Eighty-seven patients with definite multiple sclerosis (MS) were examined neurologically and administered the Mini-mental State examination (MMS) to assess cognitive disability at the beginning and end of a one-year study. A CT scan was performed in 37. A group of 16 patients with stable spinal cord injuries (SCI) were studied in a similar manner. Of the MS patients, 47% had a mean General Health Questionnaire (GHQ) score in the abnormal range. This was a higher rate than in SCI patients (P = 0.004). Mean depression scores were similar in MS and SCI patients, but MS patients with brain involvement were more depressed than those with cord lesions only (P = 0.05). Depression score was unrelated to functional disability but was correlated with the degree of neurological impairment (P = 0.03). Euphoric patients were more likely to have brain involvement (P = 0.006), to have progressive MS (P less than 0.0001), and to have enlarged ventricles (P = 0.04) and were more impaired cognitively (P = 0.04) than noneuphoric patients. These results suggest that depression in MS patients is partly determined by the presence of brain involvement, but that it is also an emotional reaction to the disorder. Euphoria and cognitive disorder are reflections of brain involvement.

The prevalence and nature of emotional disturbance in patients with multiple sclerosis (MS) was studied prospectively in 64 MS patients and 23 spinal cord-injured (SCI) control patients by administration of the 28-item subscale General Health Questionnaire (GHQ). MS patients in remission had a mean GHQ score of 4.4, and patients with acute exacerbation or progressive nonremitting MS had a mean score of 15.7, a significant difference (p less than 0.001). The prevalence of emotional disturbance was 90% in exacerbating or progressing patients, 39% in stable patients, and 12% in SCI control patients. The presence of emotional disturbance was not related to age, sex, or other demographic variables, to duration or severity of disease, or to the degree of disability. In the group of MS patients in remission, somatic complaints, anxiety, and social dysfunction were more prevalent than symptoms of depression.

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