Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
Psychosom Med. 2013 Jan;75(1):76-82. doi: 10.1097/PSY.0b013e3182757b2b. Epub 2012 Nov 28.
This study was designed to determine whether pseudoexacerbations 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 observed 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 telephone-administered symptom checklist and neurologic examination.
Both pseudoexacerbations and confirmed exacerbations were associated with concurrent somatic depressive (β = .16 and β = .33, respectively; p values < .05), affective depressive (β = .17 [p = .02] and β = .12 [p = .06]), and anxiety symptoms (β = .24 and β = .20, p values < .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; p values < .01). A standard deviation increase in anxiety symptoms relative to baseline predicted subsequent onset of pseudoexacerbations (odds ratio = 1.54, p = .02), whereas increased somatic depressive symptoms predicted confirmed exacerbations (odds ratio = 1.59, p = .01).
Patients with MS experiencing pseudoexacerbations 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 exacerbations and pseudoexacerbations.
clinicaltrials.gov Identifier: NCT00147446.
本研究旨在确定假性恶化和确诊的多发性硬化症恶化是否伴有或同时伴有焦虑或抑郁症状加重。
这是一项对 121 例多发性硬化症患者进行的二次分析，这些患者在一项随机对照试验中被观察了 48 周。参与者每月完成一次抑郁和焦虑症状的自我报告。通过电话管理的症状清单和神经检查评估患者报告的恶化情况。
假性恶化和确诊恶化均与同时存在的躯体性抑郁（β=.16 和β=.33，p 值均<.05）、情感性抑郁（β=.17 [p=.02]和β=.12 [p=.06]）和焦虑症状相关，控制了基线症状。预先存在的躯体性和情感性抑郁症状预测了同时存在的确诊恶化与这些症状之间的放大关系（β=.19 和β=.20，p 值均<.01）。与基线相比，焦虑症状的标准差增加预测了假性恶化的后续发生（比值比=1.54，p=.02），而躯体性抑郁症状的增加预测了确诊恶化（比值比=1.59，p=.01）。
经历假性恶化或确诊恶化的多发性硬化症患者应评估和监测抑郁和焦虑症状，且有抑郁病史的患者出现确诊恶化尤其令人担忧。多发性硬化症恶化的心理或精神前驱事件为确诊恶化和假性恶化的病因学产生了新的假说。
clinicaltrials.gov 标识符：NCT00147446。
