Psychiatric Disorders Emerge Early in MOGAD

TOPLINEPsychiatric comorbidities were common in patients with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), with depression, anxiety, and attention-deficit/hyperactivity disorder (ADHD) most prevalent, a study showed. Most psychiatric disorders emerged within the first year after neurologic onset and were associated with a higher attack frequency.METHODOLOGYA cross-sectional comparative study analyzed data of 388 patients with MOGAD, 257 age- and sex-matched patients with relapsing-remitting multiple sclerosis (RRMS), and 58 unmatched patients with aquaporin-4 immunoglobulin G (AQP4-IgG) seropositive neuromyelitis optica spectrum disorder (NMOSD) assessed at Mayo Clinic (1991-2025).Researchers extracted psychiatric diagnoses from electronic medical records, including depression, anxiety, ADHD, suicidality, bipolar disorder, posttraumatic stress disorder (PTSD), substance use disorders, schizophrenia, personality disorders, and insomnia.Onset latencies of psychiatric disorders were calculated relative to the first neurologic attack, with disorders occurring at or after first attack classified as new psychiatric comorbidities.Analysis included temporal distribution of psychiatric disorder onset across predefined time windows (>10 years before, 5-10 years before, 1-5 years before, within 1 year before, within 1 year after, 1-5 years after, 5-10 years after, and >10 years after neurologic onset).A large de-identified electronic health record database named NeuroBlu was used to validate findings, including 254 patients with MOGAD, 134,351 with multiple sclerosis (MS), and 2,255 with NMOSD.TAKEAWAYIn the full MOGAD cohort, 54.8% of individuals had at least one psychiatric disorder, most commonly anxiety (47.7%), depression (36.6%), and ADHD (9%). A total of 33.3% developed a new psychiatric disorder after the first attack.The onset of psychiatric disorders peaked within 12 months after first relapse in MOGAD (11.3% of patients), compared with 3.9% in RRMS during the same period (odds ratio [OR], 3.11; P = .003). In RRMS, psychiatric disorders frequently preceded neurologic onset by 5-10 years (6.6% of patients vs 2.3% in MOGAD; OR, 0.35; P = .028).A higher number of attacks was independently associated with new psychiatric comorbidities after adjustment for age at onset, migraine, and optic neuritis at onset.In the NeuroBlu dataset, patients with MOGAD had lower rates of depression but higher rates of anxiety and ADHD than patients with MS. Compared with patients with NMOSD, those with MOGAD also had lower rates of depression, higher rates of ADHD, but similar rates of anxiety.IN PRACTICE"Psychiatric comorbidities are common in MOGAD, particularly depression and anxiety, typically emerging close after onset, whereas in MS often preceded onset by years. These findings underscore the need for routine psychiatric screening in MOGAD," the authors wrote.SOURCEThe study was led by Moritz Niederschweiberer, Mayo Clinic, Rochester, Minnesota. It was published online on August 13 in the Journal of Neurology, Neurosurgery, and Psychiatry.LIMITATIONSThe study was limited by its retrospective design, absence of longitudinal tracking of symptoms, reliance on clinician-entered documentation, gaps in early psychiatric history of older cases with NMOSD or MS, and lack of accounting for potential confounders such as chronic pain and socioeconomic status.DISCLOSURESThe study was funded by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health. Several authors reported having financial or other ties with various organizations. Details are provided in the original article.This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.