From the Sleep-Wake Disorders Unit (L.B., R.L., S.C., A.L.R., Y.D.), Department of Neurology, Gui-de-Chauliac Hospital, and National Reference Network for Narcolepsy (L.B., R.L., S.C., C.P., A.L.R., Y.D.), CHU Montpellier; and PSNREC (L.B., R.L., I.J., Y.D.), Université de Montpellier, INSERM, France.
Neurology. 2020 Nov 17;95(20):e2755-e2768. doi: 10.1212/WNL.0000000000010737. Epub 2020 Sep 22.
To assess the frequency and determinants of depressive symptoms and suicidal thoughts in adults with narcolepsy type 1 (NT1) and controls, as well as the changes after NT1 management and the risk factors of major depressive episode (MDE) and suicide risk (SR) in NT1.
Two hundred ninety-seven patients with NT1 (age 39 ± 17 years, 172 drug-free) and 346 controls (age 38 ± 16 years) underwent a comprehensive clinical evaluation including the Beck Depression Inventory-II (BDI-II) self-questionnaire, with 1 item on suicidal thoughts. One hundred one drug-free patients with NT1 completed the BDI-II a second time during treatment. In 162 patients with NT1, the face-to-face Mini International Neuropsychiatric Interview was performed to formally diagnose current MDE and SR.
BDI-II total scores were higher in patients with NT1 than controls and in untreated than treated patients. Patients with moderate to severe BDI-II scores (24.9%) were less educated, were more frequently obese, and had more severe narcolepsy symptoms, more autonomic dysfunctions, and poorer quality of life. Results were unchanged in models adjusted for NT1 medication intake. Suicidal thoughts were more frequent in untreated patients than controls (22.7% vs 12.4%). Patients with suicidal thoughts were more likely to be men and to have more severe narcolepsy symptoms. After narcolepsy management, BDI-II total score and suicidal thoughts decreased. MDE was diagnosed in 29 (18.1%) and SR in 27 (16.9%) patients.
Depression, depressive symptoms, suicidal thoughts, and SR were frequent in patients with NT1, especially those without treatment, and were associated with NT1 severity. Depressive symptoms and suicidal thoughts improved after NT1 management.
评估 1 型发作性睡病（NT1）成人患者和对照组中抑郁症状和自杀意念的发生频率和决定因素，以及 NT1 管理后的变化，以及 NT1 中重度抑郁发作（MDE）和自杀风险（SR）的危险因素。
297 例 NT1 患者（年龄 39±17 岁，172 例未用药）和 346 例对照者（年龄 38±16 岁）接受了全面的临床评估，包括贝克抑郁量表第二版（BDI-II）自我问卷，其中有 1 项关于自杀意念。101 例未用药的 NT1 患者在治疗期间完成了 BDI-II 的第二次测试。在 162 例 NT1 患者中，进行了面对面的迷你国际神经精神访谈，以正式诊断当前 MDE 和 SR。
NT1 患者的 BDI-II 总分高于对照组和未治疗组。BDI-II 评分中度至重度（24.9%）的患者受教育程度较低，更常肥胖，且具有更严重的发作性睡病症状、更多的自主神经功能障碍和更差的生活质量。在调整了 NT1 药物摄入的模型中，结果保持不变。与对照组相比，未治疗患者的自杀意念更为频繁（22.7% vs 12.4%）。有自杀意念的患者更可能是男性，且具有更严重的发作性睡病症状。在进行了发作性睡病管理后，BDI-II 总分和自杀意念均下降。29 例（18.1%）患者被诊断为 MDE，27 例（16.9%）患者被诊断为 SR。
NT1 患者，尤其是未经治疗的患者，抑郁、抑郁症状、自杀意念和 SR 较为常见，且与 NT1 严重程度相关。NT1 管理后，抑郁症状和自杀意念得到改善。
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