Psychiatric Comorbidities in Patients With Idiopathic Intracranial Hypertension: A Prospective Cohort Study

BACKGROUND AND OBJECTIVES: Psychiatric disease is a frequent co-morbidity in idiopathic intracranial hypertension (IIH) and has been associated with a poor subjective outcome. No prospective studies have investigated psychiatric co-morbidities in new-onset IIH. Our primary aim was to investigate disease severity in IIH depending on co-morbid 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 two headache centers. A standardized diagnostic work-up was completed to confirm or exclude IIH according to the revised Friedman criteria: semi-structured interview, neurological and neuro-ophthalmological exam, lumbar puncture with opening pressure, neuroimaging. Exclusion criteria were known IIH, secondary intracranial hypertension, missing data, pregnancy. Disease severity was evaluated based on papilledema, visual fields, opening pressure and headache in IIH patients without psychiatric disease (IIH-P) compared to IIH patients 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: 258 patients were screened, 69 were excluded. 189 patients with clinically suspected IIH were then evaluated with the diagnostic work-up, and IIH was confirmed in 111 patients (58.7%). 45% of IIH patients had a psychiatric co-morbidity. Visual fields were worse in patients with IIH+P at baseline (-8.0 versus -6.0 dB, p = 0.04) and after 6 months (-5.5 versus -4.0 dB, p < 0.01) compared to 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 to IIH-P. Psychiatric co-morbidities, 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.