Zhang-James Yanli, Paliakkara John, Schaeffer Joshua, Strayhorn Joseph, Faraone Stephen V
Norton College of Medicine at SUNY Upstate Medical University, Department of Psychiatry and Behavioral Sciences, 505 Irving Ave, Syracuse, NY 13210 USA.
Norton College of Medicine at SUNY Upstate Medical University, Department of Family Medicine, 766 Irving Ave, Syracuse, NY 13210, Syracuse, NY 13210 USA.
medRxiv. 2024 Sep 13:2024.09.12.24313553. doi: 10.1101/2024.09.12.24313553.
Intermittent Explosive Disorder (IED) is an understudied psychiatric condition that presents with repeated episodes of impulsive aggression and poorly regulated emotional control, often resulting in interpersonal and societal consequences. Better understanding of comorbidities will allow for enhanced screening, diagnosis, and treatment of patients.
To investigate prevalence and associations of IED with psychiatric, neurological, and somatic disorders using real-world data.
Matched cohorts of patients with or without IED diagnosis were identified using data from the TriNetX Research Network (until January 31, 2024). Cox proportional hazard models were used to estimate and compare the probabilities of acquiring other diagnoses using patients' available medical records.
Analysis of electronic medical records from two patient populations.
30,357 individuals with IED and equal number of demographically matched individuals without IED from the TriNetX Research.
IED diagnosis identified through the associated ICD codes.
The main outcomes were ICD-10-CM diagnostic categories and root codes for disorders and health conditions in both cohorts. Main measures are total numbers and proportions of patients who had the diagnostic codes, as well as adjusted hazard ratios for IED diagnosis.
Although only 0.03% of the total patient population had an IED diagnosis, we found extensive and widespread comorbidities with psychiatric, neurological and somatic conditions. A significant 95.7% of the individuals with IED had another psychiatric diagnosis. All psychiatric sub-categories and 95% of the psychiatric diagnoses were significantly associated with IED, with HRs ranging from 2 to 77. Among neurological conditions, neurodegenerative diseases and epilepsy had the highest HRs, followed by extrapyramidal and movement disorders, cerebral palsy and other paralytic syndromes, and sleep disorders. Notable associations with IED also includes conditions such as obesity, hyperlipidemia, hypertension, and GERD.
Our findings illuminate the extensive comorbid relationships between IED and psychiatric, neurological, and somatic disorders. This underscores the necessity for an integrated diagnostic and treatment approach that addresses both the psychological and physical health aspects of IED. Additionally, our work highlights the need for more accurate and inclusive diagnosis of IED in patients with mental disorders.
间歇性爆发障碍（IED）是一种研究不足的精神疾病，表现为反复出现冲动攻击行为且情绪控制调节不佳，常导致人际和社会后果。更好地了解共病情况将有助于加强对患者的筛查、诊断和治疗。
利用真实世界数据调查IED与精神、神经和躯体疾病的患病率及相关性。
使用TriNetX研究网络的数据（截至2024年1月31日）确定有或无IED诊断的匹配患者队列。采用Cox比例风险模型，根据患者现有的医疗记录估计并比较获得其他诊断的概率。
对两个患者群体的电子病历进行分析。
来自TriNetX研究的30357名患有IED的个体以及数量相等、人口统计学匹配的未患IED个体。
通过相关ICD编码确定的IED诊断。
主要结局是两个队列中ICD-10-CM诊断类别以及疾病和健康状况的根代码。主要测量指标是具有诊断代码的患者总数和比例，以及IED诊断的调整后风险比。
尽管在全部患者群体中只有0.03%的人被诊断为IED，但我们发现IED与精神、神经和躯体疾病存在广泛的共病情况。显著的是，95.7%的IED患者还有其他精神疾病诊断。所有精神亚类以及95%的精神疾病诊断都与IED显著相关，风险比范围为2至77。在神经疾病中，神经退行性疾病和癫痫的风险比最高，其次是锥体外系和运动障碍、脑瘫和其他麻痹综合征以及睡眠障碍。与IED的显著关联还包括肥胖、高脂血症、高血压和胃食管反流病等情况。
我们的研究结果揭示了IED与精神、神经和躯体疾病之间广泛的共病关系。这强调了采用综合诊断和治疗方法来解决IED心理和身体健康方面问题的必要性。此外，我们的工作突出了对精神障碍患者进行更准确和全面的IED诊断的需求。
