Psychiatric comorbidity is associated with disability progression in multiple sclerosis
Psychiatric comorbidity is associated with disability progression in multiple sclerosis
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DOI：
10.1212/wnl.0000000000005302
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发表时间：
2018-04-10
期刊：
影响因子：
9.9
通讯作者：
Marrie, Ruth Ann
中科院分区：
文献类型：
--
作者：
McKay, Kyla A.;Tremlett, Helen;Marrie, Ruth Ann
新出现的证据表明，合并症可能会影响残疾的多发性硬化症（MS）的结果，我们调查了精神合并症和MS残疾的进展之间的关联在一个大的multiclinic population.MethodsThis回顾性队列研究访问前瞻性收集的信息，从链接的临床和人口为基础的卫生行政数据库在加拿大的不列颠哥伦比亚省和新斯科舍省。患有抑郁症、焦虑症或双相情感障碍的MS患者使用经验证的算法通过医生和医院访视进行识别。多变量线性回归模型拟合使用的身份链接与广义估计方程，以确定精神病合并症和残疾之间的关联，使用所有可用的扩展残疾状态量表（EDSS）scores.ResultsA共2,312例成人发病MS事件的平均为10.5年，在此期间，35.8%符合标准的情绪或焦虑障碍。情绪障碍或焦虑障碍的存在与较高的EDSS评分相关（β系数= 0.28，p = 0.0002，经疾病持续时间和病程、年龄、性别、社会经济状况、身体合并症计数和疾病修饰治疗暴露调整）。结果是统计学显着的妇女（β系数= 0.31，p = 0.0004），但不是男性（β系数0.22，p = 0.17）。结论存在精神共病，这是常见的，在我们的事件MS队列，增加了随后的神经功能障碍的严重程度。应探索精神科合并症的优化管理，作为潜在缓解MS残疾进展的一种手段。
ObjectiveEmerging evidence suggests that comorbidity may influence disability outcomes in multiple sclerosis (MS); we investigated the association between psychiatric comorbidity and MS disability progression in a large multiclinic population.MethodsThis retrospective cohort study accessed prospectively collected information from linked clinical and population-based health administrative databases in the Canadian provinces of British Columbia and Nova Scotia. Persons with MS who had depression, anxiety, or bipolar disorder were identified using validated algorithms using physician and hospital visits. Multi-variable linear regression models fitted using an identity link with generalized estimating equations were used to determine the association between psychiatric comorbidity and disability using all available Expanded Disability Status Scale (EDSS) scores.ResultsA total of 2,312 incident cases of adult-onset MS were followed for a mean of 10.5 years, during which time 35.8% met criteria for a mood or anxiety disorder. The presence of a mood or anxiety disorder was associated with a higher EDSS score (beta coefficient = 0.28, p = 0.0002, adjusted for disease duration and course, age, sex, socioeconomic status, physical comorbidity count, and disease-modifying therapy exposure). Findings were statistically significant among women (beta coefficient = 0.31, p = 0.0004), but not men (beta coefficient 0.22, p = 0.17).ConclusionPresence of psychiatric comorbidities, which were common in our incident MS cohort, increased the severity of subsequent neurologic disability. Optimizing management of psychiatric comorbidities should be explored as a means of potentially mitigating disability progression in MS.