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Cognitive and neuropsychiatric disease manifestations in MS. Mult Scler Relat Disord 2012; 2:4-12. [PMID: 25877449 DOI: 10.1016/j.msard.2012.08.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 07/25/2012] [Accepted: 08/01/2012] [Indexed: 11/20/2022]
Abstract
Multiple sclerosis is associated with a wide array of behavioral problems. This brief overview begins with a summary of the pathophysiology and treatment of MS. Thereafter, sections are devoted to psychiatric syndromes and cognitive decline linked to MS. The immune basis and brain imaging data associated with these changes are subsequently reviewed. The frequency and severity of these changes in mentation highlight the point that MS patients should, as part of their routine care, have access to psychiatrists, neuropsychologists and allied mental health specialists.
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52
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Patten SB, Williams JVA, Lavorato DH, Metz LM, Bulloch AGM. Disability in a community population with MS with and without mental disorders. Int J Psychiatry Med 2012; 43:51-65. [PMID: 22641930 DOI: 10.2190/pm.43.1.d] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Psychiatric conditions are known to have a detrimental impact on functioning and may therefore influence patterns of disability associated with MS. Population-based studies are needed to evaluate such interactions. The objective of this study was to describe the pattern of interaction of MS and mental disorders on health-related impairments. METHODS The Participation and Activity Limitation Survey (PALS) was a post-censual survey conducted by Statistics Canada in association with the 2006 Canadian Census. PALS collected detailed data from a random sample of n = 28,640 respondents with health-related impairments reported on their census form. The PALS interview collected self-reported diagnostic data and included scales to assess functioning and participation in society. RESULTS PALS identified 245 individuals with MS, leading to an estimated (weighted) population prevalence of 0.2% (200 per 100,000), consistent with other Canadian estimates. As expected, impaired agility, vision, communication, mobility, pain, and memory were strongly associated with MS. Mental disorders were also associated with impairment, but interactions between these conditions and MS were generally not evident. CONCLUSIONS Mental disorders are associated with a higher level of disability in MS but, with the exception of communication, there was no evidence of synergistic interaction between mental disorders and MS in contributing to health-related impairments.
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Affiliation(s)
- Scott B Patten
- Department of Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada.
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53
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A nurse-led mental health service for people with multiple sclerosis. J Psychosom Res 2012; 72:463-5. [PMID: 22656445 DOI: 10.1016/j.jpsychores.2012.01.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 01/25/2012] [Accepted: 01/25/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND Mental health problems are under recognised and under treated in people with multiple sclerosis (MS). METHOD A nurse-led project linking MS and mental health services was evaluated. Data on all referrals and management from 2006 to 2008 were collected prospectively. RESULTS 127 referrals were received. 82% had depression, 53% had anxiety (45% both). 42% were offered case management; 52% received Cognitive Behaviour Therapy (CBT), 55% required initiation or alteration of psychiatric medications and 19% were referred to secondary care; 16% had made suicidal plans. Significant improvements in depression at 6months occurred, but not anxiety or fatigue. CLINICAL IMPLICATIONS This service provides a model of mental health provision for patients with long term neurological conditions, in particular MS.
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54
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Abstract
Clinically significant depression can affect up to 50% of patients with multiple sclerosis over the course of their lifetime. It is associated with an increased morbidity and mortality and is regarded by patients as one of the main determinants of their quality of life. This review summarizes current perspectives relating to diagnosis, the utility of self report screening questionnaires, warning signs of suicidal intent and the biological and psychosocial variables implicated in mood change. In particular, the association between depression and structural brain abnormalities, including those derived from diffusion tensor imaging, is highlighted. Depression is treatable, as the results from randomized controlled trials of antidepressant medication, cognitive behavior therapy and mindfulness therapy, reveal. These positive findings are offset by data showing that depression in a neurological setting is often overlooked and under treated.
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Affiliation(s)
- Anthony Feinstein
- Department of Psychiatry, University of Toronto, Sunnybrook Health Sciences Centre, Canada.
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55
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Askey-Jones S, Shaw P, Silber E. Working together: multiple sclerosis and mental health nurses. ACTA ACUST UNITED AC 2011. [DOI: 10.12968/bjnn.2011.7.6.696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sally Askey-Jones
- for Parkinson’s disease, Florence Nightingale School of Nursing and Midwifery, Kings College London
| | | | - Eli Silber
- Department of Neurology, Kings College Hospital
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Validation of the danish version of functional assessment of multiple sclerosis: a quality of life instrument. Mult Scler Int 2011; 2011:121530. [PMID: 22220278 PMCID: PMC3246781 DOI: 10.1155/2011/121530] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 09/22/2011] [Accepted: 10/14/2011] [Indexed: 11/17/2022] Open
Abstract
The functional assessment of multiple sclerosis (FAMS) is a disease-specific instrument that describes functional status of individuals with multiple sclerosis. The instrument was originally developed in the US and has been adapted to different languages including Danish. This study is a validation of the Danish version of FAMS in a sample of individuals referred to a four-week rehabilitation program at either of the two Multiple Sclerosis Rehabilitation centers in Denmark. FAMS data were obtained through self-completed questionnaires from 190 individuals who attended the rehabilitation centers after referral by their general practitioner or specialist neurologist. The validation of the FAMS included assessment of data quality, scale assumptions, acceptability, construct validity, and reliability. Responsiveness was assessed by comparing individual FAMS scores at admission with the discharge score for groups of respondents who reported no change, improvement, or deterioration in their ability to cope with their illness. The Danish version of FAMS appears to be an acceptable, valid, and reliable measure of current health and functional status of individuals with multiple sclerosis.
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Koch-Henriksen N, Stenager E, Brønnum-Hansen H. Studies based on the Danish Multiple Sclerosis Registry. Scand J Public Health 2011; 39:180-4. [DOI: 10.1177/1403494811405097] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: This paper reviews the most important articles using data from the Danish Multiple Sclerosis Registry (DMSR) published in the past 25 years. Research topics: These articles include: descriptive epidemiological studies, indicating that the female incidence of multiple sclerosis (MS) in Denmark has increased considerably; follow-up studies on social events, showing that patients at a high rate lose their working ability and their spouses/partners; mortality studies, demonstrating a considerable excess mortality; cause-of-death studies; comorbidity studies; and, most importantly, historical prospective studies identifying some risk factors (e.g. infectious mononucleosis) and refuting others (head trauma and a number of occupational exposures e.g. nurses, utility workers, people exposed to solvents). The most important results are briefly presented. Conclusion: The Danish MS register has proven to be a valuable tool for MS epidemiology and has provided knowledge that could not otherwise be achieved.
