7955 Increased occurrence of psychiatric disorders and use of psychiatric-related medication in patients with congenital adrenal hyperplasia

Abstract

Abstract Disclosure: M. Lind-Holst: None. D. Hansen: None. K.M. Main: None. A. Juul: None. M. Andersen: None. M. Dunø: None. Å.K. Rasmussen: None. N. Jørgensen: None. C.H. Gravholt: None. A. Berglund: None. Background: Clinical studies on psychiatric morbidity, quality of life and cognition in patients with congenital adrenal hyperplasia (CAH) imply impaired mental health. Epidemiological studies on psychiatric morbidity in CAH are, however, scarce. Methods: A registry study of hospital diagnoses and prescribed medication related to psychiatric disorders in a national cohort of patients (n=462) diagnosed with CAH from 1943 to 2018 compared to 100 randomly selected sex- and age-matched controls (n=44,527) from the general population. Psychiatric hospital diagnoses were available for in-patient contacts from 1968 and out-patient contacts from 1994. Medication data were available from 1995. Outcomes: CAH was associated with an increased risk of hospital contacts related to any psychiatric diagnosis (incidence rate ratio (IRR)=2.73, 95% CI 1.85-4.04), and this applied to both males (IRR=2.48, 95% CI 1.57-3.91) and females (IRR=3.20, 95% CI 1.58-6.50). Psychiatric disorders due to psychoactive substance use were more common among CAH males (IRR=3.55, 95% CI 1.58-7.96) and females (IRR=3.81, 95% CI 1.71-8.48). Males with CAH also had an increased risk of suicidal behaviour (IRR=10.66, 95% CI 3.74-30.42). By the age of 30 years, 23% of CAH females and 21% of CAH males had at least one diagnosis related to a psychiatric disorder while this was the case in 14% of female controls and 15% of male controls. Stratifying by sex and CAH phenotype there were important differences among groups. Prescription of medication related to psychiatric disorders was increased for CAH overall (HR=1.73, 95% CI 1.48-2.03) and males (HR=1.80, 95% CI 1.35-2.38) and females (HR=1.70, 95% CI1.36-2.38), separately. Age at the first prescription of any psychiatry-related medication was significantly earlier for patients than for controls (HR males=1.67, 95% CI 1.2-2.3; HR females=1.48, 95% CI 1.2-1.8). Thirty-five per cent (157/448) of CAH patients and 24% of controls had at least one prescription related to a psychiatric disorder within the study period. Interpretation: An increased risk of psychiatric morbidity, psychoactive substance use and use of medication related to poor mental health was seen in both males and females with CAH. The risk of suicidal behaviour was increased for patients with CAH, yet only significantly in CAH males. The study underlines the need for more attention and extension of psychological care and support for patients with CAH. Presentation: 6/1/2024