From the Department of Neurology, Danish Headache Center, Rigshospitalet-Glostrup (J.J.K., R.H.J.), and Department of Ophthalmology, Rigshospitalet (S.M.H.), University of Copenhagen; Departments of Neurology (D.B.) and Ophthalmology (L.D.M.) and OPEN, Odense Patient Data Explorative Network (D.B.), Odense University Hospital; and Department of Clinical Research (D.B.), University of Southern Denmark.
Neurology. 2022 Jul 11;99(2):e199-e208. doi: 10.1212/WNL.0000000000200548.
Psychiatric disease is a frequent comorbidity in idiopathic intracranial hypertension (IIH) and has been associated with a poor subjective outcome. No prospective studies have investigated psychiatric comorbidities in new-onset IIH. Our primary aim was to investigate disease severity in IIH depending on comorbid psychiatric disease. Important secondary outcomes were disease severity after 6 months and prevalence of psychiatric diseases in IIH.
This prospective, observational cohort study consecutively included patients with clinically suspected, new-onset IIH from 2 headache centers. A standardized diagnostic workup was completed to confirm or exclude IIH according to the revised Friedman criteria: semi-structured interview, neurologic and neuro-ophthalmologic examination, lumbar puncture with opening pressure (OP), and neuroimaging. Exclusion criteria were known IIH, secondary intracranial hypertension, missing data, and pregnancy. Disease severity was evaluated based on papilledema, visual fields, OP, and headache in patients with IIH without psychiatric disease (IIH-P) compared with patients with IIH with psychiatric disease (IIH+P). A blinded neuro-ophthalmologist assessed visual outcomes. Age- and sex-matched prevalence rates of psychiatric diseases in the general population were found in national reports.
A total of 258 patients were screened; 69 were excluded. A total of 189 patients with clinically suspected IIH were then evaluated with the diagnostic workup and IIH was confirmed in 111 patients (58.7%). A total of 45% of patients with IIH had a psychiatric comorbidity. Visual fields were worse in patients with IIH+P at baseline (-8.0 vs -6.0 dB; = 0.04) and after 6 months (-5.5 vs -4.0 dB; < 0.01) compared with IIH-P. Highly prevalent psychiatric disorders were major depressive disorder (24.3%; n = 27), anxiety or stress-related disorders (24.3%; n = 27), and emotionally unstable personality disorder (6.3%; n = 7). Substance abuse (1.8%), schizophrenia (0.9%), and bipolar disorder (0.9%) were rare. In the general population, prevalence estimates of major depressive disorder and emotionally unstable personality disorder were 1.8%-3.3% and 2%, respectively.
Visual fields were significantly worse at baseline and 6 months in IIH+P compared with IIH-P. Psychiatric comorbidities, particularly depression and emotionally unstable personality disorder, were highly prevalent in IIH. Increased awareness of psychiatric disease as a marker for worse visual status may improve patient care.
精神疾病是特发性颅内高压（IIH）的常见合并症，与较差的主观预后有关。没有前瞻性研究调查过新发 IIH 的精神共病。我们的主要目的是根据合并的精神疾病来研究 IIH 的疾病严重程度。重要的次要结局是 IIH 患者 6 个月后的疾病严重程度和 IIH 中精神疾病的患病率。
本前瞻性、观察性队列研究连续纳入了来自 2 个头痛中心的疑似新发 IIH 的患者。根据修订后的 Friedman 标准完成了标准化的诊断评估以确认或排除 IIH：半结构化访谈、神经和神经眼科检查、腰椎穿刺以测量开放压（OP）和神经影像学检查。排除标准为已知 IIH、继发性颅内高压、数据缺失和妊娠。根据有无精神疾病（IIH-P 和 IIH+P）评估 IIH 患者的视乳头水肿、视野、OP 和头痛的疾病严重程度。由一位盲法神经眼科医生评估视觉结局。在全国报告中找到了 IIH 患者的精神疾病患病率与一般人群的年龄和性别匹配的患病率。
共筛查了 258 例患者，其中 69 例被排除。然后对 189 例疑似 IIH 的患者进行了诊断评估，并在 111 例患者中确诊为 IIH（58.7%）。45%的 IIH 患者存在精神共病。与 IIH-P 相比，IIH+P 患者的基线时（-8.0 与-6.0 dB； = 0.04）和 6 个月时（-5.5 与-4.0 dB； < 0.01）视野更差。高度流行的精神障碍是重性抑郁障碍（24.3%；n=27）、焦虑或应激相关障碍（24.3%；n=27）和情绪不稳定人格障碍（6.3%；n=7）。物质滥用（1.8%）、精神分裂症（0.9%）和双相情感障碍（0.9%）较为罕见。在一般人群中，重性抑郁障碍和情绪不稳定人格障碍的患病率估计分别为 1.8%-3.3%和 2%。
与 IIH-P 相比，IIH+P 的基线和 6 个月时视野更差。IIH 中存在高度流行的精神共病，特别是抑郁和情绪不稳定人格障碍。提高对精神疾病作为视力较差的标志物的认识，可能会改善患者的护理。