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Affiliation(s)
- Nils Koch-Henriksen
- The Danish Multiple Sclerosis Registry, Copenhagen University
Hospital, Rigshospitalet, Copenhagen, Denmark, Department of Neurology, Aarhus University Hospital
in Aalborg, Aalborg, Denmark,
| | - Egon Stenager
- The Danish Multiple Sclerosis Registry, Copenhagen University
Hospital, Rigshospitalet, Copenhagen, Denmark, MS clinic of Southern Jutland, Vejle, Sønderborg
and Esbjerg, Denmark, Institute of Regional Health Services Research, University
of Southern Denmark, Odense, Denmark
| | - Henrik Brønnum-Hansen
- National Institute of Public Health, University of Southern
Denmark, Copenhagen, Denmark
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Abstract
The development of immunomodulatory therapies for multiple sclerosis (MS) has had significant impact in altering the natural history of the disease. Although these agents reduce relapse rate and MRI-associated disease activity, they are only partially effective and do not ameliorate irreversible axonal injury, which produces much of the symptomatic burden of MS. Treatment of MS-associated symptoms remains an essential cornerstone of comprehensive care of patients with MS and, arguably, more favorably enhances quality of life than do the disease-modifying medications. This article reviews strategies of symptom management in patients with MS.
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Affiliation(s)
- Lawrence M Samkoff
- Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Mattioli F, Bellomi F, Stampatori C, Parrinello G, Capra R. Depression, disability and cognitive impairment in multiple sclerosis: a cross sectional Italian study. Neurol Sci 2011; 32:825-32. [DOI: 10.1007/s10072-011-0624-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 05/07/2011] [Indexed: 11/30/2022]
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Celano CM, Freudenreich O, Fernandez-Robles C, Stern TA, Caro MA, Huffman JC. Depressogenic effects of medications: a review. DIALOGUES IN CLINICAL NEUROSCIENCE 2011. [PMID: 21485751 PMCID: PMC3181967 DOI: 10.31887/dcns.2011.13.1/ccelano] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The literature is filled with reports that link medications with the onset or progression of depression. Because depression is so common in patients with medical illness, assessing whether a medication has in fact caused depression, or whether the relationship is coincidental, can be challenging. In this article, we review the literature on the association between medications and depression. For most agents, there are case reports or small studies linking the medication with the onset of depression, but more rigorous prospective studies are either lacking or found no association between the agent and depression. However, several medications, (eg, barbiturates, vigabatrin, topiramate, flunarizine, corticosteroids, mefloquine, efavirenz, and interferon-α) do appear to cause depression in some patients and should be used with caution in patients at risk for depression.
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da Silva AM, Vilhena E, Lopes A, Santos E, Gonçalves MA, Pinto C, Moreira I, Mendonça D, Cavaco S. Depression and anxiety in a Portuguese MS population: associations with physical disability and severity of disease. J Neurol Sci 2011; 306:66-70. [PMID: 21497358 DOI: 10.1016/j.jns.2011.03.042] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 03/24/2011] [Accepted: 03/28/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Mood disorders, namely depression and anxiety, have been well documented in patients with Multiple Sclerosis (MS). However, the putative associations between clinical features and mood disorders have not been well established. OBJECTIVES To detect anxiety and depression in MS patients; and to investigate possible associations with clinical factors. SUBJECTS AND METHODS 325 consecutive patients with MS and 183 healthy subjects answered the Hospital Anxiety and Depression Scale (HADS), a self-rating questionnaire. Multiple Regression Analysis and Multivariate Analysis of Covariance were applied to assess the effect of demographic and clinical factors on HADS' anxiety and depression scores, using age and disease duration as covariates. Logistic Regression Analysis was used to study the influence of these factors on anxiety and depression, as defined by two different cut-off scores (i.e., 8 and 11). RESULTS Levels of anxiety and depression were significantly higher (p<0.001) for MS patients group than healthy subjects. Age, disease duration, age at onset, Kurtzke Expanded Disability Status Scale, and Multiple Sclerosis Severity Scale were positively associated with depression scores. Low education (i.e., <9 years) in MS was significantly associated with more anxiety and depression symptoms. CONCLUSIONS The study findings support a close linkage between depressive mood and physical manifestations of MS.
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Affiliation(s)
- Ana Martins da Silva
- Neurology Department, Centro Hospitalar do Porto-Hospital de S. António (CHP-HSA), Porto, Portugal.
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Jobin C, Larochelle C, Parpal H, Coyle PK, Duquette P. Gender issues in multiple sclerosis: an update. ACTA ACUST UNITED AC 2011; 6:797-820. [PMID: 21118039 DOI: 10.2217/whe.10.69] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Although multiple sclerosis (MS) affects both women and men, women are more susceptible to MS than men. Accumulating evidence indicates that the incidence and prevalence of MS is increasing, more so in women than in men. Owing to pregnancy, differing hormonal states and distinct social roles, the impact of MS differs between women and men. Since Patricia K Coyle published a review on gender issues in MS, multiple studies have added to the body of knowledge. This update will summarize the current thinking on gender-related issues in MS and we will address incidence and prevalence, hormonal factors, pregnancy and breastfeeding, genetics, course and prognosis, imaging, treatment and psychosocial aspects. Future progression within this field will help elucidate the cause of and define the treatment of MS.
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Celano CM, Freudenreich O, Fernandez-Robles C, Stern TA, Caro MA, Huffman JC. Depressogenic effects of medications: a review. DIALOGUES IN CLINICAL NEUROSCIENCE 2011; 13:109-25. [PMID: 21485751 PMCID: PMC3181967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
The literature is filled with reports that link medications with the onset or progression of depression. Because depression is so common in patients with medical illness, assessing whether a medication has in fact caused depression, or whether the relationship is coincidental, can be challenging. In this article, we review the literature on the association between medications and depression. For most agents, there are case reports or small studies linking the medication with the onset of depression, but more rigorous prospective studies are either lacking or found no association between the agent and depression. However, several medications, (eg, barbiturates, vigabatrin, topiramate, flunarizine, corticosteroids, mefloquine, efavirenz, and interferon-alpha) do appear to cause depression in some patients and should be used with caution in patients at risk for depression.
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Abstract
PURPOSE Studies demonstrate that suicidal ideation (SI) is greater in persons with multiple sclerosis (MS) than in the general population. SI may offer some MS patients a mechanism for feeling in control of their lives, in the face of a daunting, unpredictable disease. In this study, we determined what specific mental constructs or perceptual themes occur for MS patients experiencing SI, while also examining the construct of 'control' as a central theme. METHODS Individual interviews (N = 16) were audiotaped, transcribed and qualitatively analysed by two independent raters to test for key themes in MS patients reporting SI. RESULTS In relation to SI, eight key themes were identified by both raters as having been expressed in interviews: perceived loss of control, increased family tension, loneliness, hopelessness and frustration, physical and psychological impact of MS, loss of perceived masculinity or femininity, regaining control and failure to achieve desired or expected role functioning. We created a model to explain the emergence of these themes as they contribute to SI among patients with MS. All participants indicated that perceived loss of control elicited thoughts of suicide. CONCLUSION Perceived loss of control appears to be a major disease related burden associated with SI in MS patients.
