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1 mai 2011 7 01 /05 /mai /2011 10:19
Zona et psychose : plus qu'une coïncidence

Une étude rétrospective taïwanaise a permis de quantifier le risque d'infection à virus varicelle zona (VVZ) dans une population de malades atteints de troubles psychiatriques. La cohorte, qui se compose de plus de 42 300 patients de plus de 18 ans souffrant d'une maladie psychiatrique diagnostiquée depuis 2004 a été comparée à une cohorte témoin de 169 360 personnes.

Après élimination des éventuels facteurs confondants tels que existence d'une affection hématologique ou de traitements immunosuppresseurs au long cours, apparaît une augmentation du risque de zona dans la population des malades psychiatriques par rapport aux contrôles (hazard ratio (HR), 1,29; IC 95 % : 1,18-1,38).

L'analyse par sous groupe en fonction des pathologies psychiatriques montre que l'association reste significative chez les patients de moins de 60 ans qu'ils soient affectés de psychose affective, de névrose grave ou de troubles de la personnalité. En revanche au-delà de 60 ans, l'association zona et maladie psychiatrique n'est significative que chez les malades présentant des états névrotiques et des troubles de la personnalité.

Cette association entre maladie psychiatrique et infection à VVZ vient corroborer le concept d'une immunité cellulaire déficiente chez les patients souffrant d'affections psychiatriques.

 

29/04/11
(JIM)
Dr Patrice Plantin


Yang YW et coll. : Risk of herpes zoster among patients with psychiatric diseases: a population-based study. JEADV 2011; 25: 447-63

 

J Eur Acad Dermatol Venereol. 2011 Apr;25(4):447-53. doi: 10.1111/j.1468-3083.2010.03811.x.

Risk of herpes zoster among patients with psychiatric diseases: a population-based study.

Source

Department of Dermatology, Taipei Medical University Hospital, Taipei, Taiwan.

Abstract

BACKGROUND:

Psychiatric disorders have been shown to be associated with impaired immune response, including decreased cellular immunity to varicella-zoster virus. However, the risk of herpes zoster (HZ) in psychiatric patients is, to date, unknown.

OBJECTIVE:

The aim of this study was to determine the risk of herpes zoster (HZ) in psychiatric patients compared with the general population.

METHODS:

We used data from the Taiwan Longitudinal Health Insurance Database from 2004 to 2006. Our study cohort consisted of patients aged 18 years and older diagnosed with psychiatric disorders in 2004 (N=42 340). The comparison cohort (N=169 360) consisted of four age- and gender-matched controls randomly selected for every patient in the study cohort. All subjects were followed from the date of cohort entry until they developed HZ or the end of 2006, whichever was earliest. Stratified Cox proportional hazard regressions were performed to compute the 2-year HZ-free survival rates.

RESULTS:

After adjusting for potential confounders, we found patients with psychiatric disorders were more likely to have an episode of HZ than the control population [adjusted hazard ratio (HR), 1.29; 95% confidence interval (CI), 1.18-1.38]. When stratified by age and psychiatric diagnostic categories, in patients aged ≤60 years, the adjusted HRs for HZ were 1.34 (P=0.026) for patients with affective psychoses, 1.42 (P<0.001) for those with neurotic illness or personality disorders and 1.53 (P<0.001) for patients with other mental disorders. However, in patients aged >60years, only neurotic illness or personality disorders were significantly associated with an increased risk of HZ (adjusted HR, 1.26; P=0.003).

CONCLUSIONS:

Our analysis suggests that patients with psychiatric disorders are at increased risk of HZ, especially those aged ≤60 years. Further study is required to elucidate the nature of this association.

© 2010 The Authors. Journal of the European Academy of Dermatology and Venereology © 2010 European Academy of Dermatology and Venereology.

PMID:
 
20666877
 
[PubMed - in process]


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