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Murphy R, O'Donoghue S, Counihan T, McDonald C, Calabresi PA, Ahmed MA, Kaplin A, Hallahan B. Neuropsychiatric syndromes of multiple sclerosis. J Neurol Neurosurg Psychiatry 2017; 88:697-708. [PMID: 28285265 DOI: 10.1136/jnnp-2016-315367] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 02/06/2017] [Accepted: 02/09/2017] [Indexed: 01/13/2023]
Abstract
Neuropsychiatric signs and symptoms occur frequently in individuals with multiple sclerosis (MS), either as the initial presenting complaint prior to a definitive neurological diagnosis or more commonly with disease progression. However, the pathogenesis of these comorbid conditions remains unclear and it remains difficult to accurately elucidate if neuropsychiatric symptoms or conditions are indicators of MS illness severity. Furthermore, both the disease process and the treatments of MS can adversely impact an individual's mental health. In this review, we discuss the common neuropsychiatric syndromes that occur in MS and describe the clinical symptoms, aetiology, neuroimaging findings and management strategies for these conditions.
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Affiliation(s)
- Ruth Murphy
- Department of Psychiatry, University College Hospital Galway, Galway, Ireland
| | - Stefani O'Donoghue
- Department of Psychiatry, National University of Ireland, Galway, Ireland
| | - Timothy Counihan
- Department of Neurology, National University of Ireland, Galway, Ireland
| | - Colm McDonald
- Department of Psychiatry, National University of Ireland, Galway, Ireland
| | - Peter A Calabresi
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mohammed As Ahmed
- Departments of Medical Education and Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Adam Kaplin
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Brian Hallahan
- Department of Psychiatry, National University of Ireland, Galway, Ireland
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Berzins SA, Bulloch AG, Burton JM, Dobson KS, Fick GH, Patten SB. Determinants and incidence of depression in multiple sclerosis: A prospective cohort study. J Psychosom Res 2017; 99:169-176. [PMID: 28712424 DOI: 10.1016/j.jpsychores.2017.06.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 06/07/2017] [Accepted: 06/08/2017] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To estimate the incidence and explore potential determinants of incidence of depression in MS. METHODS A prospective cohort study used a sample of 192 patients from the southern Alberta MS clinic registry. Participants completed baseline risk factor assessment questionnaires using either online, mail or telephone surveys, and completed the Patient Health Questionnaire every 2weeks for 6months to assess depressive symptoms in real time. Risk factors assessed included biopsychosocial variables such as socioeconomic status, illness-related factors, childhood risk factors, psychosocial factors, and health behaviors. Cox proportional hazard models were fit to estimate predictors of incidence. RESULTS 2-week incidence of depression for females was 0.019 (95% CI 0.013-0.029) and for males was 0.044 (0.026-0.074). Strongest predictor of depression incidence risk included fatigue impact, low mobility, resiliency, self-esteem, self-efficacy, and coping style. CONCLUSION Depression in MS exhibits a risk factor profile similar to that of depression in the general population, with the additional impact of MS illness-related factors. Potentially modifiable risk factors, such as coping with stress and resiliency, present opportunities for focus of further research in depression in MS treatment and prevention efforts. Some differences in determinants of incidence were found compared to the prevalence risk factors, highlighting the danger of using cross-sectional data to make assumptions about risk. For example, the finding that depression incidence was higher for men is opposite to the higher depression prevalence estimates found for women as well as the consensus in the literature.
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Affiliation(s)
- S A Berzins
- Department of Psychiatry and Department of Community Health Sciences, University of Calgary, Mathison Centre for Research & Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta T2N 4Z6, Canada.
| | - A G Bulloch
- Department of Psychiatry and Department of Community Health Sciences, University of Calgary, Mathison Centre for Research & Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta T2N 4Z6, Canada
| | - J M Burton
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, CANADA T2N 4Z6; Department of Clinical Neurosciences, Foothills Hospital, 1403-29 Street N.W., Calgary, Alberta T2N 2T9, Canada
| | - K S Dobson
- Department of Psychology, University of Calgary, 2500 University Dr. N.W., Calgary, Alberta T2N 1N4, Canada
| | - G H Fick
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, CANADA T2N 4Z6
| | - S B Patten
- Department of Psychiatry and Department of Community Health Sciences, University of Calgary, Mathison Centre for Research & Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta T2N 4Z6, Canada
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104
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Lukmanji S, Pham T, Blaikie L, Clark C, Jetté N, Wiebe S, Bulloch A, Holroyd-Leduc J, Macrodimitris S, Mackie A, Patten SB. Online tools for individuals with depression and neurologic conditions: A scoping review. Neurol Clin Pract 2017; 7:344-353. [PMID: 29185556 DOI: 10.1212/cpj.0000000000000365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 03/16/2017] [Indexed: 11/15/2022]
Abstract
Background Patients with neurologic conditions commonly have depression. Online tools have the potential to improve outcomes in these patients in an efficient and accessible manner. We aimed to identify evidence-informed online tools for patients with comorbid neurologic conditions and depression. Methods A scoping review of online tools (free, publicly available, and not requiring a facilitator) for patients with depression and epilepsy, Parkinson disease (PD), multiple sclerosis (MS), traumatic brain injury (TBI), or migraine was conducted. MEDLINE, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews, and Cochrane CENTRAL Register of Controlled Trials were searched from database inception to January 2017 for all 5 neurologic conditions. Gray literature using Google and Google Scholar as well as app stores for both Android and Apple devices were searched. Self-management or self-efficacy online tools were not included unless they were specifically targeted at depression and one of the neurologic conditions and met the other eligibility criteria. Results Only 4 online tools were identified. Of these 4 tools, 2 were web-based self-management programs for patients with migraine or MS and depression. The other 2 were mobile apps for patients with PD or TBI and depression. No online tools were found for epilepsy. Conclusions There are limited depression tools for people with neurologic conditions that are evidence-informed, publicly available, and free. Future research should focus on the development of high-quality, evidence-based online tools targeted at neurologic patients.
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Affiliation(s)
- Sara Lukmanji
- University of Calgary Cumming School of Medicine, Canada
| | - Tram Pham
- University of Calgary Cumming School of Medicine, Canada
| | - Laura Blaikie
- University of Calgary Cumming School of Medicine, Canada
| | - Callie Clark
- University of Calgary Cumming School of Medicine, Canada
| | - Nathalie Jetté
- University of Calgary Cumming School of Medicine, Canada
| | - Samuel Wiebe
- University of Calgary Cumming School of Medicine, Canada
| | - Andrew Bulloch
- University of Calgary Cumming School of Medicine, Canada
| | | | | | - Aaron Mackie
- University of Calgary Cumming School of Medicine, Canada
| | - Scott B Patten
- University of Calgary Cumming School of Medicine, Canada
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105
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Jetté N, Amoozegar F, Patten SB. Depression in epilepsy, migraine, and multiple sclerosis: Epidemiology and how to screen for it. Neurol Clin Pract 2017; 7:118-127. [PMID: 29185533 DOI: 10.1212/cpj.0000000000000349] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/07/2017] [Indexed: 11/15/2022]
Abstract
Purpose of review To provide an overview of the epidemiology of depression in chronic neurologic conditions that can affect individuals throughout the lifespan (epilepsy, migraine, multiple sclerosis [MS]) and examine depression screening tools for adults with these conditions. Recent findings Depression is common in neurologic conditions and can be associated with lower quality of life, higher health resource utilization, and poor adherence to treatment. It affects around 20%-30% of those with epilepsy, migraine, and MS, and evidence for a bidirectional association exists for each of these conditions. Depression screening tools generally perform well in neurologic conditions, but are not without limitations. Summary Depression is a major contributor to poor outcomes in epilepsy, migraine, and MS. Although psychiatric resources are scarce globally, this is no reason to ignore depression in neurologic conditions. Depression screening tools are available in neurology and should be considered in clinical practice.
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Affiliation(s)
- Nathalie Jetté
- Department of Clinical Neurosciences (NJ, FA), Hotchkiss Brain Institute (NJ, FA, SBP), Department of Psychiatry (SBP), Mathison Health Centre (SBP), Department of Community Health Sciences (NJ, FA, SBP), and O'Brien Institute for Public Health (NJ, FA, SBP), Cumming School of Medicine, University of Calgary, Canada
| | - Farnaz Amoozegar
- Department of Clinical Neurosciences (NJ, FA), Hotchkiss Brain Institute (NJ, FA, SBP), Department of Psychiatry (SBP), Mathison Health Centre (SBP), Department of Community Health Sciences (NJ, FA, SBP), and O'Brien Institute for Public Health (NJ, FA, SBP), Cumming School of Medicine, University of Calgary, Canada
| | - Scott B Patten
- Department of Clinical Neurosciences (NJ, FA), Hotchkiss Brain Institute (NJ, FA, SBP), Department of Psychiatry (SBP), Mathison Health Centre (SBP), Department of Community Health Sciences (NJ, FA, SBP), and O'Brien Institute for Public Health (NJ, FA, SBP), Cumming School of Medicine, University of Calgary, Canada
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106
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Tietjen KM, Breitenstein S. A Nurse-Led Telehealth Program to Improve Emotional Health in Individuals With Multiple Sclerosis. J Psychosoc Nurs Ment Health Serv 2017; 55:31-37. [DOI: 10.3928/02793695-20170301-04] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 02/15/2017] [Indexed: 11/20/2022]
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Gay MC, Bungener C, Thomas S, Vrignaud P, Thomas PW, Baker R, Montel S, Heinzlef O, Papeix C, Assouad R, Montreuil M. Anxiety, emotional processing and depression in people with multiple sclerosis. BMC Neurol 2017; 17:43. [PMID: 28231828 PMCID: PMC5324294 DOI: 10.1186/s12883-017-0803-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 01/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the high comorbidity of anxiety and depression in people with multiple sclerosis (MS), little is known about their inter-relationships. Both involve emotional perturbations and the way in which emotions are processed is likely central to both. The aim of the current study was to explore relationships between the domains of mood, emotional processing and coping and to analyse how anxiety affects coping, emotional processing, emotional balance and depression in people with MS. METHODS A cross-sectional questionnaire study involving 189 people with MS with a confirmed diagnosis of MS recruited from three French hospitals. Study participants completed a battery of questionnaires encompassing the following domains: i. anxiety and depression (Hospital Anxiety and Depression Scale (HADS)); ii. emotional processing (Emotional Processing Scale (EPS-25)); iii. positive and negative emotions (Positive and Negative Emotionality Scale (EPN-31)); iv. alexithymia (Bermond-Vorst Alexithymia Questionnaire) and v. coping (Coping with Health Injuries and Problems-Neuro (CHIP-Neuro) questionnaire. Relationships between these domains were explored using path analysis. RESULTS Anxiety was a strong predictor of depression, in both a direct and indirect way, and our model explained 48% of the variance of depression. Gender and functional status (measured by the Expanded Disability Status Scale) played a modest role. Non-depressed people with MS reported high levels of negative emotions and low levels of positive emotions. Anxiety also had an indirect impact on depression via one of the subscales of the Emotional Processing Scale ("Unregulated Emotion") and via negative emotions (EPN-31). CONCLUSIONS This research confirms that anxiety is a vulnerability factor for depression via both direct and indirect pathways. Anxiety symptoms should therefore be assessed systematically and treated in order to lessen the likelihood of depression symptoms.