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Affiliation(s)
- Aviva Gaskill
- Ferkauf Graduate School of Psychology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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65
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Sumelahti ML, Hakama M, Elovaara I, Pukkala E. Causes of death among patients with multiple sclerosis. Mult Scler 2010; 16:1437-42. [PMID: 20826526 DOI: 10.1177/1352458510379244] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several studies show a high mortality risk among patients with multiple sclerosis (MS). OBJECTIVES In this study, mortality and underlying causes of death were analysed among patients with MS diagnosed between 1964-1993 in Finland (n = 1595). METHODS Standardized mortality ratios (SMRs) were calculated for both genders. The follow-up was based on linkage to the national computerized Cause-of-Death Register of Statistics Finland. RESULTS Altogether, 464 deaths were recorded by the end of 2006. The SMR as compared with the general population among females was 3.4 (95% confidence interval 3.0-3.9) and among males 2.2 (1.9-2.6). In total, 270 patients (58%) died from MS; only one of these deaths occurred during the first 2 years after the MS diagnosis. Mortality was also increased for other natural causes of death (n = 160) in patients followed for more than 10 years (SMR 1.4, 1.2-1.7), with a significant increase in deaths from influenza (29, 6.0-85), pneumonia (4.7, 2.5-8.0) and gastrointestinal causes (4.4, 2.3-7.7). The SMR for violent causes was 1.2 (0.7-1.9) and for alcohol-related deaths 0.2 (0.02-0.7). The SMR for suicides was 1.7 (0.9-2.7). CONCLUSIONS The MS population has an increased disease mortality, while the increase in the risk of accidents and suicides is not significantly increased among patients with MS in Finland.
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66
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Patten SB, Berzins S, Metz LM. Challenges in screening for depression in multiple sclerosis. Mult Scler 2010; 16:1406-11. [PMID: 20685765 DOI: 10.1177/1352458510377770] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Screening has frequently been proposed as a strategy for detection of depression in multiple sclerosis (MS). In a recent study, we found a minimal impact of screening, even when this was coupled with rapidly responsive and evidence-based depression care. METHODS In order to explore the challenges involved in screening we analyzed prospective data from the Canadian Impact of MS (CIMS) database, which provides annual ratings on a self-report depression rating scale, the Center for Epidemiologic Studies Depression Rating Scale (CES-D). RESULTS Approximately 30% of respondents screened positive at each visit. CES-D ratings correlated fairly strongly from year to year, Pearson's r ranged from 0.65 to 0.73. Approximately 10% of those below the CES-D cut-point at each assessment exceeded the cut-point when rated 1 year later, but only about half of these cases had large (≥10 points) increases in their scores. CONCLUSIONS Screening interventions are generally oriented towards early detection, whereas the longitudinal pattern of depressive symptoms in MS appears to be characterized more prominently by a persistent burden of depressive symptoms in a substantial proportion of the population. Resources invested in screening efforts can probably be more effectively deployed in other areas, such as improved long-term clinical management.
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Affiliation(s)
- Scott B Patten
- Department of Community Health Sciences and Hotchkiss Brain Institute, University of Calgary, Canada.
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67
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Botega NJ, de Azevedo RCS, Mauro MLF, Mitsuushi GN, Fanger PC, Lima DD, Gaspar KC, da Silva VF. Factors associated with suicide ideation among medically and surgically hospitalized patients. Gen Hosp Psychiatry 2010; 32:396-400. [PMID: 20633743 DOI: 10.1016/j.genhosppsych.2010.02.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2009] [Revised: 02/23/2010] [Accepted: 02/26/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To identify the factors associated with suicide ideation among medically and surgically hospitalized patients. METHODS A consecutive sample of 4328 individuals admitted to a general hospital completed a screening questionnaire comprised of demographic and clinical information, the Mini International Neuropsychiatric Interview item on current suicide ideation, the Hospital Anxiety and Depression Scale subscale for depression and the Alcohol use Disorder Identification Test. A multiple logistic regression produced a discriminate profile of individuals with suicide ideation. RESULTS The prevalence rate for current suicide ideation was 4.9% (95% CI: 4.3-5.6). Patients admitted to the Infectious Disease, Oncology and Hematology units presented higher rates of suicide ideation (7.9%, 7.8% and 7.2%, respectively). Suicidal ideation was associated to depression [odds ratio (OR)=8.3], young age (18-35 years old: OR=2.5), alcohol use disorders (OR=2.3), and smoking (OR=1.8). CONCLUSION Suicidal ideation was consistently associated with indicators of mental disorders. It is proxy, not for completed suicide, but for a variety of common psychiatric conditions that can and should be dealt with in the medical/surgical setting.
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Affiliation(s)
- Neury José Botega
- Department of Psychiatry, Medical Sciences Faculty, Universidade Estadual de Campinas, Campinas, SP 13081-970, Brazil.
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69
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Chachamovich E, Stefanello S, Botega N, Turecki G. [Which are the recent clinical findings regarding the association between depression and suicide?]. BRAZILIAN JOURNAL OF PSYCHIATRY 2009; 31 Suppl 1:S18-25. [PMID: 19565147 DOI: 10.1590/s1516-44462009000500004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Suicide is one of the leading causes of mortality worldwide, especially among young subjects. Suicide is considered the outcome of a multidimensional and complex phenomenon, which is a result of the interaction between several factors. The association between psychopathology and suicide has been extensively investigated. Major depression plays an important role among the psychiatric diagnoses associated with suicide. This finding seems to be confirmed by different study designs, and in distinct populations. The present paper aims to briefly review the recent findings regarding the suicide-related clinical features of depression. Moreover, strategies for suicide prevention were also reviewed. REVIEW Recent references were identified and grouped in order to illustrate the main contributions about depression and suicide. Briefly, the literature review stresses the high prevalence of major depression among subjects presenting suicide behaviors. Psychopathological traits, such as aggression and impulsivity play a relevant role in triggering suicidal behaviors. Strategies for suicide prevention were also reviewed in Brazil and internationally. In general, detection and treatment are effective in reducing suicide rates. CONCLUSION Studies regarding suicide behaviors have had a pragmatic approach, and generated a large body of evidence about correlates of suicide. However, these studies have not been able to provide a consistent theoretical explanation for this phenomenon. The recent adoption of modern strategies represents a possibility of enhancing the research capability of such studies. In order to be clinically useful, findings should make it possible to deepen the understanding over the experience of a suicidal person, as well as to design specific strategies for prevention and treatment in population subgroups.
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Affiliation(s)
- Eduardo Chachamovich
- McGill Group for Suicide Studies, Department of Psychiatry, McGill University, Montreal, Canada
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70
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Mitsonis CI, Potagas C, Zervas I, Sfagos K. The Effects of Stressful Life Events on the Course of Multiple Sclerosis: A Review. Int J Neurosci 2009; 119:315-35. [DOI: 10.1080/00207450802480192] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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71
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Confavreux C, Vukusic S. The clinical epidemiology of multiple sclerosis. Neuroimaging Clin N Am 2009; 18:589-622, ix-x. [PMID: 19068404 DOI: 10.1016/j.nic.2008.09.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A comprehensive knowledge of the natural course and prognosis of multiple sclerosis is of utmost importance for a physician to make it affordable in simple descriptive terms to a patient when personal and medical decisions are to be taken. It is still topical because the currently acknowledged disease-modifying agents only marginally alter the overall prognosis of the disease. It provides reference for evaluating the efficacy of a therapeutic intervention in clinical trials; clues for public health services, health insurance companies, and pharmaceutical industry in their respective activities; and insights into the pathophysiology and the treatment of multiple sclerosis. Precise, consistent, and reliable data from appropriate cohorts have become available and knowledge is fairly comprehensive.
