The presence of psychiatric disorders in patients with idiopathic intracranial hypertension (IIH) is associated with poor treatment outcomes, study results published in Clinical Neurology and Neurosurgery suggests.
Researchers retrospectively examined 51 patients with an International Statistical Classification of Diseases and Related Health Problems (ICD-10) G93.2 diagnosis, obtained between 2000 and 2018. Data from medical charts, laboratory results, operative reports, imaging findings, and clinical follow-up assessments were examined. Several variables were collected prior to IIH diagnosis, at the time of IIH diagnosis, and follow-up during IIH treatment. The association between psychiatric disorders and IIH treatment outcomes were evaluated.
In the overall cohort, 45.1% (n=23) of patients had a pre-existing psychiatric disorder prior to the diagnosis of IIH. The most common psychiatric diagnosis was major depressive disorder, which was found in 37.3% (n=19) of patients. Patients with IIH and pre-existing
psychiatric disorders did not differ from IIH-patients with no prior psychiatric diagnosis in terms of age, sex distribution, body mass index, or cerebrospinal fluid opening pressure at diagnosis.
During the mean follow-up time of 4.4 years, patients with IIH and a pre-existing psychiatric diagnosis had a worse overall treatment outcome vs patients with IIH but without a history of psychiatric illness (complete resolution of symptoms, 26.1% vs 71.4%, respectively; P =.002). There was no difference between patients with vs without a psychiatric diagnosis in terms of the complete resolution of papilledema, with up to 71% of all patients having physiologic papillae at the end of follow-up (P =.405). In addition, patients with IIH and a history of psychiatric diagnoses more often had empty sella on imaging at the time of IIH diagnosis compared with patients without a pre-existing psychiatric co-morbidity (34.8% vs. 14.3%, respectively; P =.044).
Study limitations include its retrospective nature, as well as the small sample size of patients with IIH.
Almost half of the patients with IIH had psychiatric disorders, and these individuals continued to have residual symptoms although their ophthalmologic outcomes improved, concluded the researchers. They believe these patients “should be screened and treated promptly, as they may have an impact of treatment outcomes.”
Puustinen T, Tervonen J, Avellan C, et al. Psychiatric disorders are a common prognostic marker for worse outcome in patients with idiopathic intracranial hypertension [published online September 17, 2019]. Clin Neurol Neurosurg. doi:10.1016/j.clineuro.2019.105527