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Affiliation(s)
- Marie-Claire Gay
- Psychology Department, University of Paris West, Nanterre, France.
| | - Catherine Bungener
- Laboratory of Psychopathology, University of Paris Descartes, Paris, France.,Health Psychology, Université Paris Sorbonne Cité, Paris, France
| | - Sarah Thomas
- Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Pierre Vrignaud
- Psychology Department, University of Paris West, Nanterre, France
| | - Peter W Thomas
- Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Roger Baker
- Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | | | - Olivier Heinzlef
- Neurology Department, Hospital of Poissy-St-Germain en Laye, Paris, France
| | | | - Rana Assouad
- Neurology Department, GHPS Pitié Salpêtrière, Paris, France
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108
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Motl RW, Mowry EM, Ehde DM, LaRocca NG, Smith KE, Costello K, Shinto L, Ng AV, Sullivan AB, Giesser B, McCully KK, Fernhall B, Bishop M, Plow M, Casaccia P, Chiaravalloti ND. Wellness and multiple sclerosis: The National MS Society establishes a Wellness Research Working Group and research priorities. Mult Scler 2017; 24:262-267. [PMID: 28080254 PMCID: PMC5494005 DOI: 10.1177/1352458516687404] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background: People with multiple sclerosis (MS) have identified “wellness” and associated behaviors as a high priority based on “social media listening” undertaken by the National MS Society (i.e. the Society). Objective: The Society recently convened a group that consisted of researchers with experience in MS and wellness-related research, Society staff members, and an individual with MS for developing recommendations regarding a wellness research agenda. Method: The members of the group engaged in focal reviews and discussions involving the state of science within three approaches for promoting wellness in MS, namely diet, exercise, and emotional wellness. Results: That process informed a group-mediated activity for developing and prioritizing research goals for wellness in MS. This served as a background for articulating the mission and objectives of the Society’s Wellness Research Working Group. Conclusion: The primary mission of the Wellness Research Working Group is the provision of scientific evidence supporting the application of lifestyle, behavioral, and psychosocial approaches for promoting optimal health of mind, body, and spirit (i.e. wellness) in people with MS as well as managing the disease and its consequences.
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Affiliation(s)
- Robert W Motl
- Department of Physical Therapy, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ellen M Mowry
- Department of Epidemiology and Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Dawn M Ehde
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | | | - Kathy E Smith
- National Multiple Sclerosis Society, New York, NY, USA
| | | | - Lynne Shinto
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Alexander V Ng
- Exercise Science Program, Physical Therapy Department, Marquette University, Milwaukee, WI, USA
| | - Amy B Sullivan
- Mellen Center for MS, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Barbara Giesser
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kevin K McCully
- Department of Kinesiology, University of Georgia, Athens, GA, USA
| | - Bo Fernhall
- College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Malachy Bishop
- Early Childhood, Special Education, and Rehabilitation Counseling, University of Kentucky, Lexington, KY, USA
| | - Matthew Plow
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Patrizia Casaccia
- Icahn School of Medicine at Mount Sinai and Advanced Research Science Center, City University at New York, New York, NY, USA
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109
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Messer MM, Haller IV. Ketamine Therapy for Treatment-resistant Depression in a Patient with Multiple Sclerosis: A Case Report. INNOVATIONS IN CLINICAL NEUROSCIENCE 2017; 14:56-59. [PMID: 28386522 PMCID: PMC5373796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Objective: Depression is a common condition among patients with multiple sclerosis and often becomes resistant to oral antidepressants. We report a patient with multiple sclerosis who developed severe treatment-resistant depression and who was successfully treated with intravenous ketamine over the period of two years. Methods: Ketamine treatment protocol included an initial series of six treatments administered every other day, followed by a maintenance schedule. Ketamine was administered intravenously at 0.5mg/kg of ideal body weight over 40 minutes. Depression symptoms were measured using Beck Depression Index. Results: The patient's Beck Depression Index score prior to initiating ketamine treatment was 38, corresponding to severe depression. Response to treatment, defined as 50-percent reduction in Beck Depression Index score, was observed after five treatments. For this patient, the maintenance schedule ranged from a weekly treatment to one treatment every three weeks. During the two-year observation period, this patient was able to maintain a stable non-depressed mood and had no worsening of her MS symptoms. Conclusion: Ketamine may be an alternative treatment for resistant depression and may have a special use in patients with multiple sclerosis.
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Affiliation(s)
- Michael M Messer
- Dr. Messer is with Behavioral Health Department, Essentia Health, Duluth, MN, and Dr. Haller is with Essentia Institute of Rural Health, Essentia Health, Duluth, MN, USA
| | - Irina V Haller
- Dr. Messer is with Behavioral Health Department, Essentia Health, Duluth, MN, and Dr. Haller is with Essentia Institute of Rural Health, Essentia Health, Duluth, MN, USA
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110
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Prevalence of depression and anxiety in Multiple Sclerosis: A systematic review and meta-analysis. J Neurol Sci 2017; 372:331-341. [DOI: 10.1016/j.jns.2016.11.067] [Citation(s) in RCA: 303] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 11/25/2016] [Accepted: 11/28/2016] [Indexed: 11/23/2022]
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111
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Suryadevara U, Bruijnzeel DM, Nuthi M, Jagnarine DA, Tandon R, Bruijnzeel AW. Pros and Cons of Medical Cannabis use by People with Chronic Brain Disorders. Curr Neuropharmacol 2017; 15:800-814. [PMID: 27804883 PMCID: PMC5652027 DOI: 10.2174/1570159x14666161101095325] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 08/26/2016] [Accepted: 10/28/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cannabis is the most widely used illicit drug in the world and there is growing concern about the mental health effects of cannabis use. These concerns are at least partly due to the strong increase in recreational and medical cannabis use and the rise in tetrahydrocannabinol (THC) levels. Cannabis is widely used to self-medicate by older people and people with brain disorders such as amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), Alzheimer's disease (AD), Parkinson's disease (PD), bipolar disorder, and schizophrenia. OBJECTIVE This review provides an overview of the perceived benefits and adverse mental health effects of cannabis use in people with ALS, MS, AD, PD, bipolar disorder, and schizophrenia. RESULTS The reviewed studies indicate that cannabis use diminishes some symptoms associated with these disorders. Cannabis use decreases pain and spasticity in people with MS, decreases tremor, rigidity, and pain in people with PD, and improves the quality of life of ALS patients by improving appetite, and decreasing pain and spasticity. Cannabis use is more common among people with schizophrenia than healthy controls. Cannabis use is a risk factor for schizophrenia which increases positive symptoms in schizophrenia patients and diminishes negative symptoms. Cannabis use worsens bipolar disorder and there is no evidence that bipolar patients derive any benefit from cannabis. In late stage Alzheimer's patients, cannabis products may improve food intake, sleep quality, and diminish agitation. CONCLUSION Cannabis use diminishes some of the adverse effects of neurological and psychiatric disorders. However, chronic cannabis use may lead to cognitive impairments and dependence.
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Affiliation(s)
- Uma Suryadevara
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | | | - Meena Nuthi
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | | | - Rajiv Tandon
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - Adriaan W. Bruijnzeel
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
- Department of Neuroscience, University of Florida, Gainesville, Florida, USA
- Center for Addiction Research and Education, University of Florida, Gainesville, FL, USA
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112
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Veauthier C, Hasselmann H, Gold SM, Paul F. The Berlin Treatment Algorithm: recommendations for tailored innovative therapeutic strategies for multiple sclerosis-related fatigue. EPMA J 2016; 7:25. [PMID: 27904656 PMCID: PMC5121967 DOI: 10.1186/s13167-016-0073-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 10/21/2016] [Indexed: 12/11/2022]
Abstract
More than 80% of multiple sclerosis (MS) patients suffer from fatigue. Despite this, there are few therapeutic options and evidence-based pharmacological treatments are lacking. The associated societal burden is substantial (MS fatigue is a major reason for part-time employment or early retirement), and at least one out of four MS patients view fatigue as the most burdensome symptom of their disease. The mechanisms underlying MS-related fatigue are poorly understood, and objective criteria for distinguishing and evaluating levels of fatigue and tiredness have not yet been developed. A further complication is that both symptoms may also be unspecific indicators of many other diseases (including depression, sleep disorders, anemia, renal failure, liver diseases, chronic obstructive pulmonary disease, drug side effects, recent MS relapses, infections, nocturia, cancer, thyroid hypofunction, lack of physical exercise). This paper reviews current treatment options of MS-related fatigue in order to establish an individualized therapeutic strategy that factors in existing comorbid disorders. To ensure that such a strategy can also be easily and widely implemented, a comprehensive approach is needed, which ideally takes into account all other possible causes and which is moreover cost efficient. Using a diagnostic interview, depressive disorders, sleep disorders and side effects of the medication should be identified and addressed. All MS patients suffering from fatigue should fill out the Modified Fatigue Impact Scale, Epworth Sleepiness Scale, the Beck Depression Inventory (or a similar depression scale), and the Pittsburgh Sleep Quality Index (or the Insomnia Severity Index). In some patients, polygraphic or polysomnographic investigations should be performed. The treatment of underlying sleep disorders, drug therapy with alfacalcidol or fampridine, exercise therapy, and cognitive behavioral therapy-based interventions may be effective against MS-related fatigue. The objectives of this article are to identify the reasons for fatigue in patients suffering from multiple sclerosis and to introduce individually tailored treatment approaches. Moreover, this paper focuses on current knowledge about MS-related fatigue in relation to brain atrophy and lesions, cognition, disease course, and other findings in an attempt to identify future research directions.
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Affiliation(s)
- Christian Veauthier
- Interdisciplinary Center for Sleep Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany ; NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Helge Hasselmann
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany ; Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Stefan M Gold
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany ; Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology (ZMNH), University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany ; Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité - Universitätsmedizin Berlin, 10117 Berlin, Germany ; Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
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113
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Morrison JD, Mayer L. Physical activity and cognitive function in adults with multiple sclerosis: an integrative review. Disabil Rehabil 2016; 39:1909-1920. [PMID: 27764974 DOI: 10.1080/09638288.2016.1213900] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE To identify and synthesize the research evidence concerning (1) the relationship between physical activity and cognitive performance in persons with multiple sclerosis (MS) and (2) to review the reported effects of physical activity interventions on neurocognitive performance conducted in this population. METHODS Relevant peer-reviewed journal articles were identified by searching PubMed, PsychINFO, and SPORTDiscus through May 2016. Full-text articles meeting the inclusion criteria were evaluated for quality using tools developed by the National Institutes of Health. Studies deemed to be of poor quality were excluded from the review. RESULTS Nineteen studies meeting the inclusion/exclusion criteria were analyzed. Nine studies reported significant relationships between higher levels of physical activity or cardiorespiratory fitness and measures of cognitive function. Data extracted from 10 physical activity intervention studies reported mixed results on the effectiveness of physical activity to improve selected domains of cognitive function in persons with MS. CONCLUSION Although correlational studies provide evidence to support a linkage between physical activity and cognitive function in persons with MS, this linkage is confounded by factors that may have influenced the studies' results. Evidence derived from intervention studies that could support a positive effect of physical activity on cognition in persons with MS is equivocal. Implications for Rehabilitation Physical activity has numerous benefits for persons with multiple sclerosis (MS) including improvements in balance, ambulation, depression, fatigue, and quality of life. Structured physical activity programs may contribute to cognitive function stability or improvement in persons with MS.