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Affiliation(s)
- Christian Confavreux
- Service de Neurologie A, Centre de Coordination EDMUS et INSERM U842, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, 69677 Lyon-Bron cedex, France.
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73
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Haussleiter IS, Brüne M, Juckel G. Psychopathology in multiple sclerosis: diagnosis, prevalence and treatment. Ther Adv Neurol Disord 2009; 2:13-29. [PMID: 21180640 PMCID: PMC3002616 DOI: 10.1177/1756285608100325] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory disorder of the central nervous system. Demyelinization of nerve fibres not only affects the motor and sensory systems functionally, but may also cause psychopathological signs and symptoms. In addition to the psychiatric manifestations of MS, many patients have reactive psychological problems that are often hard to distinguish from the 'organic' causation of psychopathology. In any event, psychiatric comorbidity in MS deserves greater clinical attention than has been previously paid, because the presence of psychopathology may have deleterious effects on the disease process and impair coping with disability.
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Affiliation(s)
- Ida S Haussleiter
- Department of Pharmacology and Neuroscience, Institute for Aging and Alzheimer's Disease Research, Center FOR HER (Focused On Resources for her Health, Education and Research), University of North Texas Health Science Center, Fort Worth, TX, USA
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75
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Fang F, Valdimarsdóttir U, Fürst CJ, Hultman C, Fall K, Sparén P, Ye W. Suicide among patients with amyotrophic lateral sclerosis. Brain 2008; 131:2729-33. [PMID: 18669498 DOI: 10.1093/brain/awn161] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Studies on the suicide risk among patients with amyotrophic lateral sclerosis (ALS) in countries without legalized euthanasia or assisted suicide are important additions to data on the wish to die of these patients. We conducted a population-based cohort study in Sweden between 1965 and 2004, which comprised of 6,642 patients with incident ALS identified from the Swedish Inpatient Register. We calculated the standardized mortality ratios (SMRs) of suicide among the patients using the suicide rates of the general Swedish population as a reference. In total, 21 patients committed suicide during follow-up, compared to the predicted 3.6 suicides. Thus, we noted an almost 6-fold increased risk for suicide among ALS patients [SMR 5.8, 95% confidence interval (CI) 3.6-8.8]. Patients who committed suicide were, on average, around 7 years younger at the time of their first period of hospitalization than patients who did not commit suicide. The highest relative risk for suicide was observed within the first year after the patient's first period of hospitalization (SMR 11.2, 95% CI 5.8-19.6). After that, the relative risks decreased with time after hospitalization (P-value for trend = 0.006), but remained elevated 3 years later. The relative risks of suicide among ALS patients did not show a clear trend over time in contrast to the decreasing trend of relative risks for suicide among patients with cancer during the same period. Patients with ALS are at excess risk of suicide in Sweden and the relative risk is higher during the earlier stage of the disease.
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Affiliation(s)
- Fang Fang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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76
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Grytten Torkildsen N, Lie SA, Aarseth JH, Nyland H, Myhr KM. Survival and cause of death in multiple sclerosis: results from a 50-year follow-up in Western Norway. Mult Scler 2008; 14:1191-8. [DOI: 10.1177/1352458508093890] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Survival time among patients with multiple sclerosis (MS) has varied considerably according to previous reports. Objectives Survival and cause of death were analyzed among all patients with MS (878) with onset of MS in Hordaland County, Western Norway during 1953–2003, of whom 198 were dead at follow-up on January 1, 2005. Methods Standardized mortality ratios (SMRs) and relative mortality ratios (RMRs) were calculated based on observed mortality in MS and expected mortality. Results Median survival from onset was 41 years versus 49 years in the corresponding population, and mortality (SMR) was 2.7-fold increased in MS. The median survival was 43 years among women and 36 years among men, but women had higher relative mortality, when compared with the corresponding population, than men (RMR = 1.40). The median survival time was 45 years among young-onset patients (21–30 years) and 23 years among older-onset patients (51–60 years), but young-onset patients had higher relative mortality than older-onset patients, as shown by a significant reduction by 10-year interval of age at onset (RMR = 0.65). Median survival from onset was longer (43 years) among relapsing–remitting MS than primary progressive MS ([PPMS]; 49 years), and the relative mortality was higher in the PPMS group, (RMR = 1.55). According to death certificates, 57% died from MS. Conclusion Female patients and patients with young onset had longer median time to death but higher relative risk of dying compared with the corresponding population. PPMS had both shorter median time to death from onset and a higher relative risk of dying.
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Affiliation(s)
- N Grytten Torkildsen
- Department of Neurology, The Norwegian Multiple Sclerosis Competence Centre, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Section for Neurology, University of Bergen, Bergen, Norway
| | - SA Lie
- Department of Health, University Research Bergen, Bergen, Norway
| | - JH Aarseth
- Department of Neurology, The Norwegian MS Registry, Haukeland University Hospital, Bergen, Norway
| | - H Nyland
- Department of Clinical Medicine, Section for Neurology, University of Bergen, Bergen, Norway
| | - KM Myhr
- Department of Neurology, The Norwegian Multiple Sclerosis Competence Centre, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Section for Neurology, University of Bergen, Bergen, Norway
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77
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Abstract
MDD and anxiety disorders are highly prevalent among persons who have MS and have been associated with decreased adherence to MS treatment and poorer functional status and quality of life. Effective treatment is available for MDD, but this disorder continues to be underdetected and undertreated by MS providers. Treatment with pharmacotherapy is particularly challenging in this patient population, given the somatic symptom overlap between MS and depression and the increased burden of side effects. Larger randomized, controlled trials are needed to elucidate further the effectiveness of pharmacotherapy and to identify subgroups of patients who would benefit from this type of treatment for depression. There have been few rigorous studies of the prevalence and impact of anxiety disorders, substance use disorders, or serious mental illness such as bipolar disorder or schizophrenia, in MS samples.
