Bakirtzis Christos, Karakasi Maria-Valeria, Boziki Marina-Kleopatra, Moysiadis Theodoros, Tsakona Dimitra, Fyntanidou Barbara, Papazisis Georgios, Thireos Eleftherios, Grigoriadis Nikolaos
Multiple Sclerosis Center, Second Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Third Department of Psychiatry, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Psychiatriki. 2022 Feb 21;33(1):65-71. doi: 10.22365/jpsych.2022.057.
Multiple Sclerosis (MS) is highly comorbid with mental disorders in any disease stage, while psychiatric manifestations may precede the onset of neurological symptoms as well as diagnosis. Neuropsychiatric comorbidities are associated with an elevated risk of MS disability progression, and therefore, people with multiple sclerosis (PwMS) with psychiatric comorbidities often experience a significantly lower functional status, perform worse in objective neuropsychological assessment, are less likely to adhere to pharmacological treatment, and exhibit higher levels of disruption of their supportive social environment as compared with "non-psychiatric" PwMS. The present study aims to estimate the nationwide use of psychopharmacological agents by PwMS in Greece. Prescription records of the nationwide digital prescription database were analyzed, in order to identify PwMS that have received prescriptions of an antipsychotic, an antidepressant, an anxiolytic or a psychostimulant during a 2-year study period. Pseudo-anonymized prescription records of PwMS (n=21218) were extracted from the Greek nationwide prescription database, dating from June 2017 to May 2019. According to this national level study, psychopharmacological agents are frequently prescribed in PwMS. Antidepressants were prescribed in 36.1% of the study sample, followed by anxiolytics (16.23%), psychostimulants (4.97%) and antipsychotics (3.76%). The proportion of patients under treatment with these agents was increasing with age. Selective serotonin reuptake inhibitors, second generation antipsychotics and benzodiazepines were the most often prescribed agents in each drug category and especially in younger age groups, possibly indicating a better efficacy/side-effect equilibrium, while modafinil was the only psychostimulant prescribed aiming to ameliorate levels of fatigue. A pharmacological preference for antidepressants and psychostimulants was observed in the 40-60 age group (p = 0.02), while antipsychotics and anxiolytics were more frequently prescribed in the >60 age group (p<0.001). Serotonin-norepinephrine reuptake inhibitors were mostly prescribed within the 40-60 age-group. Benzodiazepines were less favored among the >60 age-group. This study highlights the increased prevalence of mental disorders in this patient group. Adequate treatment and monitoring of psychiatric symptomatology, may improve long-term outcomes of the disease, however caution is needed regarding potential drug interactions and side effects.
多发性硬化症（MS）在任何疾病阶段都与精神障碍高度共病，而精神症状可能在神经症状出现以及诊断之前就已出现。神经精神共病与MS残疾进展风险升高相关，因此，与“无精神疾病”的多发性硬化症患者（PwMS）相比，患有精神共病的PwMS功能状态通常显著更低，在客观神经心理学评估中表现更差，坚持药物治疗的可能性更小，并且其支持性社会环境的破坏程度更高。本研究旨在估计希腊PwMS使用精神药物的全国情况。分析了全国数字处方数据库的处方记录，以确定在为期2年的研究期间接受过抗精神病药、抗抑郁药、抗焦虑药或精神兴奋剂处方的PwMS。从希腊全国处方数据库中提取了PwMS（n = 21218）的伪匿名处方记录，时间跨度为2017年6月至2019年5月。根据这项国家级研究，精神药物在PwMS中经常被处方。36.1%的研究样本使用了抗抑郁药，其次是抗焦虑药（16.23%）、精神兴奋剂（4.97%）和抗精神病药（3.76%）。接受这些药物治疗的患者比例随年龄增长而增加。选择性5-羟色胺再摄取抑制剂、第二代抗精神病药和苯二氮䓬类药物是每个药物类别中最常被处方的药物，尤其是在较年轻的年龄组，这可能表明其疗效/副作用平衡更好，而莫达非尼是唯一一种旨在改善疲劳水平而处方的精神兴奋剂。在40 - 60岁年龄组中观察到对抗抑郁药和精神兴奋剂的药物偏好（p = 0.02），而在60岁以上年龄组中抗精神病药和抗焦虑药的处方更为频繁（p<0.001）。5-羟色胺-去甲肾上腺素再摄取抑制剂大多在40 - 60岁年龄组中被处方。苯二氮䓬类药物在60岁以上年龄组中不太受青睐。这项研究凸显了该患者群体中精神障碍患病率的增加。对精神症状进行充分的治疗和监测可能会改善疾病的长期预后，然而，需要注意潜在的药物相互作用和副作用。