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Affiliation(s)
- Janet D Morrison
- a School of Nursing , the University of Texas at Austin , Austin , TX , USA
| | - Lori Mayer
- b Central Texas Neurology Consultants , MS Clinic of Central Texas , Round Rock , TX , USA
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114
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Boeschoten RE, Dekker J, Uitdehaag BMJ, Beekman ATF, Hoogendoorn AW, Collette EH, Cuijpers P, Nieuwenhuis MM, van Oppen P. Internet-based treatment for depression in multiple sclerosis: A randomized controlled trial. Mult Scler 2016; 23:1112-1122. [DOI: 10.1177/1352458516671820] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Depression in multiple sclerosis (MS) patients is common but may stay untreated. Physical limitations impede face-to-face treatment. Internet-based treatment is therefore a promising tool for treating depression in MS. Objectives: To investigate effectiveness of a guided Internet-based problem-solving treatment (IPST) for depressed MS patients. Methods: MS patients with moderate or severe depressive symptoms were randomly assigned to IPST or a wait list control. Primary outcome was the change in depressive symptoms defined by a change in sum score on the Beck Depression Inventory Second Edition (BDI-II). Assessments took place at baseline (T0), within a week after the intervention (T1), and at 4 months follow-up (T2). Analyses were based on the intention-to-treat principle. Results: A total of 171 patients were randomized to IPST ( n = 85) or a wait list control ( n = 86). T1 was completed by 152 (89%) and T2 by 131 patients (77%). The IPST group and wait list control showed large significant improvements in depressive symptoms, but no differences were found between groups at T1 ( d = 0.23; 95% confidence interval (CI) = (−4.03, 1.08); p = 0.259) and T2 ( d = 0.01; 95% CI = (−2.80, 2.98); p = 0.953). Conclusion: We found no indication that IPST for MS patients with moderate or severe depression is effective in reducing depressive symptoms compared to a waiting list. Large improvements in the wait list control were unexpected and are discussed.
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Affiliation(s)
- Rosa E Boeschoten
- EMGO+ Institute for Mental Health and Care Research/Department of Psychiatry, VU University Medical Center/GGZinGeest, Amsterdam, The Netherlands
| | - Joost Dekker
- Department of Psychiatry, VU University Medical Center/GGZinGeest, Amsterdam, The Netherlands/EMGO+ Institute for Mental Health and Care Research, VU University, Amsterdam, The Netherlands; Department of Rehabilitation Medicine, VU University Medical Center Amsterdam, The Netherlands
| | - Bernard MJ Uitdehaag
- Department of Neurology, Multiple Sclerosis Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Aartjan TF Beekman
- EMGO+ Institute for Mental Health and Care Research/Department of Psychiatry, VU University Medical Center/GGZinGeest, Amsterdam, The Netherlands
| | - Adriaan W Hoogendoorn
- EMGO+ Institute for Mental Health and Care Research/Department of Psychiatry, VU University Medical Center/GGZinGeest, Amsterdam, The Netherlands
| | - Emma H Collette
- Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
| | - Pim Cuijpers
- EMGO+ Institute for Mental Health and Care Research, VU University, Amsterdam, The Netherlands/Department of Clinical, Neuro & Developmental Psychology, VU University, Amsterdam, The Netherlands
| | - Magdalena M Nieuwenhuis
- EMGO+ Institute for Mental Health and Care Research/Department of Psychiatry, VU University Medical Center/GGZinGeest, Amsterdam, The Netherlands
| | - Patricia van Oppen
- EMGO+ Institute for Mental Health and Care Research/Department of Psychiatry, VU University Medical Center/GGZinGeest, Amsterdam, The Netherlands
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Solaro C, Trabucco E, Signori A, Martinelli V, Radaelli M, Centonze D, Rossi S, Grasso MG, Clemenzi A, Bonavita S, D’Ambrosio A, Patti F, D’Amico E, Cruccu G, Truini A. Depressive Symptoms Correlate with Disability and Disease Course in Multiple Sclerosis Patients: An Italian Multi-Center Study Using the Beck Depression Inventory. PLoS One 2016; 11:e0160261. [PMID: 27632167 PMCID: PMC5025048 DOI: 10.1371/journal.pone.0160261] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 07/16/2016] [Indexed: 11/18/2022] Open
Abstract
Background Depression occurs in about 50% of patients with multiple sclerosis. The aims of this study was to investigate the prevalence of depressive symptoms in a multicenter MS population using the Beck Depression Inventory II (BDI II) and to identify possible correlations between the BDI II score and demographic and clinical variables. Methods Data were collected in a multi-center, cross-sectional study over a period of six months in six MS centers in Italy using BDI II. Results 1,011 MS patients participated in the study. 676 subjects were female, with a mean age of 34 years (SD 10.8), mean EDSS of 3.3 (0–8.5) and mean disease duration of 10.3 years (range 1–50 years). 668 (%) subjects scored lower than 14 on the BDI II and 343 (33.9%) scored greater than 14 (14 cut-off score). For patients with BDI>14 multivariate analysis showed a significant difference between EDSS and disease course. BDI II scores for subjects with secondary progressive (SP) MS were significantly different from primary progressive (PP) patients (p < 0.001) but similar to relapsing-remitting (RR) patients. Considering subjects with moderate to severe depressive symptoms (BDI II score from 20–63), in relation to disease course, 11.7% (83/710) had RR MS, 40.7% (96/236) SP and 13.6% (6/44) PP. Conclusions Using the BDI II, 30% of the current sample had depressive symptoms. BDI II score correlates with disability and disease course, particularly in subjects with SP MS. The BDI II scale can be a useful tool in clinical practice to screen depressive symptoms in people with MS.
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Affiliation(s)
- C. Solaro
- Neurology Unit, Head and Neck Dept., ASL 3 “Genovese”, Genoa, Italy
- * E-mail:
| | - E. Trabucco
- Neurology Unit, Head and Neck Dept., ASL 3 “Genovese”, Genoa, Italy
- Dep. of Experimental Medicine, Section of Diagnostic Radiology, University of Genoa, Genoa, Italy
| | - A. Signori
- Dept. of Health Sciences, Section of Biostatistics, University of Genoa, Genoa, Italy
| | - V. Martinelli
- Dept. of Neurology, San Raffaele Scientific Institute, Milan, Italy
| | - M. Radaelli
- Dept. of Neurology, San Raffaele Scientific Institute, Milan, Italy
| | - D. Centonze
- Neurology Clinic, Dept. of Systems Medicine, Tor Vergata University, Rome & IRCCS Neuromed, Rome, Italy
- Neurology Clinic, Dept. of Systems Medicine, Tor Vergata University, Rome & Istituto Neurologico Mediterraneo Neuromed, IRCCS, Pozzilli, Rome, Italy
| | - S. Rossi
- Neurology Clinic, Dept. of Systems Medicine, Tor Vergata University, Rome & IRCCS Neuromed, Rome, Italy
- Neurology Clinic, Dept. of Systems Medicine, Tor Vergata University, Rome & Istituto Neurologico Mediterraneo Neuromed, IRCCS, Pozzilli, Rome, Italy
| | | | | | - S. Bonavita
- Neurology Clinic, Second University of Naples, Naples, Italy
| | - A. D’Ambrosio
- Neurology Clinic, Second University of Naples, Naples, Italy
| | - F. Patti
- Department DANA, “GF Ingrassia”, Neuroscience Section (Multiple Sclerosis Centre), University of Catania, Catania, Italy
| | - E. D’Amico
- Department DANA, “GF Ingrassia”, Neuroscience Section (Multiple Sclerosis Centre), University of Catania, Catania, Italy
| | - G. Cruccu
- Dept. of Neurology and Psychiatry, University of Rome—La Sapienza, Rome, Italy
| | - A. Truini
- Dept. of Neurology and Psychiatry, University of Rome—La Sapienza, Rome, Italy
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116
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Portaccio E. Differential diagnosis, discerning depression from cognition. Acta Neurol Scand 2016; 134 Suppl 200:14-8. [PMID: 27580901 DOI: 10.1111/ane.12652] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 02/02/2023]
Abstract
Cognitive impairment is common in multiple sclerosis (MS), affecting up to 70% of patients. One of the most important possible confounders to cognitive assessment is the occurrence of depression, a common consequence of MS. Cognition and depression have been linked in recent neuropsychiatric research that proposed a number of neurocognitive models of mood disorders. According to these models, primary failure of key brain regions of emotional processing and regulation or abnormal connectivity between them contributes to the adoption of maladaptive cognitive strategies and the development of mood disorders. In MS, a similar interplay between cognitive function and depression has been reported. In particular, depression seems to alter attentional capacity in terms of deficits in working memory and, more specifically, deficits in the executive control. However, cognitive impairment in MS does exist also in the absence of depression and it is more likely that depression exacerbates existing cognitive difficulties rather than cause them per se. On the other hand, it is possible that a dysexecutive syndrome secondary to MS might in turn precipitate depression.
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Affiliation(s)
- E. Portaccio
- Department of NEUROFARBA; University of Florence; Florence Italy
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117
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Hind D, Kaklamanou D, Beever D, Webster R, Lee E, Barkham M, Cooper C. The assessment of depression in people with multiple sclerosis: a systematic review of psychometric validation studies. BMC Psychiatry 2016; 16:278. [PMID: 27491674 PMCID: PMC4973535 DOI: 10.1186/s12888-016-0931-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 06/15/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The prevalence of depression in people with multiple sclerosis (PwMS) is high; however, symptoms common to both conditions makes measurement difficult. There is no high quality overview of validation studies to guide the choice of depression inventory for this population. METHODS A systematic review of studies validating the use of generic depression inventories in people with MS was conducted using MEDLINE and PsycINFO. Studies validating the use of depression inventories in PwMS and published in English were included; validation studies of tests for cognitive function and general mental health were excluded. Eligible studies were then quality assessed using the COSMIN checklist and findings synthesised narratively by instrument and validity domain. RESULTS Twenty-one studies (N = 5,991 PwMS) evaluating 12 instruments were included in the review. Risk of bias varied greatly between instrument and validity domain. CONCLUSIONS The review of validation studies was constrained by poor quality reporting and outcome reporting bias. Well-conducted evaluations of some instruments are unavailable for some validity domains. This systematic review provides an evidence base for trade-offs in the selection of an instrument for assessing self-reported symptoms of depression in research or clinical practice involving people with MS. We make detailed and specific recommendations for where further research is needed. TRIAL REGISTRATION PROSPERO CRD42014010597.