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78
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José Sá M. Psychological aspects of multiple sclerosis. Clin Neurol Neurosurg 2007; 110:868-77. [PMID: 18022759 DOI: 10.1016/j.clineuro.2007.10.001] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2007] [Accepted: 10/03/2007] [Indexed: 10/22/2022]
Abstract
A significant incidence and prevalence of psychological disorders in multiple sclerosis (MS) has been reported. Their underlying mechanisms and the extent to which they are reactive to psychosocial factors or symptoms of the pathological process itself, remain unclear. Depression is the predominant psychological disturbance with lifetime prevalence around 50% and annual prevalence of 20%. Depression is commoner during relapses, may exacerbate fatigue and cognitive dysfunction and no firm evidence exists of its induction by interferon; instead, treating depression improves adherence to disease-modifying drugs. Anxiety is also frequent, occurs in newly diagnosed patients, and its co-morbidity with depression has been suggested to increase the rate of suicidal ideation. The relationship between stress and MS is an attractive issue because some studies pointed to an association between stressful life-events and MS onset/relapses; however, the evidence supporting this hypothesis is not conclusive so far. Other psychiatric illnesses, as bipolar affective disorder, pathological laughing and crying or psychosis occur less frequently in MS. Therapeutic strategies include psychotherapy, cognitive behavioural therapy, strengthen of coping, and specific medications. The "art" of the MS team in providing the best individualized care is emphasized, aiming to reduce the burden of the disease and improve the patients' quality of life.
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Affiliation(s)
- Maria José Sá
- Department of Neurology, Hospital S. João, Alameda Professor Hernâni Monteiro, Porto, Portugal.
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79
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Apel A, Greim B, Zettl UK. Complementary and alternative medicine and coping in neuroimmunological diseases. J Neurol 2007; 254 Suppl 2:II112-5. [PMID: 17503118 DOI: 10.1007/s00415-007-2027-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The utilisation of complementary and alternative medicine (CAM) is widespread in neuroimmunological diseases like multiple sclerosis (MS) but has been disregarded in research until lately. After describing the problems of definition in CAM, different categories will be described. Various confounding factors on CAM utilisation exist, though hardly investigated. Besides sociodemographic variables like education, income, gender and age, illness-related factors like severity of disease are discussed. Furthermore, the important role of coping and CAM utilisation has not been investigated in neuroimmunological diseases, yet. Results derived from our investigations on CAM utilisation in MS indicate that users of CAM apply coping strategies, such as "rumination", "search for information" and "search for meaning in religion", more frequently than non-users and that current CAM utilisation is related to depression. Further research is needed in this field, as well as in other neuroimmunological diseases.
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Affiliation(s)
- A Apel
- Dept. of Neurology, University of Rostock, Gehlsheimer Str. 20, 18147, Rostock, Germany.
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80
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Kümpfel T, Hoffmann LA, Pöllmann W, Rieckmann P, Zettl UK, Kühnbach R, Borasio GD, Voltz R. Palliative care in patients with severe multiple sclerosis: two case reports and a survey among German MS neurologists. Palliat Med 2007; 21:109-14. [PMID: 17344259 DOI: 10.1177/0269216306075112] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Due to its chronic and fluctuating time course, multiple sclerosis (MS), thus far, has not been regarded as a focus of palliative care. However, sometimes we are confronted with severely affected MS patients, who suffer from complex medical, physical and psychosocial problems, which are not fully covered by the current health care services. We present two cases of severely affected MS patients we saw in our outpatient MS clinic, and who, we believe, are candidates for palliative care. The first patient, with primary chronic progressive (pcP) MS for many years (Expanded Disability Status Scale (EDSS): 8.0) presented with complex painful dysaesthesias and a depressive syndrome. He refused any treatment, and finally committed suicide with the help of a euthanasia group in Switzerland. The second patient was also severely affected by a secondary chronic progressive (scP) MS (EDSS: 9.0) and was finally admitted to our palliative care unit due to a complex pain syndrome associated with panic attacks and anxiety. She spent three weeks on the palliative care unit and her symptoms improved gradually after changing and optimising her pain medication. The patient was discharged with home care and is seen regularly on the palliative care unit. Additionally, as a first step, a questionnaire was sent to 53 German MS specialists regarding their general view on the needs for palliative care in MS. Our two cases and the results of the questionnaire demonstrated that MS patients and their caregivers are confronted with a variety of symptoms which are difficult to treat, and are a cause of great suffering for the patients, including ataxia, depression and fatigue. The data of the questionnaire also showed that neurologists usually do not deal with end-of-life care issues in MS.More research is needed to define the role of palliative care in MS and establish appropriate interventions to improve the quality of life in advanced stage MS patients and their relatives.
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Affiliation(s)
- T Kümpfel
- Institute of Clinical Neuroimmunology Klinikum Grosshadern, Ludwig-Maximilians-Universität, Munich
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81
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Ferreira MHF, Colombo ES, Guimarães PSA, Soeiro RE, Dalgalarrondo P, Botega NJ. Suicide risk among inpatients at a university general hospital. REVISTA BRASILEIRA DE PSIQUIATRIA 2007. [DOI: 10.1590/s1516-44462006005000031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: To estimate the proportion of inpatients at a university general hospital who are at risk of committing suicide. METHOD: A random sample of 253 patients (57% males) aged 18 years old or older, admitted to surgical and clinical wards, was assessed using the the Mini International Neuropsychiatric Interview, which has a section that evaluates the risk for suicide. Uni- and multivariate analyses were performed. RESULTS: There were 58 (23%) patients with a risk for suicide, 13 (5% of total) of whom presented a high risk. The prevalence of suicide risk was greater in young adult patients, those with no matrimonial relationship and those diagnosed with major depression (univariate analysis, Chi-squared test; p = 0.01, 0.03 and 0.0001, respectively). The multivariate analysis revealed that the risk for suicide in individuals younger than 30 years old was two fold higher than in those individuals between the ages of 30 and 59 years (OR = 0.45, 95% CI = 0.22-0.93; p = 0.03) and four fold greater than in those who were 60 years old or older (OR = 0.25, 95% CI = 0.1-0.64; p = 0.004). CONCLUSION: When young adults are admitted to general hospitals they should receive special attention due to their suicidal potential.
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82
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Multiple Sklerose — eine neuroimmunendokrine Erkrankung. GEHIRN UND GESCHLECHT 2007. [PMCID: PMC7120016 DOI: 10.1007/978-3-540-71628-0_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Die Multiple Sklerose (MS) ist eine chronische, entzündlich-demyelinisierende Erkrankung des Zentralnervensystems (ZNS), betrifft also Gehirn und Rückenmark, wobei heute eine autoimmune Ätiologie allgemein angenommen wird. Sie ist die häufigste Entmarkungserkrankung des ZNS in Nordeuropa und Nordamerika (Prävalenz 1:1000) und die häufigste chronisch-neurologische Erkrankung, die bei jungen Erwachsenen zu bleibender Behinderung führt.
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83
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Montel S, Bungener C. Les troubles de l’humeur et des émotions dans la sclérose en plaques : une revue de la littérature. Rev Neurol (Paris) 2007; 163:27-37. [PMID: 17304170 DOI: 10.1016/s0035-3787(07)90352-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Even though mood and emotion are closely related concepts, they differ in some ways. This article aims to review the main mood and emotional disorders most often found in Multiple Sclerosis (MS). STATE OF ART Studies related to four fields are presented and discussed: assessment tools and methodological problems; prevalence, etiology and symptoms of mood as well as emotional disorders in MS; relationship between cognition and emotion. Beside these main subjects, we tackle some interesting questions which concern patients as well as clinicians, such as the risk of depression and protective factors, the relationship between depression and fatigue and the impact of beta-interferon on depression. PROSPECTIVES We focus on a new promising trend aiming to link neuroimaging data to psychological variables. CONCLUSIONS These four fields cover a large portion of the questions about mood and emotional disorders in MS. Due to their frequency as well as to their impact on quality of life, specific attention should be given to these disorders.
