51
|
Paparrigopoulos T, Ferentinos P, Kouzoupis A, Koutsis G, Papadimitriou GN. The neuropsychiatry of multiple sclerosis: focus on disorders of mood, affect and behaviour. Int Rev Psychiatry 2010; 22:14-21. [PMID: 20233111 DOI: 10.3109/09540261003589323] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Neuropsychiatric symptoms are common in multiple sclerosis (MS). They include two broad categories of disturbances: abnormalities in cognition, and abnormalities of mood, affect and behaviour. The present review deals with the epidemiology, clinical features, etiology and treatment of disturbances included in the second category, i.e., major depression, fatigue and sleep disorders, bipolar disorder, euphoria, pathological laughing and crying, anxiety, psychosis and personality changes. Major depression is one of the most common neuropsychiatric disorders in MS with an approximate 50% lifetime prevalence rate. Early recognition and management of depression in MS is of major importance because it is a key predictor of morbidity, mortality, quality of life, possibly physical outcome and disease exacerbations, adherence to immunomodulatory treatments and suicide risk in MS patients, as well as of the caregiver's distress and quality of life. The etiopathogenesis of neuropsychiatric disorders in MS has been incompletely investigated. It is postulated that a complex interplay of biological, disease-related, behavioural and psychosocial factors contribute to the pathophysiology of most of them. Management of neuropsychiatric symptoms in MS is often effective, although commonly based on evidence provided by case studies and uncontrolled trials. A comprehensive biopsychosocial neuropsychiatric approach is essential for the optimal care of patients with MS.
Collapse
Affiliation(s)
- Thomas Paparrigopoulos
- First Department of Psychiatry, Athens University Medical School, 115 28, Athens, Greece.
| | | | | | | | | |
Collapse
|
52
|
Stepleman L, Rutter MC, Hibbard J, Johns L, Wright D, Hughes M. Validation of the patient activation measure in a multiple sclerosis clinic sample and implications for care. Disabil Rehabil 2010; 32:1558-67. [DOI: 10.3109/09638280903567885] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Lara Stepleman
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta, GA, USA
| | - Marie-Christine Rutter
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta, GA, USA
| | - Judith Hibbard
- Department of Planning, Public Policy and Management, University of Oregon, Portland, OR, USA
| | - Lisa Johns
- School of Medicine, Medical College of Georgia, Augusta, GA, USA
| | - Dustin Wright
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA
| | - Mary Hughes
- Neuroscience Associates Greenville Hospital System, Greenville, SC
| |
Collapse
|
53
|
Abstract
Depression is one of the major problems associated with multiple sclerosis (MS). Several physical and psychological factors tend to interact and make it difficult to pinpoint the predictors of the depression. It seemed particularly important to examine how anxiety and illness evolution (characterized by the functional status) influence the appearance of depression symptoms. Thus, the aim of this article was to clarify the relationship between depression and the factors associated with it. One hundred and fifteen participants living at home recruited through various associations and MS clinics answered socio demographic, medical and psychological questions and questionnaires (depression, anxiety, coping, social support, locus of control, alexithymia, self-esteem). Results show that functional status (EDSS), trait anxiety, alexithymia and satisfaction with social support system are the predicting factors of depression. Trait anxiety and functional status are two predictors that independently and simultaneously lead to the appearance of depression symptoms, with trait anxiety playing a predominant role. Alexithymia and social support indirectly influence the appearance of these symptoms.
Collapse
Affiliation(s)
- M-C Gay
- Psychology Department, University of Paris West Nanterre la Défense, Nanterre cedex, France.