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Affiliation(s)
- Daniel Hind
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Daphne Kaklamanou
- Department of Psychology, Sociology and Politics, Sheffield Hallam University, Heart of the Campus, 42 Collegiate Crescent, Sheffield, S10 2BQ, UK.
| | - Dan Beever
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Ellen Lee
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Michael Barkham
- Centre for Psychological Services Research, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Cindy Cooper
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
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Hasselmann H, Bellmann-Strobl J, Ricken R, Oberwahrenbrock T, Rose M, Otte C, Adli M, Paul F, Brandt AU, Finke C, Gold SM. Characterizing the phenotype of multiple sclerosis–associated depression in comparison with idiopathic major depression. Mult Scler 2016; 22:1476-1484. [DOI: 10.1177/1352458515622826] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/26/2015] [Indexed: 11/17/2022]
Abstract
Background: Depression is a common co-morbidity in patients with multiple sclerosis (MS). While somatic symptoms of MS correlate with depression levels, it is unclear whether the clinical presentation of MS-associated depression differs from patients with “idiopathic” major depressive disorder (MDD). Objective: To compare the clinical phenotype of depression among MS and idiopathic MDD patients. Methods: Mean relative contribution of individual Beck Depression Inventory-II (BDI-II) items was evaluated among n = 139 patients with relapsing-remitting MS and n = 85 MDD patients without somatic illness. Next, comparisons were repeated in n = 38 MS with clinically relevant depressive symptoms (BDI-II > 19) and n = 38 MDD patients matched for sex, age, and depression severity. Finally, the underlying construct of depression was compared across groups using confirmatory factor analysis (CFA). Results: Comparisons on a whole-group level produced the expected differences along somatic/non-somatic symptoms. However, when appropriately controlling for depression severity, age, and sex, only four items contributed differentially to BDI-II total scores in MS versus MDD. CFA suggested that the underlying depression construct is essentially identical in both groups. Conclusion: The clinical phenotype of “idiopathic” MDD and MS-associated depression appears similar when adequately examined. The relevance of these findings for psychotherapeutic approaches for MS-associated depression should be explored in future studies.
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Affiliation(s)
- Helge Hasselmann
- Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany/NeuroCure Clinical Research Center, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Judith Bellmann-Strobl
- NeuroCure Clinical Research Center, Charité—Universitätsmedizin Berlin, Berlin, Germany/Experimental and Clinical Research Center, Charité—Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Roland Ricken
- Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Timm Oberwahrenbrock
- NeuroCure Clinical Research Center, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Rose
- Division of Psychosomatic Medicine, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Otte
- Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany/Fliedner Klinik Berlin, Berlin, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité—Universitätsmedizin Berlin, Berlin, Germany/Experimental and Clinical Research Center, Charité—Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin, Germany/Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander U Brandt
- NeuroCure Clinical Research Center, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Carsten Finke
- Department of Neurology, Charité—Universitätsmedizin Berlin, Berlin, Germany/Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stefan M Gold
- Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany/Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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119
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The determinants of depression in a Romanian cohort of multiple sclerosis patients. Acta Neurol Belg 2016; 116:135-43. [PMID: 26442687 DOI: 10.1007/s13760-015-0547-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 09/22/2015] [Indexed: 10/23/2022]
Abstract
The aim of the present study was to assess the prevalence of depression in a large multiple sclerosis (MS) patient group and to analyse the physical and psycho-socio-economic factors that influence its frequency and severity. In total, 351 consecutive patients with a diagnosis of MS were included in this study. All the patients completed a survey about their demographic characteristics, marital status, presence of children, employment status, educational level, duration of disease, disease course, duration of treatment and type of disease modifying therapies (DMT). Their disability level was evaluated using the Expanded Disability Status Scale (EDSS). Their depression level was evaluated using the Romanian Version (2012) of the Beck Depression Inventory-II (BDI-II). There was a significant positive correlation between the BDI-II score and the actual age of the patients, their disease duration, EDSS and the number of total relapses. From the EDSS functional scores, only the pyramidal score and the sensitive score presented a significant association with BDI-II in the logistic regression analysis. The BDI-II values decreased significantly with increasing education level. In the case of the retired patients, the BDI-II values were significantly higher. The BDI-II scores were also higher in widowers and divorced patients and in patients with children. There was no significant difference in the BDI-II values between different DMT groups. The main physical and psycho-socio-economic determinants of depression in patients with MS are the physical disability, disease duration, number of relapses, marital status, education level, employment status, and the presence of children, but many unsolved questions remain about the interrelations and relative contributions of these factors, which necessitates further research. The DMTs did not significantly influence the depression level.
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120
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Hunter SF, Agius M, Miller DM, Cutter G, Barbato L, McCague K, Meng X, Agashivala N, Chin P, Hollander E. Impact of a switch to fingolimod on depressive symptoms in patients with relapsing multiple sclerosis: An analysis from the EPOC (Evaluate Patient OutComes) trial. J Neurol Sci 2016; 365:190-8. [DOI: 10.1016/j.jns.2016.03.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 02/12/2016] [Accepted: 03/15/2016] [Indexed: 12/28/2022]
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121
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Tseng CC, Chang SJ, Tsai WC, Ou TT, Wu CC, Sung WY, Hsieh MC, Yen JH. Increased incidence of rheumatoid arthritis in multiple sclerosis: A nationwide cohort study. Medicine (Baltimore) 2016; 95:e3999. [PMID: 27368008 PMCID: PMC4937922 DOI: 10.1097/md.0000000000003999] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Past studies have shown inconsistent results on whether there is an association between multiple sclerosis (MS) and rheumatoid arthritis. To investigate the possible relationship between the 2 autoimmune diseases, we performed a nationwide cohort study utilizing the National Health Insurance Research Database and the Registry of Catastrophic Illness.A total of 1456 newly diagnosed patients with MS and 10,362 control patients were matched for age, sex, and initial diagnosis date. Patients with MS had a higher incidence of rheumatoid arthritis (age-adjusted standardized incidence ratio: 1.72; 95% confidence interval = 1.01-2.91). There was a positive correlation in being diagnosed with rheumatoid arthritis in patients previously diagnosed with MS when stratified by sex and age. The strength of this association remained statistically significant after adjusting for sex, age, and smoking history (hazard ratio: 1.78, 95% confidence interval = 1.24-2.56, P = 0.002).In conclusion, this study demonstrates that a diagnosis of MS increased the likelihood of a subsequent diagnosis of rheumatoid arthritis in patients, independent of sex, age, and smoking history.
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Affiliation(s)
- Chia-Chun Tseng
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital
| | - Shun-Jen Chang
- Department of Kinesiology, Health and Leisure Studies, National University of Kaohsiung
- Correspondence: Shun-Jen Chang, Department of Kinesiology, Health and Leisure Studies, National University of Kaohsiung, Kaohsiung, Taiwan (e-mail: ); Jeng-Hsien Yen, Division of Rheumatology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (e-mail: )
| | - Wen-Chan Tsai
- Division of Rheumatology, Department of Internal Medicine, Kaohsiung Medical University Hospital
| | - Tsan-Teng Ou
- Division of Rheumatology, Department of Internal Medicine, Kaohsiung Medical University Hospital
| | - Cheng-Chin Wu
- Division of Rheumatology, Department of Internal Medicine, Kaohsiung Medical University Hospital
| | - Wan-Yu Sung
- Division of Rheumatology, Department of Internal Medicine, Kaohsiung Medical University Hospital
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Ming-Chia Hsieh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua
- Graduate Institute of Integrated Medicine, China Medical University, Taichung
| | - Jeng-Hsien Yen
- Division of Rheumatology, Department of Internal Medicine, Kaohsiung Medical University Hospital
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
- Correspondence: Shun-Jen Chang, Department of Kinesiology, Health and Leisure Studies, National University of Kaohsiung, Kaohsiung, Taiwan (e-mail: ); Jeng-Hsien Yen, Division of Rheumatology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (e-mail: )
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Montanari E, Rottoli M, Maimone D, Confalonieri P, Plewnia K, Frigo M, Francia A, Pala A, Losignore NA, Ragonese P, Veneziano A. A 12-month prospective, observational study evaluating the impact of disease-modifying treatment on emotional burden in recently-diagnosed multiple sclerosis patients: The POSIDONIA study. J Neurol Sci 2016; 364:105-9. [PMID: 27084226 DOI: 10.1016/j.jns.2016.02.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 01/25/2016] [Accepted: 02/18/2016] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Depression and anxiety are common among patients with multiple sclerosis (MS) and are frequently present at the time of MS diagnosis. METHODS POSIDONIA was a 12-month, observational, prospective study conducted in Italy to evaluate the impact of disease-modifying treatment (DMT) on emotional burden in patients with recently-diagnosed MS. The Hospital Anxiety and Depression Scale (HADS), specifically HADS anxiety (HADS-A) and depression (HADS-D) subscale scores, the Short-Form 36 Health Survey (SF-36) and the Impact of Event Scale - Revised (IES-R) were used to measure patient-reported outcomes. The Hamilton Depression Rating Scale (HDRS), HDRS-17, was used as a measure of healthcare provider-reported outcomes. The primary study outcome was change from baseline in feelings of anxiety and depression over 12months (via HADS). RESULTS Of 250 enrolled patients, 222 (88.8%) completed the study. At baseline, mean HADS total, HADS-A and HADS-D subscale scores were within the normal range. There were no significant changes over time in mean HADS total and HADS-A and HADS-D subscale scores, although the subgroup of patients with baseline scores indicative of anxiety or depression tended to improve over time. Both the HDRS and IES-R total scores improved over time, but there were no statistically significant changes in SF-36. CONCLUSION In the patient population of the POSIDONIA study depression and anxiety were present in a minority of patients thus not allowing to detect the impact of starting DMT. However DMT appears to have a positive effect in patients with measurable anxiety or depression at baseline.
