Steinlechner Susanne, Hagenah Johann, Rumpf Hans-Jürgen, Meyer Christian, John Ulrich, Bäumer Tobias, Brüggemann Norbert, Kasten Meike, Münchau Alexander, Klein Christine, Lencer Rebekka
Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany.
Helios Fachklinik Schleswig, Schleswig, Germany.
J Neurol. 2017 Jun;264(6):1076-1084. doi: 10.1007/s00415-017-8488-x. Epub 2017 Apr 11.
Comorbidity of psychiatric disorders in patients with movement disorders is common. Often, psychiatric symptoms manifest before the onset of the movement disorder, thus not representing a mere reaction to its burden. How the disease mechanisms of psychiatric and movement disorders are related is still poorly understood. The aim of the present study was to compare prevalence rates of specific psychiatric disorders between different movement disorders including isolated focal dystonia (IFD, N = 91), monogenic Parkinson's disease (PD, N = 41), idiopathic PD (N = 45), and a sample from a Northern Germany general population (TACOS Study; N = 4075). Our results indicate an odds ratio (OR) of 2.6 [confidence interval (CI) 1.7-4.0] for general axis I disorders in IFD, an OR of 2.5 (CI 1.4-4.7) in monogenic PD, and an OR of 1.4 (CI 0.8-2.6) in idiopathic PD. More specifically, the monogenic PD group showed the highest ORs for affective disorders including depression (OR = 4.9), bipolar disorder (OR = 17.4), and hypomanic episodes (OR = 17.0), whereas IFD expressed the highest rates of anxiety disorders (OR = 3.3). Psychotic symptoms were only observed in the PD groups but not in IFD. Our findings underline the notion that psychiatric disorders are part of the phenotypic spectrum of movement disorders. Moreover, they suggest that IFD, monogenic PD, and idiopathic PD are associated with specific psychiatric disorders indicating disturbances in a different neural circuitry for sensorimotor control.
运动障碍患者中精神障碍的共病情况很常见。通常，精神症状在运动障碍发作之前就已出现，因此并非仅仅是对其负担的反应。精神障碍和运动障碍的疾病机制之间如何关联仍知之甚少。本研究的目的是比较不同运动障碍（包括孤立性局灶性肌张力障碍（IFD，N = 91）、单基因帕金森病（PD，N = 41）、特发性PD（N = 45））与来自德国北部普通人群的样本（TACOS研究；N = 4075）中特定精神障碍的患病率。我们的结果表明，IFD中一般轴I障碍的优势比（OR）为2.6 [置信区间（CI）1.7 - 4.0]，单基因PD中为2.5（CI 1.4 - 4.7），特发性PD中为1.4（CI 0.8 - 2.6）。更具体地说，单基因PD组在情感障碍方面的OR最高，包括抑郁症（OR = 4.9）、双相情感障碍（OR = 17.4）和轻躁狂发作（OR = 17.0），而IFD中焦虑障碍的发生率最高（OR = 3.3）。精神病性症状仅在PD组中观察到，而在IFD中未观察到。我们的研究结果强调了精神障碍是运动障碍表型谱一部分的观点。此外，它们表明IFD、单基因PD和特发性PD与特定精神障碍相关，这表明感觉运动控制的不同神经回路存在紊乱。