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Affiliation(s)
- S Montel
- Laboratoire de Psychopathologie et Neuropsychologie Cliniques, Université Paris Descartes et Centre d'Investigation Clinique de l'Hôpital La Pitié-Salpêtrière.
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84
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Turner AP, Williams RM, Bowen JD, Kivlahan DR, Haselkorn JK. Suicidal Ideation in Multiple Sclerosis. Arch Phys Med Rehabil 2006; 87:1073-8. [PMID: 16876552 DOI: 10.1016/j.apmr.2006.04.021] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2005] [Accepted: 04/27/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine risk factors for suicidal ideation among people with multiple sclerosis (MS). DESIGN Cohort study linking computerized medical records with a mailed self-report survey. SETTING Veteran's Health Administration (VHA) region covering the northwestern United States. PARTICIPANTS VHA patients with MS (N=445) who returned mailed surveys. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Suicidal ideation is assessed by the Patient Health Questionnaire (PHQ) suicide item with suicidal ideation more than half the days considered persistent. RESULTS One hundred thirty-one (29.4%) of 445 respondents (95% confidence interval [CI], 25.4%-33.9%) endorsed suicidal ideation, and 35 (7.9%; 95% CI, 5.7%-10.8%) endorsed persistent suicidal ideation over the last 2 weeks. In bivariate analyses, suicidal ideation was associated with younger age, earlier disease course, progressive disease subtype, lower income, not being married, lower social support, not driving, higher levels of physical disability (mobility, bowel, bladder), and depression. Analyses on persistent suicidal ideation yielded similar results. In fully adjusted multivariate logistic regression, only depression severity and bowel disability were independently associated with suicidal ideation. Only depression severity was independently associated with persistent suicidal ideation. By using the 2-question depression screen (U.S. Preventive Services Task Force) consisting of the depression and anhedonia items from the PHQ-9, sensitivity and specificity were marginal for suicidal ideation (65.6% and 79.9%) but acceptable for persistent suicidal ideation (88.6% and 71.2%). CONCLUSIONS Suicidal ideation is common among VHA patients with MS, and depression severity is the best risk marker. Brief screening for depression in MS should include the assessment of suicidal ideation.
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Affiliation(s)
- Aaron P Turner
- VA Puget Sound Health Care System, Seattle, WA 98108, USA.
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85
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Abstract
The treatment of multiple sclerosis has been revolutionized during the past 10 years by the introduction of disease-modifying therapies. However, day-to-day management of the symptoms and complications of this condition will, for the foreseeable future, continue to be important management concerns. Among the most problematic and troublesome manifestations of multiple sclerosis are its neuropsychiatric manifestations. Most prominent among these are depression, pathologic laughing and crying, fatigue, cognitive problems, sleep disorders and disorders of sexual function. There have been relatively few randomized controlled trials of pharmacologic treatments for these conditions. Available treatments for the management of fatigue and cognitive deficits remain inadequate and patients must often accommodate these symptoms in their lifestyle.
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Affiliation(s)
- Scott B Patten
- University of Calgary, Department of Community Health Sciences, Alberta, Canada.
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86
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Feinstein A. Mood disorders in multiple sclerosis and the effects on cognition. J Neurol Sci 2006; 245:63-6. [PMID: 16643952 DOI: 10.1016/j.jns.2005.08.020] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2005] [Accepted: 08/10/2005] [Indexed: 11/20/2022]
Abstract
BACKGROUND Depression and cognitive dysfunction are common in patients with multiple sclerosis. However, it is unclear whether depression may cause or exacerbate cognitive problems as data remain equivocal. The current review attempts to clarify the relationship between these behavioral disorders. METHOD The literature pertaining to the influence of depression on cognition in MS patients has been reviewed. RESULTS Early studies consistently failed to find an association and concluded that cognitive dysfunction in MS patients occurred independently of depression. A more recent literature has found fault with this, citing numerous methodological flaws in the studies undertaken. Newer data now suggests that core symptoms of depression reduce cognitive capacity, in particular exerting an adverse effect on the executive function component of working memory. CONCLUSIONS Depression may exacerbate cognitive dysfunction in MS patients. Whether treating depression will lead to cognitive improvement is not yet known, but warrants further exploration.
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Affiliation(s)
- Anthony Feinstein
- Department of Psychiatry, University of Toronto, Sunnybrook and Women's College Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, Canada M4N 3M5.
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87
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Falcone NP, Nappo A, Neuteboom B. Interferon Beta-1a Overdose in a Multiple Sclerosis Patient. Ann Pharmacother 2005; 39:1950-2. [PMID: 16204396 DOI: 10.1345/aph.1e416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To report on a patient with multiple sclerosis (MS) who attempted suicide by taking an overdose of interferon (IFN) beta-1a. CASE SUMMARY A 38-year-old man with MS and depressive symptoms self-administered approximately 6 or 7 prefilled syringes containing 44 μg (12 MIU) of subcutaneous IFN beta-1a in a suicide attempt. Clinical examination in the emergency department revealed a modest rise in body temperature and diffuse redness of the skin of the limbs and truncal region. The patient's signs and symptoms resolved over the following 24 hours. IFN beta-1a was temporarily withdrawn and treatment with citalopram, which the patient had spontaneously discontinued before the suicide attempt, was resumed. Laboratory assessment showed no modifications in biochemical and hematologic parameters. The IFN beta-1a concentration in the serum sample taken at 48 hours after the suicide attempt confirmed that the patient had taken a very high dose of IFN. DISCUSSION Depression, a common condition in MS patients, was precipitated in this patient by the spontaneous discontinuation of citalopram and not influenced by IFN beta-1a therapy, which the patient resumed at 44 μg 3 times per week. CONCLUSIONS This case demonstrates the risks of depression in MS patients and the danger of discontinuing treatment with antidepressants. This report also shows that approximately 264–308 μg of IFN beta-1a, the highest single dose of IFN beta-1a reported taken by a human as of this writing, caused only a transient and self-limiting malaise.
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Affiliation(s)
- Nicola P Falcone
- Unità Operativa di Neurologia, Ospedale Belcolle, Viterbo, Italy.
