Piacentini Sylvie Hélène Marie Jeanne, Draghi Lara, Cecchini Alberto Proietti, Leone Massimo
Clinical Neuropsychological Service, IRCCS Foundation "Carlo Besta" Neurological Institute, Via Celoria, 11, 20133, Milan, Italy.
Headache and Neuroalgology Unit, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy.
Neurol Sci. 2017 May;38(Suppl 1):181-184. doi: 10.1007/s10072-017-2929-2.
A great deal of studies suggests that cluster headache (CH) patients are usually comorbid to anxiety-mood spectrum disorders and psychopathological symptoms; however, the personality profiles reported in the literature strictly depend on type of assessment used. Psychiatric comorbidities have been extensively studied in migraine and they are recognized to represent a major risk factor associated with poorer outcome, playing a role in the headache chronification process at once as cause and consequence of it. By contrast the incidence and role of psychopathological aspects in CH is still not clarified, insufficiently explored as the striking severity of such a physical pain apparently leaves no room to psychological explanations. The aim of the present study is to describe psychopathological aspects of CH patients by means of the Millon Clinical Multiaxial Inventory-III (MCMI-III), a psychological assessment tool compatible to Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) that correlates personality disorders (PDs) and clinical syndromes. We included all consecutive inward patients with CH between January 2014 and December 2016. Patients were evaluated using the MCMI-III a validated inventory assessing 14 PDs Scales (coordinate with DSM-IV Axis II disorders) and ten Clinical Syndrome Scales (coordinate with DSM-IV Axis I disorders). Twenty-six CH patients (24 chronic CH) were tested. Personality disorders were present in 92% of the patients. The most frequent PDs were: obsessive-compulsive (30.8%), histrionic (26.9%), narcissistic (11.5%), paranoid (11.5%) and avoidant (11.5%). According to the MCMI-III, patients with CH showed a high prevalence of personality disorders (Axis II-DSM-IV). PDs in CH patients can play an important role in determining CH course toward chronification. These preliminary results suggest that behavioral treatments can find room to support more conventional drug and neurostimulation therapies in these patients. In addition, the very high prevalence of PDs in our patients suggests that CH could in some cases be considered among the spectrum of somatoform and pain syndromes in patients with PDs.
大量研究表明，丛集性头痛（CH）患者通常合并有焦虑情绪谱系障碍和精神病理症状；然而，文献中报道的人格特征严格取决于所使用的评估类型。偏头痛患者的精神共病情况已得到广泛研究，并且它们被认为是与较差预后相关的主要危险因素，在头痛慢性化过程中既是原因又是结果。相比之下，CH患者精神病理方面的发生率和作用仍不明确，由于这种身体疼痛的显著严重性显然没有给心理解释留下空间，因此尚未得到充分探索。本研究的目的是通过米隆临床多轴问卷第三版（MCMI-III）来描述CH患者的精神病理方面，MCMI-III是一种与《精神疾病诊断与统计手册》（DSM-IV）兼容的心理评估工具，可将人格障碍（PDs）与临床综合征相关联。我们纳入了2014年1月至2016年12月期间所有连续入院的CH患者。使用MCMI-III对患者进行评估，MCMI-III是一种经过验证的问卷，可评估14种PDs量表（与DSM-IV轴II障碍相对应）和10种临床综合征量表（与DSM-IV轴I障碍相对应）。对26例CH患者（24例慢性CH）进行了测试。92%的患者存在人格障碍。最常见的PDs为：强迫型（30.8%）、表演型（26.9%）、自恋型（11.5%）、偏执型（11.5%）和回避型（11.5%）。根据MCMI-III，CH患者人格障碍（DSM-IV轴II）的患病率较高。CH患者的PDs在决定CH向慢性化发展的过程中可能起重要作用。这些初步结果表明，行为治疗在这些患者中可以为支持更传统的药物和神经刺激疗法提供空间。此外，我们患者中PDs的极高患病率表明，在某些情况下，CH可被视为PDs患者躯体形式和疼痛综合征谱系中的一部分。
