by Sharon Roman[i]
In recent years, compelling evidence of a measurable, symptomatic stage of multiple sclerosis (MS) that occurs prior to classic MS symptom onset has emerged—a stage known as a prodrome. A prodrome is an early, often nondescript set of signs and symptoms that indicate onset of a disease. While psychiatric conditions including depression and anxiety are common after receiving a diagnosis of MS, little is known about the prodromal phase. Previous work has raised the possibility of a psychiatric component to the MS prodrome. For example, in the 5-years before MS onset, those developing MS versus those who did not, had 50% more visits to a psychiatrist and were more likely to fill a prescription related to the ‘nervous system’ (which included, among other medications, the antidepressants). However, much remains unknown. A better understanding of psychiatric conditions in MS is vital, especially as they can reduce quality of life and impact disease progression—prompt management may benefit both short and long-term health outcomes. The aim of this study was to investigate, in more detail than ever before, psychiatric conditions and psychiatric-related health-care use in those with MS compared to those without in the 5-years before MS onset.
Using administrative health data from all people living in the province of British Columbia, Canada, and data from people who visited one of 4 MS clinics in the region, 7,829 people with MS were identified; 6,863 formed the ‘administrative’ group and 966 formed the ‘clinical’ group. As expected, the majority (over 70%) were women. Each person with MS was matched with up to 5 people without MS by age, sex, and the neighbourhood where they lived. The researchers compared yearly numbers of doctors’ visits for psychiatric conditions (depression, anxiety, bipolar disorder, and schizophrenia), visits to psychiatrists, psychiatric-related hospitalizations and all psychiatric-related prescriptions in the 5-years before MS onset to those without MS.
Psychiatric conditions and related health-care use higher in those with MS in the prodromal phase
In both the administrative and the clinical groups, the use of psychiatric-related health-care was higher for those with MS compared to those without MS—for each of the 5-years before MS onset. Over the entire 5-year period, in the larger administrative MS group, 28% had a psychiatric condition compared to 15% for those without MS; in the clinical MS group, 22% had a psychiatric condition compared to 14% in those without MS. In addition, as the MS onset date approached, the differences rose steadily.
In those with MS from the administrative group, the presence of psychiatric conditions (measured as a prevalence ratio) was 91% higher than in those without MS in the 5-years before MS onset; similar results were observed for the clinical group. Health-care use was also higher for the administrative MS group compared to those without MS in each year before MS onset.
- Doctors’ visits for any psychiatric condition were 78% higher in the 5th year before MS onset, rising to 124% higher in the year before MS onset.
- Visits to psychiatrists were 132% higher in the 5th year before MS onset and 146% higher in the year before.
- Psychiatric-related hospitalizations were 129% higher in the 5th year before MS onset and 197% higher in the year before.
- Psychiatric-related prescriptions dispensed were 72% higher in the 5th year before MS onset and 100% higher in the year before.
Results did not reach statistical significance for the smaller clinical group.
Psychiatric conditions may be a feature of the MS prodrome
Few studies have examined psychiatric conditions in the years before MS onset. This large population-level study using both administrative and clinical data, in a universal healthcare setting, found that psychiatric-related health-care use was higher in those with MS than in those without in each of the 5-years before MS symptom onset. Additionally, these differences rose steadily over the 5-year period as MS onset approached, and were evident for a range of psychiatric conditions and related health-care use, including doctors’ visits, hospitalizations and prescription medications dispensed.
This study demonstrates differences in psychiatric-related health-care use for an entire population between those with MS and those without in the 5-years before MS onset, substantially advancing previous work and understanding of the early stage of the disease. The ability to better identify people in the prodromal phase of MS may allow for earlier recognition, diagnosis, and treatment. These findings suggest that psychiatric conditions contribute to significant healthcare use very early in the MS disease course and may be a feature of the MS prodrome.
[i] Vancouver, BC, Canada
Twitter: @SRoman_SPQR
Psychiatric Comorbidity During the Prodromal Period in Patients With Multiple Sclerosis Anibal S Chertcoff, Fardowsa Yusuf, Feng Zhu, Charity Evans, John D. Fisk, Yinshan Zhao, Ruth Ann Marrie, Helen Tremlett Neurology Sep2023, 10.1212/WNL.0000000000207843; DOI: 10.1212/WNL.0000000000207843
Tremlett's MS Research Explained 