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Affiliation(s)
| | - Mariarosa Rottoli
- Centro Sclerosi Multipla, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Davide Maimone
- Centro Sclerosi Multipla, U.O. Neurologia, Azienda Ospedaliera Garibaldi, Catania, Italy
| | - Paolo Confalonieri
- Centro Sclerosi Multipla, U.O Neurologia IV, Fondazione Istituto Neurologico Carlo Besta, Milano, Italy
| | | | - Maura Frigo
- Clinica Neurologica, Ospedale San Gerardo, Monza, Italy
| | - Ada Francia
- Centro Sclerosi Multipla Azienda Policlinico Umberto I, Roma, Italy
| | - Antonello Pala
- U.O. di Neurologia Ospedaliera, Presidio Ospedaliero A. Segni, Ozieri, Italy
| | | | - Paolo Ragonese
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy
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123
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Sacco R, Santangelo G, Stamenova S, Bisecco A, Bonavita S, Lavorgna L, Trojano L, D'Ambrosio A, Tedeschi G, Gallo A. Psychometric properties and validity of Beck Depression Inventory II in multiple sclerosis. Eur J Neurol 2016; 23:744-50. [DOI: 10.1111/ene.12932] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 11/04/2015] [Indexed: 01/03/2023]
Affiliation(s)
- R. Sacco
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences; Second University of Naples; Naples Italy
| | - G. Santangelo
- Department of Psychology; Second University of Naples; Caserta Italy
| | - S. Stamenova
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences; Second University of Naples; Naples Italy
- Multiprofile Hospital for Active Treatment in Neurology and Psychiatry ‘St. Naum’; Sofia Bulgaria
| | - A. Bisecco
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences; Second University of Naples; Naples Italy
| | - S. Bonavita
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences; Second University of Naples; Naples Italy
| | - L. Lavorgna
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences; Second University of Naples; Naples Italy
| | - L. Trojano
- Department of Psychology; Second University of Naples; Caserta Italy
- Salvatore Maugeri Foundation; Scientific Institute of Telese; Telese Terme (BN) Italy
| | - A. D'Ambrosio
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences; Second University of Naples; Naples Italy
| | - G. Tedeschi
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences; Second University of Naples; Naples Italy
- Neurological Institute for Diagnosis and Care ‘Hermitage Capodimonte’; Naples Italy
| | - A. Gallo
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences; Second University of Naples; Naples Italy
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Carletto S, Borghi M, Francone D, Scavelli F, Bertino G, Cavallo M, Malucchi S, Bertolotto A, Oliva F, Ostacoli L. The efficacy of a Mindfulness Based Intervention for depressive symptoms in patients with Multiple Sclerosis and their caregivers: study protocol for a randomized controlled clinical trial. BMC Neurol 2016; 16:7. [PMID: 26757728 PMCID: PMC4711056 DOI: 10.1186/s12883-016-0528-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 01/05/2016] [Indexed: 12/02/2022] Open
Abstract
Background Multiple Sclerosis has a great impact on psychological functioning of patients and can be associated with various mental health disorders and symptoms. The most prevalent one is depression, which ranges from 15 to 47 %. Mindfulness Based Interventions are a relatively brief and cost-effective program that has been studied in patients with several chronic diseases and recently also in patients with Multiple Sclerosis. Mindfulness Based Interventions are based on the assumption that a non-judgmental awareness and acceptance of one’s moment-to-moment experience can have a positive effect on the adaptation to the disease, reducing the psychological burden and improving patients’ quality of life. Several studies concluded that Mindfulness Based Interventions can be beneficial in terms of improving both psychological and psychical aspects of Multiple Sclerosis, but none of them compared the intervention with an active control group. The primary objective of the study is to evaluate the efficacy of a group-based Mindfulness Based Intervention on depressive symptoms in patients with Multiple Sclerosis, as compared with an active control group. Methods The study design is a randomized controlled clinical trial. Eighty-eight patients with Multiple Sclerosis and depressive symptoms will be recruited and randomized to either Mindfulness Based Intervention or an active control group. The latter is designed to control for non-specific elements of the intervention and it comprises psycho-education and relaxation techniques. The primary outcome is the reduction of depressive symptoms as measured via the Beck Depressive Inventory-II. Secondary outcome measures are level of quality of life, anxiety, perceived stress, illness perception, fatigue and quality of interpersonal relationship. Outcomes will be assessed at baseline, after treatment and 6 months after the end of the treatment. Caregivers will participate in groups together with patients. Discussion As far as we know this trial will be the first randomized controlled trial testing the efficacy of group-based Mindfulness Based Intervention for patients with Multiple Sclerosis with a comparison with an active control group with a specific focus on depressive symptoms. Trial registration NCT02611401.
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Affiliation(s)
- Sara Carletto
- Clinical Psychology and Psychosomatics Service, A.O.U. San Luigi Gonzaga, University of Turin, Regione Gonzole 10, Orbassano, TO, 10043, Italy. .,Clinical and Biological Sciences Department, University of Turin, A.O.U. San Luigi Gonzaga, Regione Gonzole 10, Orbassano, TO, 10043, Italy.
| | - Martina Borghi
- Clinical Psychology and Psychosomatics Service, A.O.U. San Luigi Gonzaga, University of Turin, Regione Gonzole 10, Orbassano, TO, 10043, Italy. .,Neurologia 2-CRESM (Centro Riferimento Regionale Sclerosi Multipla), AOU San Luigi, Regione Gonzole 10, Orbassano, TO, 10043, Italy.
| | - Diana Francone
- Clinical Psychology and Psychosomatics Service, A.O.U. San Luigi Gonzaga, University of Turin, Regione Gonzole 10, Orbassano, TO, 10043, Italy.
| | - Francesco Scavelli
- Clinical Psychology and Psychosomatics Service, A.O.U. San Luigi Gonzaga, University of Turin, Regione Gonzole 10, Orbassano, TO, 10043, Italy. .,Neurologia 2-CRESM (Centro Riferimento Regionale Sclerosi Multipla), AOU San Luigi, Regione Gonzole 10, Orbassano, TO, 10043, Italy.
| | - Gabriella Bertino
- Clinical Psychology and Psychosomatics Service, A.O.U. San Luigi Gonzaga, University of Turin, Regione Gonzole 10, Orbassano, TO, 10043, Italy.
| | - Marco Cavallo
- eCampus University, Via Isimbardi, Novedrate, Como, 10-22060, Italy. .,Department of Mental Health, Azienda Sanitaria Locale Torino 3, Via Martiri XXX Aprile, Collegno, Torino, 30-10093, Italy.
| | - Simona Malucchi
- Neurologia 2-CRESM (Centro Riferimento Regionale Sclerosi Multipla), AOU San Luigi, Regione Gonzole 10, Orbassano, TO, 10043, Italy.
| | - Antonio Bertolotto
- Neurologia 2-CRESM (Centro Riferimento Regionale Sclerosi Multipla), AOU San Luigi, Regione Gonzole 10, Orbassano, TO, 10043, Italy.
| | - Francesco Oliva
- Clinical and Biological Sciences Department, University of Turin, A.O.U. San Luigi Gonzaga, Regione Gonzole 10, Orbassano, TO, 10043, Italy.
| | - Luca Ostacoli
- Clinical Psychology and Psychosomatics Service, A.O.U. San Luigi Gonzaga, University of Turin, Regione Gonzole 10, Orbassano, TO, 10043, Italy. .,Clinical and Biological Sciences Department, University of Turin, A.O.U. San Luigi Gonzaga, Regione Gonzole 10, Orbassano, TO, 10043, Italy.
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Chruzander C, Gottberg K, Ytterberg C, Backenroth G, Fredrikson S, Widén Holmqvist L, Johansson S. A single-group pilot feasibility study of cognitive behavioural therapy in people with multiple sclerosis with depressive symptoms. Disabil Rehabil 2016; 38:2383-91. [PMID: 26750510 DOI: 10.3109/09638288.2015.1130179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The aims were to evaluate (a) the feasibility of face-to-face cognitive behavioural therapy (CBT) in people with MS (PwMS) with depressive symptoms; (b) the feasibility of methods and measurements used; and (c) the outcome of the intervention before the conducting of an equivalence study of comparative methods of face-to-face CBT. DESIGN A single-group pilot feasibility study. PATIENTS PwMS (n = 15) with sub-threshold to moderate depressive symptoms, recruited at the Karolinska University Hospital, Stockholm, Sweden. METHODS The intervention consisted of 15-20 sessions of face-to-face CBT. Feasibility outcomes included recruitment rate, recruitment procedure and adverse events. Primary clinical outcome was the Beck Depression Inventory-II (BDI-II). Follow-ups were conducted after 3 weeks and 3 months. An estimated sample size calculation was conducted. RESULTS The face-to-face CBT intervention, methods and measurements used were feasible. The outcome on BDI-II indicated that face-to-face CBT is an effective method for alleviating sub-threshold to moderate depressive symptoms in PwMS. CONCLUSION Face-to-face CBT is feasible for use in PwMS aiming at decrease depressive symptoms. For an equivalence study, a screening process for depressive symptoms and two comparative intervention arms including traditional face-to-face CBT and low-intensity face-to-face CBT is recommended. Primary outcomes should include the BDI-II and also assessment of anxiety symptoms. Implications for Rehabilitation Depression is common among people with MS (PwMS), however, depressed PwMS do not always receive adequate treatment for depression which may lead to increased disability and worse health-related quality of life (HRQL). Cognitive behavioural therapy (CBT) is a psychological treatment method that might be beneficial for PwMS with depressive symptoms, but the evidence is still weak and further research is needed. The results from our pilot feasibility study demonstrate that for an effectiveness study of face-to-face CBT for PwMS with sub-threshold to moderate depressive symptoms the following points should be acknowledged. The design of an effectiveness study should be a randomized controlled trial including two treatment arms: traditional face-to-face CBT and a low-intensity face-to-face CBT. To increase the inclusion rate a screening process for depressive symptoms is recommended. Primary outcomes besides the Beck Depression Inventory-II should include the Hospital Anxiety and Depression Scale in order to capture anxiety symptoms and the Multiple Sclerosis Impact Scale-29 to capture HRQL.
