Afectaciones psiquiátricas en pacientes con esclerosis múltipleasociación entre ansiedad, depresión, manifestaciones clínicas de la enfermedad y calidad de vida

Abstract

Introduction: MS is a chronic and degenerative CNS disease that causes axonal damage in various locations of the brain and spinal cord. In many cases, the course of the disease is chronic and degenerative, so over time, the individual accumulates a higher degree of disability. When a person with MS suffers from depressive or anxious symptoms, their quality of life is greatly reduced, and adherence to treatment and disease prognosis are potentially worsened. Symptoms related to depression and anxiety can overlap or be confused with some clinical manifestations of MS such as fatigue, cognitive decline, and sleep problems, which complicates the diagnosis and managing of psychiatric symptomatology. Understanding the prevalence of depressive and anxious symptoms in patients with MS, and their interaction with the clinical manifestations of the disease, is of particular importance. This is because, despite the existence of relevant research, the results obtained exhibit high heterogeneity, and models have not been formulated taking into account all potentially related variables Likewise, understanding the impact of anxious and depressive symptoms on the quality of life of patients with MS, independently of the effect of disease symptoms, will increase the evidence about the relevance of psychiatric conditions in MS. These are still largely undervalued in routine practice. Objective: The general objective of this doctoral thesis was to study the prevalence of depression and anxiety in a sample of adult MS patients, as well as their relationship with other clinical manifestations of MS and their impact on quality of life. Method: This research employed an observational methodology through the execution of a multicentric cross-sectional descriptive study, including 200 MS patients from two university hospitals in the Region of Murcia. To be included in the study, patients had to have a diagnosis of RRMS, SPMS, or PPMS and be over 18 years old. After informed consent, data on sociodemographic characteristics, clinical history, MS activity and treatment, depression, anxiety, clinical manifestations of MS (degree of disability, ambulatory ability, manual dexterity, cognitive functioning, fatigue, sleep quality, drowsiness) and quality of life were collected. Potential depression cases identified by scales or by the specialist neurologist were evaluated by the clinician (psychiatrist). A descriptive analysis of the sample characteristics was conducted. Prevalence rates and severity scores for anxious and depressive symptomatology were calculated. A comparative study was carried out between both measures of depression and the clinical diagnosis in a subsample of patients. The relationship between depression and anxiety with clinical manifestations of MS and their effect on quality of life was analyzed using bivariate (correlation and comparison of means) and multivariate analyses (construction of multiple regression models). Finally, bivariate analyses were carried out to examine the influence of sociodemographic variables, clinical history, and variables related to MS activity and treatment. Conclusions: Depression and anxiety are highly common psychiatric conditions and produce a significant impact on the quality of life of patients with MS, especially depressive symptoms. Additionally, the presence of these symptoms seems to be somewhat independent of socio-demographic characteristics or those related to the course of MS. Fatigue, sleep issues, and to a lesser extent, cognitive impairment, exponentially increase the likelihood of the patient suffering from depression and/or anxiety. Therefore, it is necessary to screen for these symptoms using validated and adapted instruments for this population. In this way, it will be possible to initiate early treatment of psychiatric symptoms, preventing their negative effects on the course and treatment of MS.