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88
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McGuigan C, Hutchinson M. Unrecognised symptoms of depression in a community-based population with multiple sclerosis. J Neurol 2005; 253:219-23. [PMID: 16177840 DOI: 10.1007/s00415-005-0963-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2005] [Revised: 04/19/2005] [Accepted: 04/22/2005] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS The association between multiple sclerosis (MS) and depression has been well established but prevalence estimates have varied widely. The aims of this study were to assess the point prevalence of previously unrecognised symptoms of depression in a community-based population with MS and examine their relationship to other disease characteristics. PATIENTS AND METHODS Three hundred and seventy six patients with clinically definite or probable MS (Poser criteria) were ascertained during the course of an epidemiological study on two counties in Ireland. Of these 211 agreed to participate in the study. Subjects were examined and a Kurtzke Expanded Disability Status Scale Score and Multiple Sclerosis Functional Composite score rated. Participants also completed a Beck's Depression Inventory-II and a Multiple Sclerosis Impact Scale. RESULTS In total 60 (28%) patients had moderate or severe symptoms of depression. Only thirty-five of the 211 patients had a history of depression as defined by a medical diagnosis of depression or prescription of an anti-depressant medication at any time prior to enrollment in the present study, of the remaining 176 patients, 41 (23.3%) had moderate or severe symptoms of depression as assessed by Beck's Depression Inventory-II. The only significant clinical difference between the 41 patients with pronounced depressive symptoms and the 135 less affected was shorter disease duration in the former. CONCLUSIONS In this study one in four patients with MS had unrecognised and therefore untreated symptoms of depression. Disability alone is not a good indicator of the likelihood of coexistent depressive symptoms.
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Affiliation(s)
- C McGuigan
- Dept. of Neurology, St. Mary's Hospital, London, UK.
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89
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Abstract
BACKGROUND In January 2002 the New York City Chapter of the National Multiple Sclerosis Society convened a panel of experts to review the issue of depressive affective disorders associated with multiple sclerosis (MS). This Consensus Conference was supported by a grant from the Goldman family of New York City. RESULTS The panel reviewed summaries of current epidemiologic, neurobiologic, and therapeutic studies having to do with depressive disorders among MS patient populations. Depressive disorders occur at high rates among patients with MS, and there is reason to believe that the immunopathology of the disease is involved in the clinical expression of affective disorders. The depressive syndromes of MS have a major, negative impact on quality of life for MS sufferers, but are treatable. At the present time, most MS patients with depression do not receive adequate recognition and treatment. CONCLUSIONS The Goldman Consensus Conference Study Group provides recommendations for improved screening, diagnosis, and clinical management for depressive affective disorders among patients suffering from MS.
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90
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Abstract
Several studies have reported high rates of depression in multiple sclerosis (MS) with a lifetime prevalence of approximately 50% and an annual prevalence of 20% not uncommon. Concern about the potential of new drug treatments to exacerbate or precipitate depression in MS has led to increased interest in the relation between MS and depression. This review on MS and depression identifies the following key issues: How common is depression in people with MS? Is depression in MS associated with lesions in specific regions of the central nervous system? Is there an increased risk of suicide in MS? Is there a higher than expected incidence of anxiety disorders in MS? Are fatigue and depressed mood related in MS? Is there a relation between depression and cognitive impairment in MS? Which psychosocial variables affect the development of depression in MS? Does treatment with interferon increase the risk of depression? How effective are treatments for MS patients with depression? Each of these issues is briefly reviewed with critical commentary, and some priorities for future research are suggested.
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Affiliation(s)
- R J Siegert
- Rehabilitation Teaching and Research Unit, Department of Medicine, Wellington School of Medicine, University of Otago, PO Box 7343, Wellington South, New Zealand.
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91
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Ekestern E, Lebhart G. Mortality from multiple sclerosis in Austria 1970-2001: dynamics, trends, and prospects. Eur J Neurol 2004; 11:511-20. [PMID: 15272894 DOI: 10.1111/j.1468-1331.2004.00818.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A divergence in earlier multiple sclerosis (MS) mortality rates observed within Europe, prompted us to determine the MS mortality rate in Austria and several European countries. Our aim was to examine the temporal and geographical variations within Austria and to determine future MS mortality rates based on a projection model. MS mortality data set, differentiated by age groups, sex, and region at death for the period 1970-2001 were obtained. Prognostic MS mortality trends for the period 2002-2020 were estimated using the simultaneous multiple cause-delay (SIMCAD) method. Our findings indicate a decline (47%) in the MS mortality rate from 1.41 (1970-79) to 0.96 (1980-89) and 0.70 (1990-2001) per 100 000 in Austria during the 32-year period observed. Conversely, the scenarios of our projection for the period 2002-2020, reveal an increasing MS mortality rate. The median age at death because of MS increased with 0.7 years for men and 2.9 years for women during the observed period (1970-2001). Austria, like many other European countries, has experienced a decreasing MS mortality rate over the last three decades. An increased MS mortality rate is however expected over the next decades in Austria. This increase will be most prominent in the elderly population cohorts because of demographic shifts.
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Affiliation(s)
- E Ekestern
- Department of Neuroimmunology, Brain Research Institute, University of Vienna, Vienna, Austria.
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92
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Abstract
Multiple sclerosis (MS) is a fairly common condition that affects approximately 350,000 people in the United States. It is associated with various neuropsychiatric symptoms including cognitive and behavioral symptoms. However, visual hallucinations are rare in multiple sclerosis without the presence of cognitive deficits. We are describing the case of a 40-year-old married white female with isolated complex visual hallucinations compatible with the Charles Bonnet syndrome (CBS). The patient was successfully treated with the atypical antipsychotic olanzapine.
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Affiliation(s)
- Adekola O Alao
- SUNY Upstate Medical University, Syracuse, NY 13210, USA.
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93
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VISSCHEDIJK MARIELLEAJ. DEVELOPMENT OF A COGNITIVE BEHAVIORAL GROUP INTERVENTION PROGRAMME FOR PATIENTS WITH MULTIPLE SCLEROSIS: AN EXPLORATORY STUDY. Psychol Rep 2004. [DOI: 10.2466/pr0.95.7.735-746] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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94
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Kanner AM, Barry JJ. The impact of mood disorders in neurological diseases: should neurologists be concerned? Epilepsy Behav 2003; 4 Suppl 3:S3-13. [PMID: 14592635 DOI: 10.1016/j.yebeh.2003.08.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Depression is one of the most frequent comorbid psychiatric disorders identified in patients with neurological disorders. The prevalence rates range between 20 and 50% of patients with stroke, epilepsy, multiple sclerosis, and Parkinson's disease. Despite these relatively high prevalence rates, depression remains underrecognized and undertreated in these patients. And yet, depression accounts for poor quality-of-life ratings and has a negative impact on the recovery from neurological symptoms. In this article, we review the epidemiological and clinical characteristics of mood disorders in patients with multiple sclerosis, Parkinson's disease, stroke, and epilepsy, and focus on the impact mood disorders have on the quality of life of these patients and on their recovery from their neurological deficits.
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Affiliation(s)
- Andres M Kanner
- Department of Neurological Sciences, Rush Medical College, Rush Epilepsy Center, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612, USA.