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Affiliation(s)
- Charlotte Chruzander
- a Department of Neurobiology , Care Sciences and Society, Karolinska Institutet , Huddinge , Sweden ;,b Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden ;,c Department of Physiotherapy , Karolinska University Hospital , Stockholm , Sweden
| | - Kristina Gottberg
- a Department of Neurobiology , Care Sciences and Society, Karolinska Institutet , Huddinge , Sweden ;,b Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Charlotte Ytterberg
- a Department of Neurobiology , Care Sciences and Society, Karolinska Institutet , Huddinge , Sweden ;,b Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden ;,c Department of Physiotherapy , Karolinska University Hospital , Stockholm , Sweden
| | - Gunnel Backenroth
- b Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Sten Fredrikson
- b Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Lotta Widén Holmqvist
- a Department of Neurobiology , Care Sciences and Society, Karolinska Institutet , Huddinge , Sweden ;,b Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden ;,c Department of Physiotherapy , Karolinska University Hospital , Stockholm , Sweden
| | - Sverker Johansson
- a Department of Neurobiology , Care Sciences and Society, Karolinska Institutet , Huddinge , Sweden ;,b Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden ;,c Department of Physiotherapy , Karolinska University Hospital , Stockholm , Sweden
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126
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Bove R, McHenry A, Hellwig K, Houtchens M, Razaz N, Smyth P, Tremlett H, Sadovnick AD, Rintell D. Multiple sclerosis in men: management considerations. J Neurol 2016; 263:1263-73. [DOI: 10.1007/s00415-015-8005-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/16/2015] [Accepted: 12/17/2015] [Indexed: 01/28/2023]
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127
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Fiest K, Walker J, Bernstein C, Graff L, Zarychanski R, Abou-Setta A, Patten S, Sareen J, Bolton J, Marriott J, Fisk J, Singer A, Marrie R. Systematic review and meta-analysis of interventions for depression and anxiety in persons with multiple sclerosis. Mult Scler Relat Disord 2016; 5:12-26. [DOI: 10.1016/j.msard.2015.10.004] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 10/09/2015] [Accepted: 10/16/2015] [Indexed: 11/24/2022]
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128
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Raissi A, Bulloch AGM, Fiest KM, McDonald K, Jetté N, Patten SB. Exploration of Undertreatment and Patterns of Treatment of Depression in Multiple Sclerosis. Int J MS Care 2015; 17:292-300. [PMID: 26664335 DOI: 10.7224/1537-2073.2014-084] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Depression is a common comorbid condition with multiple sclerosis (MS). Historically, however, it has been undertreated. Little is known about the characteristics of those who receive, or do not receive, treatment for depression in the MS population. This study evaluated depression treatment in patients with MS, associated patient characteristics, and probable determinants of antidepressant drug use in those with and without depression. METHODS A total of 152 patients with MS completed questionnaires and the Structured Clinical Interview for DSM-IV-TR (SCID) to determine depression status. Tabular analyses and a binary regression model were used to identify patient characteristics associated with antidepressant drug use. RESULTS Of participants with major depression according to the SCID, 65% were taking antidepressant medications. With adjustment for successful treatment (antidepressant drug use by those not currently depressed and currently depressed), the prevalence of treated depression increased to 85.7%. Of those receiving treatment for depression, 19% were receiving nonpharmacologic treatment alone, 38% were taking antidepressant drugs only, and 44% were receiving both pharmacologic and nonpharmacologic treatments. Demographic and clinical variables were not statistically significantly associated with antidepressant drug use in those with depression. CONCLUSIONS A large proportion of participants with depression in MS are now receiving treatment, a change from previous reports. The adequacy of treatment has become a bigger question because many of the treated patients continued to have depressive symptoms. Further research is needed to identify ways to achieve better outcomes for depression.
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Affiliation(s)
- Aida Raissi
- Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute (AR, AGMB, KMF, KM, SBP), Department of Community Health Sciences (AGMB, KMF, KM, NJ, SBP), Department of Psychiatry (AGMB, SBP), and Department of Clinical Neurosciences, Hotchkiss Brain Institute, and Institute for Public Health (NJ), University of Calgary, AB, Canada
| | - Andrew G M Bulloch
- Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute (AR, AGMB, KMF, KM, SBP), Department of Community Health Sciences (AGMB, KMF, KM, NJ, SBP), Department of Psychiatry (AGMB, SBP), and Department of Clinical Neurosciences, Hotchkiss Brain Institute, and Institute for Public Health (NJ), University of Calgary, AB, Canada
| | - Kirsten M Fiest
- Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute (AR, AGMB, KMF, KM, SBP), Department of Community Health Sciences (AGMB, KMF, KM, NJ, SBP), Department of Psychiatry (AGMB, SBP), and Department of Clinical Neurosciences, Hotchkiss Brain Institute, and Institute for Public Health (NJ), University of Calgary, AB, Canada
| | - Keltie McDonald
- Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute (AR, AGMB, KMF, KM, SBP), Department of Community Health Sciences (AGMB, KMF, KM, NJ, SBP), Department of Psychiatry (AGMB, SBP), and Department of Clinical Neurosciences, Hotchkiss Brain Institute, and Institute for Public Health (NJ), University of Calgary, AB, Canada
| | - Nathalie Jetté
- Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute (AR, AGMB, KMF, KM, SBP), Department of Community Health Sciences (AGMB, KMF, KM, NJ, SBP), Department of Psychiatry (AGMB, SBP), and Department of Clinical Neurosciences, Hotchkiss Brain Institute, and Institute for Public Health (NJ), University of Calgary, AB, Canada
| | - Scott B Patten
- Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute (AR, AGMB, KMF, KM, SBP), Department of Community Health Sciences (AGMB, KMF, KM, NJ, SBP), Department of Psychiatry (AGMB, SBP), and Department of Clinical Neurosciences, Hotchkiss Brain Institute, and Institute for Public Health (NJ), University of Calgary, AB, Canada
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129
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Amtmann D, Bamer AM, Johnson KL, Ehde DM, Beier ML, Elzea JL, Bombardier CH. A comparison of multiple patient reported outcome measures in identifying major depressive disorder in people with multiple sclerosis. J Psychosom Res 2015; 79:550-7. [PMID: 26363679 DOI: 10.1016/j.jpsychores.2015.08.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 08/20/2015] [Accepted: 08/26/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Depression is one of the most prominent and debilitating symptoms in individuals with multiple sclerosis (MS), yet there is currently no consensus on the best instruments for depression screening in MS. More head to head comparisons of available screening instruments are needed to advise MS researchers and clinicians. METHODS A cross-sectional comparison of the effectiveness of screening for MDD using multiple patient reported outcome (PRO) screeners against a modified SCID telephone interview was completed in 164 individuals with MS. Stratum goals were set for depression levels to ensure participation by people with borderline and higher levels of depression. Criterion standard was a modified SCID MDD module. PRO measures included the PHQ-9, BDI-FS, PROMIS depression, Neuro-QOL depression, M-PHQ-2, PHQ-2, and CESD. RESULTS 48 (29%) individuals met the modified SCID criteria for MDD. The sensitivity of the PRO measures ranged from 60% to 100% while specificity ranged from 46% to 86%. The ROC area for the PRO measures ranged from 0.79 to 0.83. Revised (higher) cutoff scores were suggested by the ROC analyses for most self-reported screeners. LIMITATIONS Enrollment was stopped early because of difficulties with recruitment. Several SCID recording could not be reviewed and diagnosis confirmed. CONCLUSIONS CESD-10 and PHQ9 had the best diagnostic performance using optimal cutoffs, but no one PRO measure stood out as significantly better than any other. Even when revised cutoff scores were used, none of the self-reported screeners identified people with MDD with adequate accuracy. More accurate self-reported screeners would facilitate diagnosing of MDD for both research and clinical purposes.
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Affiliation(s)
- Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
| | - Alyssa M Bamer
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Kurt L Johnson
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Dawn M Ehde
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Meghan L Beier
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Jamie L Elzea
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Charles H Bombardier
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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130
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de Cerqueira AC, Semionato de Andrade P, Godoy Barreiros JM, Teixeira AL, Nardi AE. Psychiatric disorders in patients with multiple sclerosis. Compr Psychiatry 2015; 63:10-4. [PMID: 26555486 DOI: 10.1016/j.comppsych.2015.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 07/27/2015] [Accepted: 08/02/2015] [Indexed: 10/23/2022] Open
Abstract
UNLABELLED The aim of this study was to evaluate the frequency of psychiatric disorders, particularly mood disorders and anxiety in an outpatient sample of patients with multiple sclerosis in Brazil, and correlate the result with sociodemographic and clinical data. METHODS Cross-sectional study, patients evaluated consecutively, for the clinical, demographic, prevalence of psychiatric disorders was used structured interview (MINI), severity of symptoms of depression and anxiety was used Beck inventory. RESULTS The prevalence of major lifelong depression in this population was 36.6%, and the risk of suicide was high. There was no detectable correlation between depression, degree of disability, or disease duration. CONCLUSION The prevalence of mood disorders is high in MS. Depression is an important factor related to the risk of suicide and should be investigated systematically.
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Affiliation(s)
| | | | | | - Antonio Lúcio Teixeira
- Federal University of Minas Gerais, Interdisciplinary Laboratory of Medical Investigation
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131
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Fischer A, Fischer M, Nicholls RA, Lau S, Poettgen J, Patas K, Heesen C, Gold SM. Diagnostic accuracy for major depression in multiple sclerosis using self-report questionnaires. Brain Behav 2015; 5:e00365. [PMID: 26445703 PMCID: PMC4589811 DOI: 10.1002/brb3.365] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 05/31/2015] [Accepted: 06/07/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Multiple sclerosis and major depressive disorder frequently co-occur but depression often remains undiagnosed in this population. Self-rated depression questionnaires are a good option where clinician-based standardized diagnostics are not feasible. However, there is a paucity of data on diagnostic accuracy of self-report measures for depression in multiple sclerosis (MS). Moreover, head-to-head comparisons of common questionnaires are largely lacking. This could be particularly relevant for high-risk patients with depressive symptoms. Here, we compare the diagnostic accuracy of the Beck Depression Inventory (BDI) and 30-item version of the Inventory of Depressive Symptomatology Self-Rated (IDS-SR30) for major depressive disorder (MSS) against diagnosis by a structured clinical interview. METHODS Patients reporting depressive symptoms completed the BDI, the IDS-SR30 and underwent diagnostic assessment (Mini International Neuropsychiatric Interview, M.I.N.I.). Receiver-Operating Characteristic analyses were performed, providing error estimates and false-positive/negative rates of suggested thresholds. RESULTS Data from n = 31 MS patients were available. BDI and IDS-SR30 total score were significantly correlated (r = 0.82). The IDS-SR30total score, cognitive subscore, and BDI showed excellent to good accuracy (area under the curve (AUC) 0.86, 0.91, and 0.85, respectively). CONCLUSION Both the IDS-SR30 and the BDI are useful to quantify depressive symptoms showing good sensitivity and specificity. The IDS-SR30 cognitive subscale may be useful as a screening tool and to quantify affective/cognitive depressive symptomatology.
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Affiliation(s)
- Anja Fischer
- Department of Health Psychology, King's College London SE1 9RT, London, UK ; Center for Molecular Neurobiology, Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Marcus Fischer
- Department of Pharmaceutical Chemistry, University of California San Francisco San Francisco, California, 94158
| | - Robert A Nicholls
- Structural Studies Division, MRC Laboratory of Molecular Biology Cambridge, CB2 0QH, UK
| | - Stephanie Lau
- Center for Molecular Neurobiology, Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Jana Poettgen
- Center for Molecular Neurobiology, Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Kostas Patas
- Center for Molecular Neurobiology, Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Christoph Heesen
- Center for Molecular Neurobiology, Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf Hamburg, Germany ; Department of Neurology, University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Stefan M Gold
- Center for Molecular Neurobiology, Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf Hamburg, Germany ; Department of Medical Psychology, University Medical Center Hamburg-Eppendorf Hamburg, Germany ; Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin (CBF), Charité Universitätsmedizin Berlin, Germany
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132
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Alschuler KN, Beier ML. Intolerance of Uncertainty: Shaping an Agenda for Research on Coping with Multiple Sclerosis. Int J MS Care 2015; 17:153-8. [PMID: 26300700 DOI: 10.7224/1537-2073.2014-044] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Multiple sclerosis (MS) is a chronic and progressive neurologic condition that, by its nature, carries uncertainty as a hallmark characteristic. Although all patients face uncertainty, there is variability in how individuals cope with its presence. In other populations, the concept of "intolerance of uncertainty" has been conceptualized to explain this variability such that individuals who have difficulty tolerating the possibility of future occurrences may engage in thoughts or behaviors by which they attempt to exert control over that possibility or lessen the uncertainty but may, as a result, experience worse outcomes, particularly in terms of psychological well-being. This topical review introduces MS-focused researchers, clinicians, and patients to intolerance of uncertainty, integrates the concept with what is already understood about coping with MS, and suggests future steps for conceptual, assessment, and treatment-focused research that may benefit from integrating intolerance of uncertainty as a central feature.
