Pediatric patients with central nervous system demyelinating diseases, including multiple sclerosis (MS), have a greater risk of psychiatric disorders than the general population, according to data presented at the 32nd European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) Congress, September 14-17, 2016 in London.
Children with MS and related diseases face an especially high risk of psychiatric comorbidities since the diseases develop at a critical time of neurodevelopment.
To better understand the risk of psychiatric disorders in pediatric patients with MS and related diseases, Julia Pakpoor, BA, BM BCh (Oxon), of the University of Oxford, and colleagues analyzed data from the English Hospital Episode Statistics and mortality data from 1999-2011 in children with MS and other demyelinating diseases <18 years of age.
Ultimately, 201 children were included in the MS cohort, 1097 in the CNS demyelinating diseases cohort, and more than 1.1 million in the reference cohort. Those with a demyelinating disease had an increased risk of psychotic disorders, (standardized rate ratio [RR] 5.77 (95% CI 2.48-11.41), P <.001), anxiety, stress-related and somatoform disorders (RR=2.38 (1.39-3.81), P <.001), intellectual disability (RR=6.56 (3.66-10.84), P <.001), other behavioral disorders (RR=8.99 (5.13-14.62), P <.001), as well as a greater risk of any psychiatric disorders (RR=1.56 (1.24-1.94), P =.0001). This risk remained significant with a 1-year minimum interval between first demyelinating disease episode and first psychiatric disorder episode, and a 5-year interval for psychotic disorders, intellectual disability, and behavioral disorders.
When the researchers analyzed the MS cohort, they found that patients had a greater rate of psychotic disorders (RR=10.76 (2.93-27.63), P <.001), mood disorders (RR=2.57 (1.03-5.31), P =.022), and intellectual disability (RR=6.08 (1.25-17.80), P =.004). When reversed, the researchers found that patients who had anxiety, stress-related and somatoform disorders (RR 3.15 (1.70-5.39), P <.001), ADHD (RR 3.88 (1.75-7.48), P <.001), autism (RR 3.80 (2.05-6.50), P <.001), intellectual disability (RR 6.33 (2.86-12.21), P <.001), other behavioral disorders (RR 8.30 (5.17-12.75), P <.001), and any psychiatric disorders (RR 2.15 (1.70-2.72), P <.001) had an increased risk of demyelinating diseases.
The evidence suggests that mental health professionals should be part of the early treatment team for children with demyelinating diseases.
The authors report no relevant disclosures.
Pakpoor J, Goldacre R, Schmierer K, Giovannoni G, Waubant E, Goldacre M. Risks of psychiatric disorders in children and young adults with demyelinating diseases of the central nervous system: a national record-linkage study. Presented at: ECTRIMS 2016. September 14-17, 2016; London, UK. Abstract 72.