| | | | | | | |
Collapse
|
54
|
Forman AC, Lincoln NB. Evaluation of an adjustment group for people with multiple sclerosis: a pilot randomized controlled trial. Clin Rehabil 2009; 24:211-21. [DOI: 10.1177/0269215509343492] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The aim was to evaluate a group treatment for people with multiple sclerosis and low mood. Design: Randomized controlled trial. Setting: Community. Participants: Patients with multiple sclerosis and low mood, scoring >7 on the Hospital Anxiety and Depression Scales or >2 on the General Health Questionnaire 12. Interventions: Participants either attended an adjustment group for six, 2-hour group treatment sessions or were on a waiting list to attend the group. Outcomes: Hospital Anxiety and Depression Scale, General Health Questionnaire 12, Multiple Sclerosis Self Efficacy Scale, Multiple Sclerosis Impact Scale and Short Form 36 administered 3 and 6 months after random allocation. Results: Of the 219 patients identified, 100 (46%) reported depressive symptoms and 126 (58%) anxiety symptoms. Forty participants were recruited, aged 25—68 (mean 47.7 SD 9.7) and eight were men. Patients allocated to the group intervention reported fewer depressive symptoms than those in the control group (U 109.5, P<0.05) but there were no significant differences in anxiety symptoms, self-efficacy or quality of life. Conclusion: Depressive symptoms were reduced following group intervention, which suggests this may be an effective psychological treatment and warrants further evaluation.
Collapse
Affiliation(s)
- AC Forman
- Institute of Work, Health and Organisations, University of Nottingham, Nottingham, UK
| | - NB Lincoln
- Institute of Work, Health and Organisations, University of Nottingham, Nottingham, UK,
| |
Collapse
|
55
|
Marrie RA, Horwitz R, Cutter G, Tyry T, Campagnolo D, Vollmer T. The burden of mental comorbidity in multiple sclerosis: frequent, underdiagnosed, and undertreated. Mult Scler 2009; 15:385-92. [PMID: 19153176 DOI: 10.1177/1352458508099477] [Citation(s) in RCA: 148] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mental comorbidity is common in multiple sclerosis (MS), but some studies suggest that mental comorbidity may be underrecognized and undertreated. OBJECTIVE Using the North American Research Committee on MS Registry, we assessed the frequency of mental comorbidities in MS and sociodemographic characteristics associated with diagnosis and treatment of depression. METHODS We queried participants regarding depression, anxiety, bipolar disorder, and schizophrenia. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CESD); a score>or=21 indicated probable major depression. RESULTS Mental comorbidity affected 4264 (48%) responders; depression most frequently (4012, 46%). Among participants not reporting mental comorbidity, 751 (16.2%) had CESD scores>or=21 suggesting undiagnosed depression. Lower socioeconomic status was associated with increased odds of depression (Income $15,000-30,000 vs >$100,000 OR 1.34; 1.11-1.62), undiagnosed depression (Income $15,000-30,000 vs >$100,000 OR 1.52; 1.08-2.13), and untreated depression (<high school vs postgraduate degree OR 3.13; 1.65-5.99). CONCLUSIONS Mental comorbidity remains underdiagnosed and undertreated in MS. Patients of lower socioeconomic status bear a disproportionate share of the burden of depression.
Collapse
Affiliation(s)
- R A Marrie
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
| | | | | | | | | | | |
Collapse
|
56
|
Namaka M, Turcotte D, Leong C, Grossberndt A, Klassen D. Multiple sclerosis: etiology and treatment strategies. ACTA ACUST UNITED AC 2009; 23:886-96. [PMID: 19072013 DOI: 10.4140/tcp.n.2008.886] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To review the etiology and treatment strategies for multiple sclerosis (MS). DATA SOURCES Published information on MS and targeted treatment strategies extending back to 1955. The search terms multiple sclerosis and pathology, prevalence, genetics, and each of the common symptoms of MS were used. STUDY SELECTION Seventy-two studies were reviewed based on level 1, 2, and 3 search strategies. DATA EXTRACTION Level 1 search strategy targeted evidence-based trials of large sample size (N > 100) with a randomized, double-blind, placebo-controlled design. A level 2 search targeted additional trials with some of the traits of evidence-based trials. A level 3 search compared key findings in reports of very small (N < 15) poorly designed trials with the results of well-designed trials. DATA SYNTHESIS MS affects each patient differently, making a definitive diagnosis and management of symptoms very difficult. Effective symptom management requires an interprofessional team approach. CONCLUSION Despite all the research dedicated to this disease, there is still no cure. The treatments currently available function at best only to slow the disease progression and mitigate symptoms. Using the skills and knowledge available from a team of health care professionals will help patients navigate the trials and tribulations that follow throughout a life with MS.
