[Validation of EHD self questionnaire in multiple sclerosis]. / Validation de l'Echelle d'Humeur Dépressive (EHD), version autoquestionnaire, dans la sclérose en plaques.

Depressive Mood Scale (EHD) aims at assessing the various depressive mood dimensions as "blunted affect" and "lack of emotional control". It is an 18 items hetero-evaluation scale. The aim of this study was the validation of an EHD self questionnaire version. Self questionnaire items were generated from genuine scale items. As in the former version, response format was a Lickert 5 point scale. This validation study was carried out on 77 Multiple Sclerosis (MS) patients. Mood disorders are frequent during the course of MS and might be triggered or worsened by immuno-modulation therapies. Principal Component Analysis (ACP) with Varimax rotation revealed a two factors structure. The first one, corresponding to a "blunted affect" dimension, explained 33.5% of the scale variance and was composed of 7 items. The second one, corresponding to a "lack of emotional control" dimension, explained 20% of total scale variance and was composed of 4 items. The questionnaire internal coherence coefficient (Cronbach alpha) was excellent (=0.87) and the two sub-scales ones were satisfactory [0.89 for "blunted affect" dimension and 0.71 for "lack of emotional control" dimension. The questionnaire's external validity was confirmed by a positive correlation between "lack of control" sub-score and state sub-score of the Stait-Trait Anger eXpression Inventory (STAXI)] (r=0.55, p<0.01). Moreover we found a positive correlation between the total EHD autoquestionnaire score and both sub-scores on the one hand, and the Beck Depression Inventory score on the second hand (EHD/BDI: r=0.76, p<0.01; "lack of emotional control"/BDI: r=0.68, p<0.01; "blunted affect"/BDI: r=0.63, p<0.01). Test-retest reliability was good with a positive correlation between all the initial scores and their retests, a week later. Secondarily, a structural equation modeling analysis confirmed the two-factors structure model suggested by ACP. Various indicators showed a good fit between theoretical variance-covariance matrix and the observed one (chi(2)=41.55, p=0.49, ddl=42, Goodness Fit Index GFI=0.91, Root Mean Square Residual RMSEA=0.00). Thus, we proposed a well validated self questionnaire that allows the assessment of "blunted affect" and "lack of emotional control". It should be challenging to correlate those dimensions with neuro-psycho-logical testing and neuro-imagery, in patients affected by CNS diseases. Moreover, the assessment of those dimensions during interferon treatment in MS could allow a more precise evaluation of the emotional changes potentially induced by immuno-modulatory treatments.

[Headache and transformed migraine with medication overuse: what differences between disability, emotional distress and coping?]. / Migraine et migraine transformée avec abus médicamenteux: quelles différences en termes de handicap, de détresse emotionnelle et de stratégies de coping?

LITERATURE FINDINGS: Twelve percent of general population is estimated to suffer from migraine (Henryet al., 2002), which represent in France 6 to 7 millions of individuals. Transformed migraine (TM) with medication overuse is a complication of migraine characterized by an increase of crisis frequency and by a parallel increase of medication intake. French prevalence of TM with analgesic overuse seems to reach up to 3% of general population (Lanteri-Minet, 2003). TM is associated with an increased disability (concerning housework, leisure, job and social activities). Moreover TM is associated with a bad emotional adjustment, which can lead to anxiety and depressive disorders. Those disorders have been founded to be more frequent in TM than in simple migraine (Radatet al., 1999). As a consequence, TM patients's quality of life is severely impaired. The use of dysfunctional coping strategies against pain should explain bad emotional adjustment in those patients. One study have found a statistical relationship between dysfunctional coping strategies such as nd depressive disorders in migraineurs (Materazzo et al., 2000). METHOD: The aim of this study was to compare 30 simple migraineurs (SM) to 32 transformed migraineurs with medication overuse (TM) for impairment, emotional adjustment and coping strategies. Patients have been assessed with Pain Disability Inventory (PDI) (Pollard et al., 1984), Hospital Anxiety Depression scale (HAD) (Zigmond and Snaith, 1983) and Coping Strategies Questionnaire (CSQ) (Rosentiel and Keefe, 1983). RESULTS: Principal Component Analysis (SPSS Software) confirms the good psychometric properties of PDI and HAD in headache patients. Statistical analysis shows higher emotional distress scores (HAD mean score = 32,2 +/- 10,9) in TM than in SM (24, 1 +/- 7,3) (p < 0,001). Both groups didn't use the same coping strategies against pain. TM were characterized by the use of "dramatisation", "distraction" and "pray", which are considered as dysfunctional coping strategies, although SM used "reinterpretation" which is associated with a better adjustment in term of disability and emotional distress (Riley et al., 1999). CONCLUSION: These results suggest that dysfunctional coping strategies in TM should explained the increased prevalence of emotional distress in this population. It should be of an utmost interest to assess temporal evolution of coping strategies after medication withdrawal. Withdrawal is the main therapeutical measure proposed to TM patients. It should also be supposed that behavioural changes related to medication with drawal evolve in parallel with changes in the use of coping strategies against pain.

Psychiatric comorbidity in the evolution from migraine to medication overuse headache.

We set out to study the role of psychiatric comorbidity in the evolution of migraine to medication overuse headache (MOH) by a comparative study of 41 migraineurs (MIG) and 41 patients suffering from MOH deriving from migraine. There was an excess risk of suffering from mood disorders [odds ratio (OR) = 4.5, 95% confidence interval (CI) 1.5, 13.5], anxiety (OR = 5, 95% CI 1.2, 10.7) and disorders associated with the use of psychoactive substances other than analgesics (OR = 7.6, 95% CI 2.2, 26.0) in MOH compared with MIG. Retrospective study of the order of occurrence of disorders showed that in the MOH group, psychiatric disorders occurred significantly more often before the transformation from migraine into MOH than after. There was no crossed-family transmission between MOH and psychiatric disorders, except for substance-related disorders. MOH patients have a greater risk of suffering from anxiety and depression, and these disorders may be a risk factor for the evolution of migraine into MOH. Moreover, MOH patients have a greater risk of suffering from substance-related disorders than MIG sufferers. This could be due to the fact that MOH is part of the spectrum of addictive disorders.