The neuropsychiatry of multiple sclerosis

Abstract

Kate Jefferies is a specialist registrar in old age psychiatry at Farnham Road Hospital (Farnham Road, Guildford GU2 7LX, UK. Email: katejefferies@tiscali.co.uk). She is training in old age and general adult psychiatry and her special interest is neuropsychiatry.Abstract Multiple sclerosis is the most common disabling neurological illness affecting young and middle-aged adults. Although attention has tended to focus mainly on its neurological manifestations, reports of the presence of neuropsychiatric symptoms date back to the writings of Charcot in 1877. This article details the neuropsychiatric sequelae of multiple sclerosis and the evidence base for available treatments.

Neuropsychiatric syndromes of multiple sclerosis

“…Those symptoms which may more accurately indicate a comorbid depressive episode include a pervasive low mood, anhedonia, diurnal mood variation, suicidal ideation, pessimistic or negative patterns of thinking and impaired functionality unrelated to or out of proportion to one’s physical disability (table 1). 9 …”

“…This increased rate is not solely attributable to the effects of steroid treatment although up to one-third of individuals experience a corticosteroid-induced manic episode or to antidepressant-induced (hypo)manic states 74 75. Other agents have also been implicated in causing episodes of (hypo)mania including baclofen, dantrolene, tizanidine and psychoactive substances 9. Drug-induced manic symptoms appear generally to be dose dependent, occur early in treatment and are usually responsive to treatment 76.…”

“…Caution in the use of antipsychotics is required due to their potential adverse effects on balance, coordination, incontinence and fatigue. Corticosteroid-induced mania can be managed with lithium, olanzapine and phenytoin,9 without the requirement for steroid discontinuation (see table 1). …”

Further rare and unusual dementias

“…Depression is common, with raised suicide risk. Psychosis is uncommon in MS and is distinct from schizophrenia as it has a later age at onset, quicker resolution, fewer relapses, better response to treatment and a better prognosis (Jefferies 2006). Schizophreniform psychosis may be secondary to steroid treatment.…”

Cognitive Impairment in Multiple Sclerosis: Historical Aspects, Current Status, and Beyond

“…In his original description of MS, Jean Martin Charcot, the father of modern neurology (2), noted loss of memory and reduced understanding (1). In 1877, Charcot observed that people with MS might show "marked enfeeblement of the memory, conceptions are formed slowly, and intellectual and emotional faculties are blunted in their totality" (3).…”