Collapse
Affiliation(s)
- Michael Namaka
- Faculty of Pharmacy and Neurology, University of Manitoba, Health Sciences Centre, Winnipeg, Manitoba, Canada.
| | | | | | | | | |
Collapse
|
57
|
Autoimmune pathology accounts for common manifestations in a wide range of neuro-psychiatric disorders: the olfactory and immune system interrelationship. Clin Immunol 2008; 130:235-43. [PMID: 19097945 DOI: 10.1016/j.clim.2008.10.010] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Revised: 10/12/2008] [Accepted: 10/14/2008] [Indexed: 12/12/2022]
Abstract
Smell has traditionally been considered a less important sense when compared to sight or hearing, but recent research has unraveled important features inherent to the sense of smell. Once considered just a chemical sensor for sampling the environment, data from animal models and human studies currently imply numerous and complex effects of smell on behavior, mood, and on the immune response. In this review we discuss a possible inter-relationship between olfactory impairment, autoimmunity and neurological/psychiatric symptoms in several diseases affecting the central nervous system (CNS) such as Parkinson, Alzheimer's disease, autism, schizophrenia, multiple sclerosis and neuropsychiatric lupus erythematosus. We suggest that common manifestations are not mere coincidences. Current data from animal models show that neuropsychiatric manifestations are intimately associated with smell impairment, and autoimmune dysregulation, via autoantibodies (anti-NMDAR, anti-ribosomal P) or other mechanisms. From clues of pathological manifestations, we propose a novel approach to the understanding of the interactions between the CNS, the smell and the immune system.
Collapse
|
58
|
Abstract
Depression is common in patients with neurologic disorders such as Alzheimer disease, stroke, Parkinson disease, and multiple sclerosis. Diagnosing depression in the context of neurologic disease is challenging, given the overlap between many signs and symptoms of depression with those of the neurologic disorders. Cognitive impairment further complicates diagnostic evaluation. The etiology of depression in these patients is not well understood and variously has been attributed to emotional reaction to the diagnosis or disability associated with the neurologic condition, the anatomical and/or neurochemical outcomes of neurodegeneration, and the influence of other disease factors. Beyond the inherent burden depression places on patients and caregivers, it increases cognitive and functional disability and, depending on the neurologic disorder, poorer treatment adherence and recovery, earlier institutionalization, and increased suicide risk. Few controlled antidepressant trials are available to guide treatment. In the absence of validated diagnostic guidelines for depression in each neurologic condition, clinicians are urged to remain vigilant for this treatable comorbidity. Although more controlled trials clearly are needed, existing studies suggest that depression in patients with neurologic disorders responds to antidepressant medication and, in some disorders, to psychotherapeutic approaches. Investigating the neuroanatomical and neurochemical correlates of depression comorbid with neurologic conditions also may clarify depression etiology and treatment in the general population.
Collapse
Affiliation(s)
- Murray A Raskind
- Mental Health Service, VA Puget Sound Health Care System Mental Illness Research, University of Washington, Seattle, Washington 98108, USA.
| |
Collapse
|
59
|
Hart SL, Vella L, Mohr DC. Relationships among depressive symptoms, benefit-finding, optimism, and positive affect in multiple sclerosis patients after psychotherapy for depression. Health Psychol 2008; 27:230-8. [PMID: 18377142 DOI: 10.1037/0278-6133.27.2.230] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE While many patients with multiple sclerosis (MS) experience psychological problems, such as depression, benefit-finding is commonly reported. Using the Broaden-and-Build Model of positive emotions (Fredrickson, 2001) and the Expectancy-Value Model of optimism (Carver & Scheier, 1998) as two related, yet, distinct conceptual frameworks, this study examined positive affect and optimism as mediators of the relationship between improved depression and enhanced benefit-finding. DESIGN MS patients (N=127), who participated in a larger, randomized clinical trial comparing two types of telephone psychotherapy for depression, were assessed at baseline, midtherapy (8 weeks), end of therapy (16 weeks), and 6- and 12-month posttherapy. MAIN OUTCOME MEASURES Depression was measured with a telephone administered version of the Hamilton Rating Scale for Depression; Positive Affect was measured with the Positive Affect Subscale from the Positive and Negative Affect Scale; Optimism was measured with the Life Orientation Test-Revised; Benefit-Finding was measured with the revised version of the Stress-Related Growth Scale. RESULTS Data were analyzed with multilevel random-effects models, controlling for time since MS diagnosis and type of treatment. Improved depression was associated with increased benefit-finding over time. The relationship between improved depression and benefit-finding was significantly mediated by both increased optimism and increased positive affect. CONCLUSION Findings provide support to both theoretical models. Positivity appears to promote benefit-finding in MS.
