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Abstract
Background and Objectives 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.
Methods 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.
Results 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; p = 0.04) and after 6 months (−5.5 vs −4.0 dB; p < 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.
Discussion 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.
Glossary
- BMI=
- body mass index;
- DSM-V=
- Diagnostic and Statistical Manual of Mental Disorders, 5th Edition;
- ICD-10=
- International Classification of Diseases, 10th Revision;
- ICP=
- intracranial pressure;
- IH=
- intracranial hypertension;
- IIH=
- idiopathic intracranial hypertension;
- IIH−P=
- IIH without psychiatric disease;
- IIH+P=
- IIH with psychiatric disease;
- OP=
- opening pressure;
- PMD=
- perimetric mean deviation
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Submitted and externally peer reviewed. The handling editor was Rebecca Burch, MD.
Podcast: NPub.org/Podcast9826
- Received November 12, 2021.
- Accepted in final form March 2, 2022.
- © 2022 American Academy of Neurology
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