Michel Ian M, Gardea-Reséndez Manuel, Ercis Mete, Ortiz-Orendain Javier, Ali Dina N, Pazdernik Vanessa K, Miola Alessandro, Gonzalez-Campos Tamahara, Siralp Bostan, Bisoglio Joseph, Gruhlke Peggy M, Bostwick J Michael, McKean Alastair J, Vande Voort Jennifer L, Ozerdem Aysegul, Frye Mark A
Mayo Clinic Alix School of Medicine, Rochester, MN; Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN.
Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN; Department of Psychiatry, Universidad Autónoma de Nuevo León, Monterrey, Mexico.
J Acad Consult Liaison Psychiatry. 2025 Jun 16. doi: 10.1016/j.jaclp.2025.06.002.
Asthma, characterized by chronic inflammatory burden, may increase the risk of developing bipolar disorder (BD) and schizophrenia (SZ). Emerging evidence suggests that sex differences can further influence the presentation and course of these conditions.
To investigate the impact of antecedent asthma diagnosis on the clinical trajectory and age at first episode of mania (FEM) or psychosis (FEP) in individuals and explore sex differences in these associations.
We identified patients with FEM or FEP within the Rochester Epidemiology Project. Patient demographics, psychiatric antecedents, and prior medical diagnoses were collected. Antecedent asthma diagnoses were extracted using International Classification of Diseases-10 codes via the Rochester Epidemiology Project records-linkage system.
Among 201 patients with FEM (n = 72) or FEP (n = 129), 50 (24.9%) had a prior diagnosis of asthma. There was no difference in asthma prevalence by diagnosis (24.8% BD vs. 25.0% SZ; P = 0.976) or sex (male 22.4% vs. female 31.5%, P = 0.189). Patients with asthma were more likely to have an antecedent psychiatric disorder prior to their first episode (P = 0.008), particularly depressive disorders (P = 0.006). A significant interaction effect was found between sex and asthma on age at first episode, with females with asthma experiencing a significantly earlier illness onset (F [1197] = 8.20, P = 0.006). These findings remained significant in sensitivity analyses excluding patients without at least one year of follow-up prior to the first episode.
Antecedent asthma was prevalent in our cohort and associated with increased psychiatric illness burden and an earlier age of onset in females with BD or SZ. These findings highlight important comorbidity patterns to consider in the antecedent illness trajectory and the need for further research into the inflammatory and sex-specific mechanisms underlying serious mental illness.
哮喘以慢性炎症负担为特征，可能会增加患双相情感障碍（BD）和精神分裂症（SZ）的风险。新出现的证据表明，性别差异可能会进一步影响这些疾病的表现和病程。
研究先前哮喘诊断对个体临床病程和首次躁狂发作（FEM）或精神病发作（FEP）年龄的影响，并探讨这些关联中的性别差异。
我们在罗切斯特流行病学项目中确定了FEM或FEP患者。收集了患者的人口统计学信息、精神病史和既往医疗诊断。通过罗切斯特流行病学项目记录链接系统，使用国际疾病分类第10版代码提取先前的哮喘诊断。
在201例FEM（n = 72）或FEP（n = 129）患者中，50例（24.9%）先前被诊断为哮喘。哮喘患病率在诊断类型（24.8%的BD患者 vs. 25.0%的SZ患者；P = 0.976）或性别（男性22.4% vs. 女性31.5%，P = 0.189）方面无差异。哮喘患者在首次发作前更有可能患有先前的精神疾病（P = 0.008），尤其是抑郁症（P = 0.006）。在首次发作年龄方面，发现性别与哮喘之间存在显著的交互作用，患有哮喘的女性发病明显更早（F [1,197] = 8.20，P = 0.006）。在排除首次发作前没有至少一年随访的患者的敏感性分析中，这些发现仍然显著。
在我们的队列中，先前哮喘很常见，并且与BD或SZ女性患者的精神疾病负担增加和发病年龄提前有关。这些发现突出了在先前疾病病程中需要考虑的重要共病模式，以及对严重精神疾病潜在的炎症和性别特异性机制进行进一步研究的必要性。
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