Collapse
Affiliation(s)
- Stacey L Hart
- Department of Psychiatry, University of California, San Francisco, CA, USA.
| | | | | |
Collapse
|
60
|
Bamer AM, Cetin K, Johnson KL, Gibbons LE, Ehde DM. Validation study of prevalence and correlates of depressive symptomatology in multiple sclerosis. Gen Hosp Psychiatry 2008; 30:311-7. [PMID: 18585533 DOI: 10.1016/j.genhosppsych.2008.04.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Revised: 04/14/2008] [Accepted: 04/16/2008] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To validate previous research findings on the prevalence of and factors associated with depressive symptoms in a community-dwelling sample of individuals with multiple sclerosis (MS). METHOD A cross-sectional survey study of 530 individuals with MS from Eastern Washington (EW) was conducted and compared to a previous cross-sectional survey study of 738 individuals with MS from Western Washington (WW). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D), and multivariate logistic regression was employed to detect related factors. RESULTS Prevalence of depressive symptoms was similar in both populations (EW 51%, WW 45%). Factors associated with a clinically significant level of depressive symptoms (CES-D > or =16) in both groups were greater disease severity, shorter disease duration, lower education and less social support (all P<.01). Lower age was also associated with a significant level of depressive symptoms in the WW but not in the EW sample. CONCLUSIONS Despite differences in disease-related and demographic factors, predictors of depressive symptoms were highly similar in both MS study populations.
Collapse
Affiliation(s)
- Alyssa M Bamer
- Department of Rehabilitation Medicine, National Rehabilitation Research and Training Center on Multiple Sclerosis, University of Washington, Box 356490, Seattle, WA 98195, USA.
| | | | | | | | | |
Collapse
|
61
|
|
62
|
Pucak ML, Carroll KAL, Kerr DA, Kaplin AI. Neuropsychiatric manifestations of depression in multiple sclerosis: neuroinflammatory, neuroendocrine, and neurotrophic mechanisms in the pathogenesis of immune-mediated depression. DIALOGUES IN CLINICAL NEUROSCIENCE 2007. [PMID: 17726912 PMCID: PMC3181849 DOI: 10.31887/dcns.2007.9.2/mpucak] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Evidence suggests that depression in multiple sclerosis (MS) is largely biologically mediated by some of the same processes involved in the immunopathogenesis of this neurologic disease. In particular, the increase in proinflammatory cytokines, activation of the hypothalamic-pituitary-adrenal (HPA) axis, and reduction in neurotrophic factors that occur in MS may each account for the increased rate of depression seen in MS. The possible contributions of these neuroinflammatory, neuroendocrine, and neurotrophic mechanisms suggest a diverse array of novel treatment strategies for depression, both in the context of inflammatory conditions as well as in idiopathic depression. Furthermore, if such processes in MS play a causative role in the pathogenesis of depression, and depression in turn has affects on neurophysiological processes related to immune function, then treatment of depression might have a positive effect on MS disease progression. This makes treating MS depression a neuropsychiatric imperative.
Collapse
Affiliation(s)
- Michele L Pucak
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
| | | | | | | |
Collapse
|
63
|
Vahter L, Kreegipuu M, Talvik T, Gross-Paju K. One question as a screening instrument for depression in people with multiple sclerosis. Clin Rehabil 2007; 21:460-4. [PMID: 17613567 DOI: 10.1177/0269215507074056] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate how effectively one question 'Are you depressed?' works as a screening tool for depression in people with multiple sclerosis. DESIGN The results from a single question were compared with formal clinical diagnosis and the classification from a standard questionnaire. SETTING Estonian Multiple Sclerosis Centre, from October 2001 to April 2002. SUBJECTS One hundred and thirty-four consecutive inpatients with multiple sclerosis. INTERVENTION During two weeks of inpatient stay the mood disorder was analysed. On the basis of clinical interview and Beck Depression Inventory the diagnosis of depression was confirmed. MAIN MEASURES Beck Depression Inventory and structured clinical interview. RESULTS Fifty-seven per cent (77/134) of people with multiple sclerosis answered 'Yes' to the question 'Are you depressed?'. The diagnosis of depression was confirmed in 94% (72/77) of people with multiple sclerosis and not confirmed in 6% (5/77). Hence, the screening test sensitivity was 91%. Forty-three per cent (57/134) answered 'No'; 70% (40/57) did not have depression. In this case the sensitivity was 54%. In this group 30% (17/57) were actually depressed according to tests and clinical impression. The age, sex, duration of disease, cognitive abilities and physical disability did not influence consistency of the answers with test results and clinical opinion. CONCLUSIONS One-question interview is a useful tool for screening for depression in people with multiple sclerosis as it confirms existing depression (sensitivity 91%), but the results should be treated with caution if the person denies mood problems.
