Julia Pakpoor
LONDON—Strong evidence suggests an association between pediatric CNS demyelinating diseases and psychiatric disorders, according to a population-based study presented at the 32nd Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS). Mental health professionals need to be involved early with patients with MS as part of a multidisciplinary care approach, said the researchers.
In adults, MS is associated with various psychiatric disorders. When MS onset occurs in children, particularly when the pathophysiology occurs during a key period of CNS development, MS may be associated with a different set of psychiatric disorders, compared with those in adults.
To assess the risk of psychiatric disorders in children with MS and other demyelinating diseases, and vice versa, Julia Pakpoor, academic and clinical trainee at the University of Oxford in the United Kingdom, and colleagues analyzed linked English Hospital Episode Statistics and mortality data for the years 1999 to 2011. Cohorts were constructed of children (ie, patients younger than 18) admitted with MS and other CNS demyelinating diseases. The investigators searched for any subsequent episode of care with psychiatric disorders in these cohorts, and compared them to a reference cohort.
The researchers included 201 children in the MS cohort, 1,097 children in the CNS demyelinating-diseases cohort, and more than 1.1 million children in the reference cohort. Children with a demyelinating disease had an increased risk of psychotic disorders (standardized rate ratio [RR] 5.77); anxiety, stress-related, and somatoform disorders (RR, 2.38); intellectual disability (RR, 6.56); and other behavioral disorders (RR, 8.99), as well as an elevated rate of any of the psychiatric disorders studied (RR, 1.56). These findings remained significant with a one-year minimum interval between the first demyelinating disease episode and the first psychiatric disorder episode. They remained significant for psychotic disorders, intellectual disability, and other behavioral disorders with a minimum five-year interval.
In an analysis of the pediatric MS cohort as the exposure, the researchers observed elevated rates of psychotic disorders (RR, 10.76), mood disorders (RR, 2.57), and intellectual disability (RR, 6.08). In reverse analyses, the researchers found elevated rates of demyelinating diseases after anxiety, stress-related, and somatoform disorders (RR, 3.15); ADHD (RR, 3.88); autism (RR, 3.80); intellectual disability (RR, 6.33); other behavioral disorders (RR, 8.30); and any of the psychiatric disorders studied (RR, 2.15).
“What this study and what many other studies of comorbidities in MS demonstrate is that it’s high time to abandon the single-disease approach, which has perhaps been the approach for a long time not only in medical research, but also medical care and medical education,” said Ms. Pakpoor. “What we clearly need to do is develop more comprehensive algorithms to identify psychiatric comorbidities for a broad range of these individuals.”
—Erik Greb