Contributions
Abstract: 72
Type: Oral
Abstract Category: Clinical aspects of MS - Paediatric MS
Background: The profile of psychiatric disorders associated with multiple sclerosis (MS) may differ in children, where the pathophysiology occurs during a key period of CNS development.
Objective: To assess the risk of psychiatric disorders in children with MS and other demyelinating diseases, and vice versa.
Methods: We analysed linked English Hospital Episode Statistics, and mortality data, 1999-2011. Cohorts were constructed of children (age < 18) admitted with MS and other CNS demyelinating diseases. We searched for any subsequent episode of care with psychiatric disorders in these cohorts, and compared to a reference cohort.
Results: We included 201 children in the MS cohort, 1097 children in the CNS demyelinating diseases cohort, and >1.1 million children in the reference cohort. Children with a demyelinating disease had an increased risk of psychotic disorders (standardised rate ratio (RR) 5.77 (95% CI 2.48-11.41), p< 0.001), anxiety, stress-related and somatoform disorders (RR=2.38 (1.39-3.81), p< 0.001), intellectual disability (RR=6.56 (3.66-10.84), p< 0.001), other behavioural disorders (RR=8.99 (5.13-14.62), p< 0.001), and an elevated rate of any of the studied psychiatric disorders (RR=1.56 (1.24-1.94), p=0.0001). These remained significant with a 1 year minimum interval between first demyelinating disease episode and first psychiatric disorder episode, and remained significant for psychotic disorders, intellectual disability and other behavioural disorders with a minimum 5 year interval. In analysis of the paediatric MS cohort as the exposure, there were elevated rates of psychotic disorders (RR=10.76 (2.93-27.63), p< 0.001), mood disorders (RR=2.57 (1.03-5.31), p=0.022) and intellectual disability (RR=6.08 (1.25-17.80), p=0.004)). In reverse analyses, there were elevated rates of demyelinating diseases after anxiety, stress-related and somatoform disorders (RR 3.15 (1.70-5.39), p< 0.001), ADHD (RR 3.88 (1.75-7.48), p< 0.001), autism (RR 3.80 (2.05-6.50), p< 0.001), intellectual disability (RR 6.33 (2.86-12.21), p< 0.001), other behavioral disorders (RR 8.30 (5.17-12.75), p< 0.001), and for any of the studied psychiatric disorders (RR 2.15 (1.70-2.72), p< 0.001).
Conclusions: This population-based study reports strong evidence for an association between paediatric CNS demyelinating diseases and psychiatric disorders. We highlight a need for early involvement of mental health professionals as part of a multi-disciplinary care approach.
Disclosure: This study received no specific funding. The building of the linked datasets, and the development of the analytical software used to study disease associations, was funded by the English National Institute for Health Research (ref RNC/035/002).
All authors declare that they have no relevant disclosures/potential conflicts of interest.
Julia Pakpoor: Nothing to disclose.
Raph Goldacre: Nothing to disclose.
Klaus Schmierer: Nothing to disclose.
Gavin Giovannoni: Nothing to disclose.
Emmanuelle Waubant: Nothing to disclose.
Michael Goldacre: Nothing to disclose.
Abstract: 72
Type: Oral
Abstract Category: Clinical aspects of MS - Paediatric MS
Background: The profile of psychiatric disorders associated with multiple sclerosis (MS) may differ in children, where the pathophysiology occurs during a key period of CNS development.
Objective: To assess the risk of psychiatric disorders in children with MS and other demyelinating diseases, and vice versa.
Methods: We analysed linked English Hospital Episode Statistics, and mortality data, 1999-2011. Cohorts were constructed of children (age < 18) admitted with MS and other CNS demyelinating diseases. We searched for any subsequent episode of care with psychiatric disorders in these cohorts, and compared to a reference cohort.
Results: We included 201 children in the MS cohort, 1097 children in the CNS demyelinating diseases cohort, and >1.1 million children in the reference cohort. Children with a demyelinating disease had an increased risk of psychotic disorders (standardised rate ratio (RR) 5.77 (95% CI 2.48-11.41), p< 0.001), anxiety, stress-related and somatoform disorders (RR=2.38 (1.39-3.81), p< 0.001), intellectual disability (RR=6.56 (3.66-10.84), p< 0.001), other behavioural disorders (RR=8.99 (5.13-14.62), p< 0.001), and an elevated rate of any of the studied psychiatric disorders (RR=1.56 (1.24-1.94), p=0.0001). These remained significant with a 1 year minimum interval between first demyelinating disease episode and first psychiatric disorder episode, and remained significant for psychotic disorders, intellectual disability and other behavioural disorders with a minimum 5 year interval. In analysis of the paediatric MS cohort as the exposure, there were elevated rates of psychotic disorders (RR=10.76 (2.93-27.63), p< 0.001), mood disorders (RR=2.57 (1.03-5.31), p=0.022) and intellectual disability (RR=6.08 (1.25-17.80), p=0.004)). In reverse analyses, there were elevated rates of demyelinating diseases after anxiety, stress-related and somatoform disorders (RR 3.15 (1.70-5.39), p< 0.001), ADHD (RR 3.88 (1.75-7.48), p< 0.001), autism (RR 3.80 (2.05-6.50), p< 0.001), intellectual disability (RR 6.33 (2.86-12.21), p< 0.001), other behavioral disorders (RR 8.30 (5.17-12.75), p< 0.001), and for any of the studied psychiatric disorders (RR 2.15 (1.70-2.72), p< 0.001).
Conclusions: This population-based study reports strong evidence for an association between paediatric CNS demyelinating diseases and psychiatric disorders. We highlight a need for early involvement of mental health professionals as part of a multi-disciplinary care approach.
Disclosure: This study received no specific funding. The building of the linked datasets, and the development of the analytical software used to study disease associations, was funded by the English National Institute for Health Research (ref RNC/035/002).
All authors declare that they have no relevant disclosures/potential conflicts of interest.
Julia Pakpoor: Nothing to disclose.
Raph Goldacre: Nothing to disclose.
Klaus Schmierer: Nothing to disclose.
Gavin Giovannoni: Nothing to disclose.
Emmanuelle Waubant: Nothing to disclose.
Michael Goldacre: Nothing to disclose.