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134
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Feinstein A, Freeman J, Lo AC. Treatment of progressive multiple sclerosis: what works, what does not, and what is needed. Lancet Neurol 2015; 14:194-207. [PMID: 25772898 DOI: 10.1016/s1474-4422(14)70231-5] [Citation(s) in RCA: 180] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Disease-modifying drugs have mostly failed as treatments for progressive multiple sclerosis. Management of the disease therefore solely aims to minimise symptoms and, if possible, improve function. The degree to which this approach is based on empirical data derived from studies of progressive disease or whether treatment decisions are based on what is known about relapsing-remitting disease remains unclear. Symptoms rated as important by patients with multiple sclerosis include balance and mobility impairments, weakness, reduced cardiovascular fitness, ataxia, fatigue, bladder dysfunction, spasticity, pain, cognitive deficits, depression, and pseudobulbar affect; a comprehensive literature search shows a notable paucity of studies devoted solely to these symptoms in progressive multiple sclerosis, which translates to few proven therapeutic options in the clinic. A new strategy that can be used in future rehabilitation trials is therefore needed, with the adoption of approaches that look beyond single interventions to concurrent, potentially synergistic, treatments that maximise what remains of neural plasticity in patients with progressive multiple sclerosis.
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Affiliation(s)
- Anthony Feinstein
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
| | - Jenny Freeman
- Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Albert C Lo
- Departments of Neurology and Epidemiology, Brown University, Providence, RI, USA
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Steen K, Narang P, Lippmann S. Electroconvulsive Therapy in Multiple Sclerosis. INNOVATIONS IN CLINICAL NEUROSCIENCE 2015; 12:28-30. [PMID: 26351621 PMCID: PMC4558788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We performed a literature search regarding the safety and efficacy of electroconvulsive therapy in patients with multiple sclerosis and comorbid psychiatric symptoms. Literature review was conducted via PubMed databases. Of the cases we reviewed, most subjects with multiple sclerosis reported significant psychiatric symptom relief, with only a handful reporting neurologic deterioration. There was some evidence that active white matter lesions may be predictive of neurologic deterioration when electroconvulsive therapy is used in patients with multiple sclerosis. A brief description of the pathophysiology and effects of depression in patients with multiple sclerosis is also provided. Although no clinical recommendations or meaningful conclusions can be drawn without further investigation, the literature suggests that electroconvulsive therapy for treatment of psychiatric illnesses in patients with multiple sclerosis is safe and efficacious.
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Affiliation(s)
- Katie Steen
- Dr. Steen is psychiatry resident at the University of Minnesota, Minneapolis; Dr. Narang is Staff Physician and Lead ECT Psychiatrist, Regions Hospital, Minneapolis-St. Paul, Minnesota; and Dr. Lippmann is Professor of Psychiatry, University of Louisville School of Medicine, Louisville, Kentucky
| | - Puneet Narang
- Dr. Steen is psychiatry resident at the University of Minnesota, Minneapolis; Dr. Narang is Staff Physician and Lead ECT Psychiatrist, Regions Hospital, Minneapolis-St. Paul, Minnesota; and Dr. Lippmann is Professor of Psychiatry, University of Louisville School of Medicine, Louisville, Kentucky
| | - Steven Lippmann
- Dr. Steen is psychiatry resident at the University of Minnesota, Minneapolis; Dr. Narang is Staff Physician and Lead ECT Psychiatrist, Regions Hospital, Minneapolis-St. Paul, Minnesota; and Dr. Lippmann is Professor of Psychiatry, University of Louisville School of Medicine, Louisville, Kentucky
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Grech LB, Kiropoulos LA, Kirby KM, Butler E, Paine M, Hester R. The effect of executive function on stress, depression, anxiety, and quality of life in multiple sclerosis. J Clin Exp Neuropsychol 2015; 37:549-62. [DOI: 10.1080/13803395.2015.1037723] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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137
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di Nuzzo L, Orlando R, Tognoli C, Di Pietro P, Bertini G, Miele J, Bucci D, Motolese M, Scaccianoce S, Caruso A, Mauro G, De Lucia C, Battaglia G, Bruno V, Fabene PF, Nicoletti F. Antidepressant activity of fingolimod in mice. Pharmacol Res Perspect 2015; 3:e00135. [PMID: 26171219 PMCID: PMC4492751 DOI: 10.1002/prp2.135] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 02/05/2015] [Accepted: 02/11/2015] [Indexed: 01/22/2023] Open
Abstract
Recent findings indicate that fingolimod, the first oral drug approved for the treatment of multiple sclerosis (MS), acts as a direct inhibitor of histone deacetylases (HDACs) and enhances the production of brain-derived neurotrophic factor (BDNF) in the CNS. Both mechanisms are relevant to the pathophysiology and treatment of major depression. We examined the antidepressant activity of fingolimod in mice subjected to chronic unpredictable stress (CUS), a model of reactive depression endowed with face and pharmacological validity. Chronic treatment with fingolimod (3 mg kg(-1), i.p., once a day for 4 weeks) reduced the immobility time in the forced swim test (FST) in a large proportion of CUS mice. This treatment also caused anxiogenic-like effects in the social interaction test without affecting anxiety-like behavior in the elevated plus maze or spatial learning in the water maze. CUS mice showed reduced BDNF levels and enhanced HDAC2 levels in the hippocampus. These changes were reversed by fingolimod exclusively in mice that showed a behavioral response to the drug in the FST. Fingolimod treatment also enhanced H3 histone K14-acetylation and adult neurogenesis in the hippocampus of CUS mice. Fingolimod did not affect most of the parameters we have tested in unstressed control mice. The antidepressant-like activity of fingolimod was confirmed in mice chronically treated with corticosterone. These findings show for the first time that fingolimod exerts antidepressant-like effect acting in a "disease-dependent" manner, and raise the interesting possibility that the drug could relieve depressive symptoms in MS patients independently of its disease-modifying effect on MS.
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Affiliation(s)
- Luigi di Nuzzo
- Department of Physiology and Pharmacology, University Sapienza of Rome Rome, Italy
| | - Rosamaria Orlando
- IRCCS Associazione Oasi Maria S.S., Institute for Research on Mental Retardation and Brain Aging Troina, Italy
| | - Cristina Tognoli
- Department of Neurological and Movement Sciences, University of Verona Verona, Italy
| | | | - Giuseppe Bertini
- Department of Neurological and Movement Sciences, University of Verona Verona, Italy
| | - Jessica Miele
- Department of Physiology and Pharmacology, University Sapienza of Rome Rome, Italy
| | | | | | - Sergio Scaccianoce
- Department of Physiology and Pharmacology, University Sapienza of Rome Rome, Italy
| | - Alessandra Caruso
- Department of Physiology and Pharmacology, University Sapienza of Rome Rome, Italy
| | - Gianluca Mauro
- Institute of Psychiatry, Catholic University of Sacred Heart Rome, Italy
| | - Carmine De Lucia
- Department of Physiology and Pharmacology, University Sapienza of Rome Rome, Italy
| | | | - Valeria Bruno
- Department of Physiology and Pharmacology, University Sapienza of Rome Rome, Italy ; IRCCS Neuromed Pozzilli, Italy
| | | | - Ferdinando Nicoletti
- Department of Physiology and Pharmacology, University Sapienza of Rome Rome, Italy ; IRCCS Neuromed Pozzilli, Italy
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Raglio A, Attardo L, Gontero G, Rollino S, Groppo E, Granieri E. Effects of music and music therapy on mood in neurological patients. World J Psychiatry 2015; 5:68-78. [PMID: 25815256 PMCID: PMC4369551 DOI: 10.5498/wjp.v5.i1.68] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 01/12/2015] [Accepted: 02/11/2015] [Indexed: 02/05/2023] Open
Abstract
Mood disorder and depressive syndromes represent a common comorbid condition in neurological disorders with a prevalence rate that ranges between 20% and 50% of patients with stroke, epilepsy, multiple sclerosis, and Parkinson’s disease. Notwithstanding, these conditions are often under-diagnosed and under-treated in the clinical practice and negatively affect the functional recovery, the adherence to treatment, the quality of life, and even the mortality risk. In addition, a bidirectional association between depression and neurological disorders may be possible being that depressive syndromes may be considered as a risk factor for certain neurological diseases. Despite the large amount of evidence regarding the effects of music therapy (MT) and other musical interventions on different aspects of neurological disorders, no updated article reviewing outcomes such as mood, emotions, depression, activity of daily living and so on is actually available; for this reason, little is known about the effectiveness of music and MT on these important outcomes in neurological patients. The aim of this article is to provide a narrative review of the current literature on musical interventions and their effects on mood and depression in patients with neurological disorders. Searching on PubMed and PsycInfo databases, 25 studies corresponding to the inclusion criteria have been selected; 11 of them assess the effects of music or MT in Dementia, 9 explore the efficacy on patients with Stroke, and 5 regard other neurological diseases like Multiple Sclerosis, Amyotrophic Lateral Sclerosis/motor neuron disease, Chronic quadriplegia, Parkinson’s Disease, and Acquired Brain dysfunctions. Selected studies are based on relational and rehabilitative music therapy approaches or concern music listening interventions. Most of the studies support the efficacy of MT and other musical interventions on mood, depressive syndromes, and quality of life on neurological patients.
