Neuropsychiatric Symptoms of Multiple Sclerosis: State of the Art

Abstract

Multiple Sclerosis (MS) is a chronic disabling neuroinflammatory disease. Psychiatric manifestations have a high prevalence in MS patients and may worsen the illness progression and the patients’ quality of life (QoL). Depression is a highly prevalent condition in MS patients, associated with poorer adherence to treatment, decreased functional status and QoL, and increased suicide risk. Diagnosis and treatment of this disorder is challenging because of symptom overlap. Other prevalent psychiatric comorbidities are anxiety disorders, bipolar disorder, psychotic disorders, substance misuse and personality disorders. As the illness progresses, personality changes can happen, as well as affect abnormalities. Cognitive changes occur frequently in MS patients, and affect features like processing speed, attention, learning, memory, visual spatial capabilities, and some language deficits. Disease-modifying treatments may reduce cognitive impairment because of their container action on the brain’s lesion burden. Other QoL determinants such as fatigue, pain, sexual dysfunction, exercise, resilience and social support should be taken into account, in order to promote the individuals’ well-being. Further studies are needed in order to elucidate the effectiveness of pharmacotherapy and more neuroimaging studies are required to clarify the relationship between structural changes and psychiatric comorbidities.

Associations between psychiatric disorders, COVID-19 testing probability and COVID-19 testing results: findings from a population-based study

“…One example would be the high rates of depressive symptoms in Parkinson's disease 32 and multiple sclerosis. 33 Furthermore, dementias and other types of brain disorders causing behavioral symptoms are grouped within psychiatric disorders in ICD-10; 24 these show high degrees of symptom overlap with van der Meer et al neurodegenerative disorders, especially regarding mood and cognitive functioning. 34,35 Therefore, people with neurological conditions, either comorbid with psychiatric conditions or presenting symptomatology overlapping with psychiatric symptoms, being both within the realm of brain functioning, would be expected to be affected similarly in the context of COVID-19.…”

Patient and Provider Insights into the Impact of Multiple Sclerosis on Mental Health: A Narrative Review

“…Research on the prevalence of mental health disorders reports variable data, in part due to the study population, study size, or type of screening test used. While prevalence rates may vary between studies, it is generally accepted that mood and mental health disorders may be more likely for people living with MS than for the general population [ 7 , 8 , 17 ]. In Table 1 , we reference approximate prevalence rates and signs/symptoms for each mental health disorder discussed and share patient perspectives with the objective to familiarize the MS care team with the language patients may use to convey their experience.…”

“…The depressed times were like dark periods of times that were semi-connected to me…I would comply with my appointments during my periods of depression, but it was almost robotically. I was not able to shed much light on the previous 6 months or a year because I did not really remember” Anxiety (e.g., panic attacks, phobias, obsessive-compulsive disorder, and generalized anxiety disorder) ~ 22.1% [ 31 ]; 3 times higher than general population [ 8 ] Physiological: trembling, increased heart rate, dry mouth, shortness of breath, nausea, hot/cold sensations, tingling in fingers or toes, lightheadedness, faintness/fatigue, muscular tension, restlessness, insomnia, or frequent urination Psychological: chronic unhappiness, frequent worry/guilt or feeling out of control, indecisiveness, feeling inadequate or easily embarrassed, rigidity, hostility, repetitive behavior or ruminating, over-anticipation, excessive concern with physical health, negative thinking about the future, or racing thoughts [ 34 ] “With COVID in play, the increased potential for anxiety in social situations (someone is not wearing a mask or their idea of ‘social distancing’ is not the same as mine) has risen. Also, for many of us, there is heightened concern that our DMT may have us at greater risk for developing COVID-19 than others may experience.” “Although, I am aware of pseudo-exacerbation if I feel something new or different with my body, it is easy for me to project on how [disease progression] will affect me well into the future” Adjustment disorder ~ 22% [ 40 ] Rebellious or impulsive actions, anxiousness, feelings of sadness/hopelessness, crying, withdrawn attitude, lack of concentration, loss of self-esteem, suicidal thoughts, insomnia, muscle twitches or trembling, fatigue, body pain/soreness, or indigestion following a stressful life event/diagnosis [ 42 ] “I thought I had landed in the ideal place for my health, educational growth, vocational goals, and spirituality.…”

“…In this review, we focus on mood and mental health disorders, as they are a vital component of overall health yet are often overlooked. People living with MS are more likely than the general population to experience certain mood and mental health disorders; these conditions can include, but are not limited to, elevated/chronic stress levels, depression, anxiety, adjustment disorder, psychosis, and suicidal ideation [ 7 , 8 ]. Depression and stress can also exacerbate the difficulties of managing bipolar disorder, which may be more prevalent in people living with MS [ 9 ].…”

Cognitive Performance in Relapsing-Remitting Multiple Sclerosis: At Risk or Impaired?

“…The variability in CI prevalence in MS patients relies on many factors such as different diagnostic criteria and neuropsychological batteries (NBs) used, clinical heterogeneity of MS population, and time interval from relapses. Many studies aimed at identifying specific neuropsychological and neuroradiological pattern profiles peculiar to different MS subtypes gave heterogeneous results [3][4][5].…”