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Psychiatric Morbidity May be Early Sign of MS
Before the onset of multiple sclerosis (MS), patients are nearly twice as likely to experience psychiatric comorbidity, according to a study published in Neurology. The finding suggests that anxiety, depression, and other mental health symptoms may be part of the prodromal phase of MS.
“For a long time, it was thought that MS only really began clinically when a person experienced their first demyelinating event, such as in the form of vision problems,” said corresponding author Helen Tremlett, PhD, a neurology professor at the University of British Columbia in Canada. “But we’ve come to understand there is a whole period preceding those events where the disease presents itself in more indirect ways.”
The study analyzed health records for 6863 patients from British Columbia, each matched for age, sex, and geographic location with up to five controls from the general population. Researchers looked at the prevalence of depression, anxiety, bipolar disorder, and schizophrenia during the 5 years preceding a patient’s first demyelinating claim.
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Some 28% of patients later diagnosed with MS experienced psychiatric morbidity in the 5 years before MS onset compared with 14.9% of the 31,865 matched controls from the general population, according to the study. Health care use for mental health symptoms, including physician and psychiatrist visits, psychotropic medications, and psychiatric-related hospitalizations, also occurred at higher rates among patients later diagnosed with MS.
Furthermore, researchers found the gap in health care use between patients and the general population widened each of the 5 years before MS onset. Compared with controls, patients’ physician visits were 78% higher at 5 years before MS onset and 124% higher at 1 year before MS onset; psychiatrist visits were 132% higher at 5 years before and 146% higher at 1 year before; hospitalizations were 129% higher at 5 years before and 197% higher at 1 year before; and dispensed prescriptions were 72% higher at 5 years before and 100% higher at 1 year before MS onset.
“We see higher and higher rates of psychiatric conditions that peak in the final year before MS onset,” said first author Anibal Chertcoff, MD, PhD, an assistant professor at the University of Manitoba in Canada. “While we’re not suggesting that these conditions alone can be a predictor of MS, they may be one piece of the MS prodrome puzzle and a potential signal when combined with other factors.”
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