Prospective examination of anxiety and depression before and during confirmed and pseudoexacerbations in patients with multiple sclerosis.
Prospective examination of anxiety and depression before and during confirmed and pseudoexacerbations in patients with multiple sclerosis.
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DOI：
10.1097/psy.0b013e3182757b2b
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发表时间：
2013-01
影响因子：
3.3
通讯作者：
Mohr DC
中科院分区：
文献类型：
--
作者：
Burns MN;Nawacki E;Siddique J;Pelletier D;Mohr DC
尽管一些研究表明MS恶化和心理困扰之间存在关系，但方法上的缺陷限制了他们的结论。本研究旨在确定假性和确诊的MS加重是否在焦虑或抑郁症状增加之前或同时发生。这是对121例MS患者的二次分析，这些患者在随机对照试验期间随访了48周。参与者每月完成抑郁和焦虑症状的自我报告。通过电话管理的症状检查表和神经系统检查对患者报告的急性加重进行评估。假性急性加重和确诊急性加重均与并发躯体抑郁相关，分别为β = 0.16和β = 0.33，ps <0.05，情感抑郁相关，分别为β = 0.17，p = 0.02和β = 0.12，p = 0.06，以及焦虑症状，β = 0.24和β = 0.20，ps <0.01，控制基线症状。预先存在的躯体和情感抑郁症状预测了并发确认的急性加重与这些症状之间的放大关系，分别为β = .19和β = .20，ps < .01。焦虑症状相对于基线的标准差增加可预测随后假性急性加重的发生，比值比[OR] = 1.54，p = 0.02，而躯体抑郁症状增加可预测确认的急性加重，OR = 1.59，p = 0.01。应评估和监测出现假性或确诊急性加重的MS患者的抑郁和焦虑症状，确诊急性加重尤其涉及有抑郁病史的患者。MS急性加重的心理或精神前驱因素产生了关于确诊和假性急性加重病因的新假设。ClinicalTrials.gov（NCT00147446）。
Although some studies have suggested a relationship between MS exacerbations and psychological distress, methodological weaknesses limit their conclusions. This study was aimed to determine whether pseudo- and confirmed MS exacerbations are preceded by or concurrent with increased anxiety or depressive symptoms. This was a secondary analysis of 121 patients with MS who were followed for 48 weeks during a randomized controlled trial. Participants completed monthly self-reports on depressive and anxiety symptoms. Patient-reported exacerbations were assessed through a phone-administered symptom checklist and neurological exam. Both pseudo-exacerbations and confirmed exacerbations were associated with concurrent somatic depressive, β = .16 and β = .33, respectively, ps < .05, affective depressive, β = .17, p = .02 and β = .12, p = .06, and anxiety symptoms, β = .24 and β = .20, ps < .01, controlling for baseline symptoms. Preexisting somatic and affective depressive symptoms predicted amplified relationships between concurrent confirmed exacerbations and these symptoms, β = .19 and β = .20, respectively, ps < .01. A standard deviation increase in anxiety symptoms relative to baseline predicted subsequent onset of pseudo-exacerbations, odds ratio [OR] = 1.54, p = .02, while increased somatic depressive symptoms predicted confirmed exacerbations, OR = 1.59, p = .01. Patients with MS experiencing pseudo- or confirmed exacerbations should be assessed and monitored for depressive and anxiety symptoms, and confirmed exacerbations are particularly concerning in patients with a history of depression. The psychological or psychiatric antecedents of MS exacerbations generate new hypotheses on etiologies of confirmed and pseudo-exacerbations. ClinicalTrials.gov (NCT00147446).