Psychiatric event in multiple sclerosis: could it be the tip of the iceberg?

Abstract

Multiple sclerosis (MS) is a chronic progressive inflammatory disease of the central nervous system. Psychiatric comorbidities are highly prevalent in patients with MS, and can have drastic impact on quality of life and interpersonal relationships. Despite this high prevalence, whether psychiatric manifestations may represent the first signs of MS is still debatable. This constitutes an important issue, since early diagnosis of ''psychiatric-onset MS'' would result in prompt management, which usually ameliorates long-term prognosis. Here, we discuss clinical and radiological hints that suggest a diagnosis of psychiatric-onset MS. Briefly, this entity should be considered in healthy patients presenting with late-onset psychiatric symptoms, with or without cognitive decline, and with negative family history of psychiatric diseases. A thorough neurological exam is crucial to detect any subtle neurological signs. Brain magnetic resonance imaging is recommended to rule out frontotemporal lesions that might explain the clinical picture. Poor response to standard psychiatric treatments provides additional evidence for the diagnosis of an organic disease (e.g., MS). Combining psychopharmaceuticals with intravenous corticosteroids would result in good outcomes, but patients should be monitored carefully for possible psychiatric exacerbation, a common side effect of steroids.

Associated Psychological Disorders and Impairment of Emotional Regulation among Patients with Multiple Sclerosis

“…Посттравматическое стрессовое расстройство (ПТСР). В ряде случаев выраженные тревога и депрессия, развивающиеся как нозогенные реакции на факт заболевания и его прогноз, могут приводить к формированию ПТСР у пациентов с РС [2,23].…”

“…[41,52] При этом обострения могут протекать как с полным, так и с неполным клиническим восстановлением, что может приводить к постепенному накоплению неврологического дефицита, способствовать нарушению социального функционирования. Зачастую патологический процесс влечет нарушения двигательной сферы, координации, изменения работы тазовых органов, чувствительные расстрой-DOI : 10.31363/2313-7053-2019-4-2- [19][20][21][22][23][24][25][26][27][28] Научные обзоры ства, а также нарушения в эмоционально -волевой и когнитивной сферах [48].…”

Fatigue and Affective Manifestations in Multiple Sclerosis—A Cluster Approach

“…The last century has witnessed a growing literature on the existence of a potential link between MS and psychiatric manifestations [4]. Among these manifestations, anxiety and depression are of particular interest, could respectively affect 41%-50% of MS patients, and would be responsible for a deep suffering [5]. Compared to the general population, lifetime prevalence of major depressive disorders, anxiety disorders, and suicidal attempts are higher in MS patients (rates being double those reported in the general population).…”

“…Although one might perceive anxiety and depression as logical consequences of, or pure reactions to, a chronic debilitating illness, this perception should be adopted with caution and could not explain by itself the occurrence of these symptoms. Several reports have documented the existence of psychiatric relapses in the context of MS [5], pointing towards the presence of destructive lesions behind the emergence of these symptoms. Apart from the acute onset of depressive or anxious episodes, pathological changes (i.e., demyelinating lesions and axonal generation) usually accumulate along the disease course and might contribute to an insidious development and progressive aggravation of these affective manifestations.…”

The relationship between multiple sclerosis and neuropsychiatric syndromes

“…The update article by Chalah & Ayache 3 comprehensively examines the existing literature on the concept of a ''psychiatric attack'' preceding an initial presentation of MS. Even though psychiatric disorders usually present subsequent to a diagnosis of MS, up to 2% of individuals experience a first presentation of MS consisting solely of psychiatric symptoms.…”