Neuropsychiatric symptoms are common in multiple sclerosis (MS). They include two broad categories of disturbances: abnormalities in cognition, and abnormalities of mood, affect and behaviour. The present review deals with the epidemiology, clinical features, etiology and treatment of disturbances included in the second category, i.e., major depression, fatigue and sleep disorders, bipolar disorder, euphoria, pathological laughing and crying, anxiety, psychosis and personality changes. Major depression is one of the most common neuropsychiatric disorders in MS with an approximate 50% lifetime prevalence rate. Early recognition and management of depression in MS is of major importance because it is a key predictor of morbidity, mortality, quality of life, possibly physical outcome and disease exacerbations, adherence to immunomodulatory treatments and suicide risk in MS patients, as well as of the caregiver's distress and quality of life. The etiopathogenesis of neuropsychiatric disorders in MS has been incompletely investigated. It is postulated that a complex interplay of biological, disease-related, behavioural and psychosocial factors contribute to the pathophysiology of most of them. Management of neuropsychiatric symptoms in MS is often effective, although commonly based on evidence provided by case studies and uncontrolled trials. A comprehensive biopsychosocial neuropsychiatric approach is essential for the optimal care of patients with MS.

The present review addresses some of the issues pertaining to the family whose member suffers from multiple sclerosis (MS), the implications that arise, and the potential therapeutic interventions. The family role can be better conceptualized from a psychosocial view mainly in a systemic perspective. From this point of view, MS can be classified, in the context of chronic illnesses, according to several 'non-medical' characteristics of the disease, such as age at onset and course. Furthermore, MS challenges the individual roles, needs and coping styles of all members of the family, and establishes a frail balance in the relationships, which needs to be reset. Future research ought to focus on specific problems, such as the identification of members of MS families at risk of developing depression and anxiety, and application of the optimal psychotherapeutic interventions. Research on psychosocial and psycho-educational interventions that improve social support and decrease burden of illness would certainly ameliorate clinical practice.