Collapse
Affiliation(s)
- L Vahter
- Tallinn University, Estonian Multiple Sclerosis Centre, West-Tallinn Central Hospital, Tallinn, Estonia.
| | | | | | | |
Collapse
|
64
|
Isaksson AK, Gunnarsson LG, Ahlström G. The presence and meaning of chronic sorrow in patients with multiple sclerosis. J Clin Nurs 2007; 16:315-24. [PMID: 17608632 DOI: 10.1111/j.1365-2702.2007.01995.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM AND OBJECTIVES The aim of this study was to explore the presence and meaning of chronic sorrow and the presence of depression in a fairly large group of persons with multiple sclerosis (MS). BACKGROUND MS is a chronic and progressive neurological disease with a variety of symptoms. The patients have to live with losses of different kinds. A few earlier studies have used the concept of chronic sorrow to illustrate the emotional situation of such patients. METHOD Sixty-one patients were interviewed about the occurrence of chronic sorrow and, thereafter, screened for depression. Thirty-eight (62%) of them fulfilled the criteria for chronic sorrow. The interviews were analysed with latent content analysis. RESULTS Seven themes describe the losses that caused sorrow: loss of hope, loss of control over the body, loss of integrity and dignity, loss of a healthy identity, loss of faith that life is just, loss of social relations and loss of freedom. The sorrow was constantly present or periodically overwhelming. Only four of the 38 patients with chronic sorrow had symptoms of being mildly depressed. CONCLUSION Chronic sorrow meant loss of hope, of control over the body, of integrity and of identity. The concept of chronic sorrow complements that of depression in providing important new knowledge relevant to understanding the consequences MS can have for the individual. RELEVANCE TO CLINICAL PRACTICE Knowledge of the meaning of chronic sorrow can contribute to the nurse's ability to give psychological support and promote a sense of hope and control in the MS patient.
Collapse
|
65
|
Gottberg K, Einarsson U, Fredrikson S, von Koch L, Holmqvist LW. A population-based study of depressive symptoms in multiple sclerosis in Stockholm county: association with functioning and sense of coherence. J Neurol Neurosurg Psychiatry 2007; 78:60-5. [PMID: 16847048 PMCID: PMC2117795 DOI: 10.1136/jnnp.2006.090654] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To explore and analyse the prevalence of depressive symptoms in people with multiple sclerosis (PwMS), taking into account disease-related and sociodemographic factors, and also to analyse the association between depressive symptoms and functioning (tested and self-reported) and sense of coherence (SOC), respectively. METHODS Home visits were made to a population-based sample of 166 PwMS. Data were obtained from structured, face-to-face interviews using the Beck Depression Inventory (BDI), the Sickness Impact Profile (SIP) and the SOC scale. A range of tests were also carried out for analyses of different aspects of functioning such as cognitive function, walking capacity and manual dexterity, and structured interviews examined activities of daily living and frequency of social/lifestyle activities. RESULTS 19% (28/149) of the people were depressed (BDI > or = 13). Depressive symptoms were associated with worse self-reported functioning on the SIP and with poor memory function, but not with any of the other tests of functioning. Depressive symptoms were associated with weak SOC, but not with any of the disease-related or sociodemographic factors studied. CONCLUSION The prevalence of depressive symptoms in a population-based sample of PwMS is high. Given the serious nature of depression and its association with worse self-reported functioning and weak SOC, attention to, and treatment of, mental-health problems and depression are strongly indicated in the clinical management of multiple sclerosis.
Collapse
Affiliation(s)
- K Gottberg
- Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | | | | | | | | |
Collapse
|