportion of MS patients (13/249, 5.2%) had psychiatric disorders before neurological diagnosis, compared to AQP4-Ab NMOSD (1/102, 1.0%) and MOGAD (0/48, 0.0%) (p = 0.054). Within MS patients, univariate logistic regression revealed that age, sex, race, MS subtype, initial MRI lesion load, and interval between classical MS symptom onset to MS diagnosis were not associated with pre-existing psychiatric disorders. Mean PHQ-9 score for MS patients at their first MS consult was 4.4 (cut-off for no/minimal depression is ≤4); no clinical factors were predictive of higher PHQ-9 scores on univariate linear regression. The proportion of MS patients (29/236, 12.2%) who developed psychiatric illness after neurological diagnosis was not different from AQP4-Ab NMOSD (9/101, 8.9%) (p > 0.999), while this was significantly higher compared to MOGAD (0/48, 0.0%) (p = 0.021). The incidence rate of psychiatric diseases after neurological diagnosis, accounting for follow up time, was also similar between MS and AQP4-Ab NMOSD (incidence rate ratio 1.2; 95% confidence interval 0.54 - 2.8; p = 0.689).
CONCLUSIONS: There is a significant psychiatric burden prior to MS diagnosis compared to AQP4-Ab NMOSD and MOGAD. The increased frequency of psychiatric comorbidity after NMOSD diagnosis merits further study to investigate the determinants of this phenomenon.