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95
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Patten SB, Metz LM. Hopelessness ratings in relapsing-remitting and secondary progressive multiple sclerosis. Int J Psychiatry Med 2003; 32:155-65. [PMID: 12269596 DOI: 10.2190/2g2n-we19-nm47-jny8] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Two recent randomized double-blind placebo controlled clinical trials of interferon beta-1a in multiple sclerosis have obtained hopelessness ratings using the Beck Hopelessness Scale (BHS). One of these studies, the PRISMS trial, evaluated interferon beta-1a in relapsing remitting multiple sclerosis (RRMS). Another, the SPECTRIMS trial, evaluated the same medication in secondary progressive (SP) MS. The objective of this analysis was to compare levels of hopelessness in persons with RRMS and SPMS, and to describe changes over time in the clinical trial participants. METHOD Raw data from each clinical trial was obtained from the sponsor of the trials (Serono). Median BHS ratings, and the proportions at or above the BHS cut-point of 10 were calculated over a two (PRISMS) or three (SPECTRIMS) year period. RESULTS The analysis included n = 532 clinical trial participants. Ratings of hopelessness were higher in SPMS clinical trial participants (SPECTRIMS) than in the RRMS group (PRISMS) at baseline (Fisher's exact test, p = 0.0035). Furthermore, ratings of hopelessness were higher during follow-up than at baseline, in the SPMS group (McNemar's exact probability,p = 0.0015), but not in the RRMS group (McNemar's exact probability,p = 0.65). Depression was strongly associated with hopelessness in both RRMS (z = 4.13, p < 0.001) and SPMS (z = 5.24, p < 0.001). CONCLUSIONS Hopelessness is associated with SPMS, and may increase over time in this group. Hopelessness may influence suicide risk in people with MS and may potentially have an impact on coping and quality of life. Additional research is necessary to define the clinical implications of hopelessness in persons with this condition.
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Affiliation(s)
- Scott B Patten
- Department of Community Health Sciences, University of Calgary MS Clinic, Alberta, Canada.
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96
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Chapter 8 Neuropsychiatry: Cognition and Mood Disorders. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s1877-3419(09)70037-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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97
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Abstract
The risk of attempted or completed suicide is increased in patients with migraine with aura, epilepsy, stroke, multiple sclerosis, traumatic brain injury, and Huntington's disease. Contrary to the general perception that the risk of suicide among patients with Alzheimer's disease and other dementing conditions is low, several reports suggest that the risk of suicide in these patients increases relative to the general population. Some patients at risk for neurologic disorders are also at increased risk for suicide; in particular, the risk of suicide is increased among persons at risk for Huntington's disease, independent of the presence or absence of the Huntington's gene mutation. The risk of attempted or completed suicide in neurologic illness is strongly associated with depression, feelings of hopelessness or helplessness, and social isolation. Additional suicide risk factors in persons with neurologic illness include cognitive impairment, relatively younger age (under 60 years), moderate physical disability, recent onset or change in illness, a lack of future plans or perceived meaning in life, recent losses (personal, occupational, or financial), and prior history of psychiatric illness or suicidal behavior. Substance dependence, psychotic disorders, anxiety disorders, and some personality disorders (eg, borderline personality disorder) may also contribute to increased risk of suicide among persons with neurologic illnesses. Identification and aggressive treatment of psychiatric problems, especially depression, as well as reduction of modifiable suicide risk factors among patients with neurologic illness is needed to reduce the risk of attempted and completed suicide in this population.
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Affiliation(s)
- David B. Arciniegas
- *Neuropsychiatry Service, Departments of Psychiatry and Neurology, University of Colorado Health Sciences Center, 4200 East Ninth Avenue, Campus Box C268-68, Denver, CO 80262, USA.
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98
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Lana-Peixoto MA, Teixeira AL, Haase VG. Interferon beta-1a-induced depression and suicidal ideation in multiple sclerosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2002; 60:721-4. [PMID: 12364937 DOI: 10.1590/s0004-282x2002000500007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Depression and suicide have been reported in association with multiple sclerosis (MS). Some studies show that interferon beta may increase the depression rate. We report a case of depression and suicidal ideation in coincidence with the start of increased doses of interferon beta-1a and their complete reversal following the drug withdrawal. The patient was a 21-year-old man with MS and no past history of affective disorders who was given interferon beta-1a in the dose of 11 microgram three times per week. As a new relapse occurred the dose of interferon beta-1a was increased to 22 microgram three times a week. The patient then observed increased worry, irritability and a sense of discouragement as well as recurring suicidal thoughts. His mood was rapidly restored following interferon beta-1a withdrawal. This case suggests that patients with MS may develop depression and suicidal thoughts when treated with high doses of interferon beta-1a.
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Affiliation(s)
- Marco Aurélio Lana-Peixoto
- Minas Gerais Center for Investigation of Multiple Sclerosis, Medical School, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
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99
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Girish K, Gangadhar BN, Janakiramaiah N. Ect in neurological counditions. Indian J Psychiatry 2002; 44:228-39. [PMID: 21206577 PMCID: PMC2954393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
It is a myth that electroconvulsive therapy (ECT) produces greater side effects and worsens the neurological condition when used in neurologically ill patients. With the advancement and sophistication in ECT practice standards and modification procedures, it can be safely administered either to treat selected neurological conditions or the co-morbid psychiatric illnesses without additional risks. However ECT should be administered only after thorough evaluation of risks and benefits in such individuals.
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Affiliation(s)
- K Girish
- K. GIRISH, M.D., D.N.B., Senior Resident, Department of Psychiatry, National Institute of Mental Health & Neuro Sciences, Bangalore-560029
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100
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Frohman E, Phillips T, Kokel K, Van Pelt J, O'Leary S, Gross S, Hawker K, Racke M. Disease-modifying therapy in multiple sclerosis: strategies for optimizing management. Neurologist 2002; 8:227-36. [PMID: 12803682 DOI: 10.1097/00127893-200207000-00003] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The objective for this article is to highlight several challenges faced by patients and providers in the utilization of disease-modifying agent (DMA) therapy in multiple sclerosis (MS) and to offer practical management strategies that can effectively mitigate or even prevent limiting adverse reactions and enhance treatment compliance. REVIEW SUMMARY Our discussion will be limited to the use of interferon beta1a (Avonex, Rebif), interferon beta1b (Betaseron), and glatiramer acetate (Copoxane) as these are the primary agents used in the United States for primary disease-modifying therapy in relapsing forms of MS. Some of the recommendations contained herein are derived from evidence-based studies, while others are contingent upon our collective clinical experiences. At the University of Texas Southwestern Medical Center at Dallas and Texas Neurology in Dallas we actively follow approximately 5000 MS patients. The majority of our patients with relapsing-remitting MS (RRMS) or secondary progressive MS (SPMS) are treated with one of the currently available DMAs. Our experience with these patients, and the challenges they face in continuing long-term treatment, constitutes the basis of our proposed treatment strategies. As part of this effort we formulated an assessment and intervention instrument that can be used in the clinic and by telephone to enhance compliance and minimize adverse events. CONCLUSION A comprehensive treatment approach to the utilization of disease-modifying therapy in MS can serve to optimize the management of our patients and effectively meet the challenges that arise during the course of treatment.
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Affiliation(s)
- Elliot Frohman
- Department of Neurology, University of Texas Southwestern Medical Center at Dallas, 75235, USA.
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