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139
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Fischer A, Schröder J, Vettorazzi E, Wolf OT, Pöttgen J, Lau S, Heesen C, Moritz S, Gold SM. An online programme to reduce depression in patients with multiple sclerosis: a randomised controlled trial. Lancet Psychiatry 2015; 2:217-23. [PMID: 26359900 DOI: 10.1016/s2215-0366(14)00049-2] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 10/22/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND With a lifetime risk for major depressive disorder of up to 50%, depression is a common comorbidity in multiple sclerosis but remains widely underdiagnosed and untreated. We investigated the potential of a fully automated, internet-based, cognitive behavioural therapy programme, Deprexis, to reduce depressive symptoms in patients with multiple sclerosis. METHODS For this randomised controlled trial, we recruited patients from an outpatient clinic in Hamburg, Germany. Patients aged 18-65 years were eligible for inclusion if they had multiple sclerosis and self-reported depressive symptoms. By use of a computer-generated randomisation sequence, we allocated 90 patients (1:1; no blocking or stratification) to either the intervention group or a waitlist control group for 9 weeks. The primary endpoint was the Beck Depression Inventory (BDI), as assessed by an intention-to-treat analysis. This trial is registered with ClinicalTrials.gov, number NCT01663649. FINDINGS 71 patients completed the trial: 35 patients in the intervention group and 36 patients in the control group. During the intervention, BDI scores decreased in the Deprexis group and increased in the control group, yielding a positive effect of Deprexis relative to the waitlist group (mean group difference -4·02 points [95% CI -7·26 to -0·79], p=0·015, effect size d=0·53). Worsening of depressive symptoms from below to above the clinical cutoff (BDI >13) occurred in three (7%) of 45 patients in the control group and no patients in the Deprexis group. We noted no adverse events with respect to new occurrence of suicidal ideation during the trial. INTERPRETATION Psychological online-intervention programmes could be suitable for patients with multiple sclerosis who are unable to regularly attend therapeutic sessions because of mobility impairments. FUNDING European Union and the Deutsche Forschungsgemeinschaft.
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Affiliation(s)
- Anja Fischer
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Johanna Schröder
- Department of Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver T Wolf
- Department of Cognitive Psychology, Ruhr-University, Bochum, Germany
| | - Jana Pöttgen
- Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Stephanie Lau
- Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan M Gold
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Medical Psychology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
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140
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Patten SB, Burton JM, Fiest KM, Wiebe S, Bulloch AGM, Koch M, Dobson KS, Metz LM, Maxwell CJ, Jetté N. Validity of four screening scales for major depression in MS. Mult Scler 2015; 21:1064-71. [PMID: 25583846 DOI: 10.1177/1352458514559297] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 10/16/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is a role for brief assessment instruments in detection and management of major depression in MS. However, candidate scales have rarely been validated against a validated diagnostic interview. In this study, we evaluated the performance of several candidate scales: Patient Health Questionnaire (PHQ)-9, PHQ-2, Center for Epidemiologic Studies Depression rating scale (CES-D), and Hospital Anxiety and Depression Scale (HADS-D) in relation to the Structured Clinical Interview for DSM-IV (SCID). METHODS The sample was an unselected series of 152 patients attending a multiple sclerosis (MS) clinic. Participants completed the scales during a clinic visit or returned them by mail. The SCID was administered by telephone within two weeks. The diagnosis of major depressive episode, according to the SCID, was used as a reference standard. Receiver-operator curves (ROC) were fitted and indices of measurement accuracy were calculated. RESULTS All of the scales performed well, each having an area under the ROC > 90%. For example, the PHQ-9 had 95% sensitivity and 88.3% specificity when scored with a cut-point of 11. This cut-point achieved a 56% positive predictive value for major depression. CONCLUSIONS While all of the scales performed well in terms of their sensitivity and specificity, the availability of the PHQ-9 in the public domain and its brevity may enhance the feasibility of its use.
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Affiliation(s)
- Scott B Patten
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada/Mathison Centre for Research & Education in Mental Health, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jodie M Burton
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada/Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Kirsten M Fiest
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Samuel Wiebe
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada/Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Andrew G M Bulloch
- Mathison Centre for Research & Education in Mental Health, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada/Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Marcus Koch
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada/Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Keith S Dobson
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Luanne M Metz
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada/Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | | | - Nathalie Jetté
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada/Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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141
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Senders A, Sando K, Wahbeh H, Peterson Hiller A, Shinto L. Managing psychological stress in the multiple sclerosis medical visit: Patient perspectives and unmet needs. J Health Psychol 2014; 21:1676-87. [PMID: 25527612 DOI: 10.1177/1359105314562084] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Psychological stress can negatively impact multiple sclerosis. To further understand how stress is addressed in the multiple sclerosis medical visit, 34 people with multiple sclerosis participated in focus groups. Transcripts were analyzed by inductive thematic analysis. The majority of participants did not discuss stress with their provider, citing barriers to communication such as lack of time, poor coordination between specialties, physician reliance on pharmaceutical prescription, and patient lack of self-advocacy. Participants recommended several ways to better manage psychological well-being in the clinical setting. These findings provide a foundation for future studies aimed at minimizing the detrimental effect of stress in multiple sclerosis.
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Affiliation(s)
- Angela Senders
- Oregon Health & Science University, USA National College of Natural Medicine, USA
| | | | | | - Amie Peterson Hiller
- Oregon Health & Science University, USA Portland Veterans Affairs Medical Center, USA
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142
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Motl RW. Benefits, safety, and prescription of exercise in persons with multiple sclerosis. Expert Rev Neurother 2014; 14:1429-36. [DOI: 10.1586/14737175.2014.983904] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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143
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Pérez LP, González RS, Lázaro EB. Treatment of mood disorders in multiple sclerosis. Curr Treat Options Neurol 2014; 17:323. [PMID: 25398464 DOI: 10.1007/s11940-014-0323-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OPINION STATEMENT Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system with a significant comorbidity with depressive disorders. Prevalence rates for major depressive disorder (MDD) range from 36 % to 54 % and the rate is around 22 % for adjustment disorders. Selective serotonin reuptake inhibitors (SSRIs) are considered well-tolerated first-line treatment. Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) are generally reserved for second-line use after SSRIs, because of sedating or anticholinergic side effects. SNRIs, with the exception of duloxetine, and combinations of newer antidepressants have failed to treat depression due to their side effects profile and frequent interaction with other drugs. Among SSRIs, sertraline is usually the first option, starting at 25 mg/day and increasing to 50 mg/day; and waiting a few weeks to assess drug effects before increasing the dose. The maximum is generally 200 mg/day in a single dose. Paroxetine is the second choice, starting at 10 mg/day for the first 5 days, and then at 20 mg/day thereafter. The maximum dose is about 50 mg/day in a single dose. Fluvoxamine is used at 100-200 mg/day, starting with 25 mg/day, and increasing 25 mg/day every 5 days until 200 mg/day is reached. We should take into account increasing blood level amounts of MS treatments (corticosteroids and cyclophosphamide) with fluvoxamine. With duloxetine, doses will be at 60-120 mg/day. The initial dose for depression is 40 mg/day in two doses; it can increase to 60 mg/day in one to two doses if necessary. The maximum dose is generally 120 mg/day. Duloxetine may increase liver problems through interaction with these MS treatments: teriflunomide, interferon beta-1a, and interferon beta-1b. Considering psychotherapy, only cognitive behavior therapy and mindfulness-based interventions have shown efficacy in improving depression disorders in MS. A comprehensive treatment for depression should include pharmacotherapy and psychotherapy.
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Affiliation(s)
- Luis Pintor Pérez
- Department of Psychiatry, Institut de Neurociències, Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain,
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144
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Abstract
Depression--be it a formal diagnosis based on consensus clinical criteria, or a collection of symptoms revealed by a self-report rating scale--is common in patients with multiple sclerosis (MS) and adds substantially to the morbidity and mortality associated with this disease. This Review discusses the prevalence and epidemiology of depression in patients with MS, before covering aetiological factors, including genetics, brain pathology, immunological changes, dysregulation of the hypothalamic-pituitary-adrenal axis, and psychosocial influences. Treatment options such as antidepressant drugs, cognitive-behavioural therapy, mindfulness-based therapy, exercise and electroconvulsive therapy are also reviewed in the context of MS-related depression. Frequent comorbid conditions, namely pain, fatigue, anxiety, cognitive dysfunction and alcohol use, are also summarized. The article then explores three key challenges facing researchers and clinicians: what is the optimal way to define depression in the context of diseases such as MS, in which the psychiatric and neurological symptoms overlap; how can current knowledge about the biological and psychological underpinnings of MS-related depression be used to boost the validity of this construct; and can intervention be made more effective through use of combination therapies with additive or synergistic effects, which might exceed the modest benefits derived from their individual components?
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145
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Lugaresi A, Rottoli MR, Patti F. Fostering adherence to injectable disease-modifying therapies in multiple sclerosis. Expert Rev Neurother 2014; 14:1029-42. [PMID: 25109614 DOI: 10.1586/14737175.2014.945523] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Multiple sclerosis requires long-term management, often with disease-modifying therapies. Poor medication adherence, especially to injectables, can increase relapse and hospitalisation rates and consume healthcare resources. We discuss adherence definitions and terminology and its prevalence in multiple sclerosis (MS). Typical causes of poor adherence in patients with MS include: insufficient efficacy or tolerability, concurrent disorders, and consequences of MS (e.g., forgetfulness, depression, fatigue and poor motor skills). Ways to improve adherence rates are reviewed, focusing on interdisciplinary healthcare teams, good communication between healthcare workers and patients (and their families), ongoing support and digital tools to promote adherence. We consider open communication and continuing education to be key, and that MS nurses have a pivotal role in ensuring patients' adherence to MS medicines.
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Affiliation(s)
- Alessandra Lugaresi
- Department of Neuroscience, Imaging and Clinical Sciences, Multiple Sclerosis Center, University "G. d'Annunzio", Ospedale Clinicizzato "SS Annunziata", VII livello, Corpo A, Via dei Vestini snc, 66100 Chieti, Italy
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146
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Ensari I, Motl RW, Pilutti LA. Exercise training improves depressive symptoms in people with multiple sclerosis: results of a meta-analysis. J Psychosom Res 2014; 76:465-71. [PMID: 24840141 DOI: 10.1016/j.jpsychores.2014.03.014] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 03/21/2014] [Accepted: 03/22/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE There is a high prevalence, yet under-treatment of depressive disorder and symptoms by conventional therapy in people with multiple sclerosis (MS). We conducted a meta-analysis examining the overall effect of exercise training on depressive symptoms in MS. METHODS We searched PubMed for randomized controlled trials (RCT) of exercise training and depression as an outcome in samples with MS. There were 13 RCTs that met inclusion criteria and yielded data for effect size (ES) generation (Cohen's d). An overall ES was calculated using a random effects model and expressed as Hedge's g. RESULTS The weighted mean ES was small, but statistically significant (Hedge's g=0.36, SE=0.09, 95% CI=0.18-0.54, z=3.92, p<.001) indicating the exercise training resulted in an improvement in depressive symptoms compared to control. The overall effect was not heterogeneous (Q=16.46, df=12, p=0.17, I2=27.08); and post-hoc, exploratory analyses only identified depression symptom scale as a potential moderator variable (p=0.04). CONCLUSION The cumulative evidence indicates that exercise training can yield a small, yet statistically significant and reliable reduction in depressive symptoms for people with MS.
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Affiliation(s)
- Ipek Ensari
- University of Illinois Urbana-Champaign, Department of Kinesiology and Community Health, Urbana, IL, USA
| | - Robert W Motl
- University of Illinois Urbana-Champaign, Department of Kinesiology and Community Health, Urbana, IL, USA.
| | - Lara A Pilutti
- University of Illinois Urbana-Champaign, Department of Kinesiology and Community Health, Urbana, IL, USA
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