The Prevalence of Bipolar Disorders and Association With Quality of Life in a Cohort of Patients With Multiple Sclerosis

Jun-O’Connell, Adalia H.; Butala, Ankur; Morales, Idanis Berrios; Henninger, Nils; Deligiannidis, Kristina M.; Byatt, Nancy; Ionete, Carolina

doi:10.1176/appi.neuropsych.15120403

Cited by 15 publications

(19 citation statements)

References 59 publications

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“…For example, psychiatric disturbances in the incipient phase of MS may be predictive of future psychiatric illness in a considerable proportion of PwMS, so their early detection is crucial [31]. Table 2) Mood dysfunction, including depression, anxiety, and bipolar disorder, is more common among PwMS than in the general population [10,32]. Mood disorders are also associated with rapid disease progression and overall decreased QoL among PwMS [14], and can occur before the onset of neurologic symptoms of MS [33].…”

Section: Psychiatric/neurologic Comorbiditiesmentioning

confidence: 99%

A global view of comorbidity in multiple sclerosis: a systematic review with a focus on regional differences, methodology, and clinical implications

2020

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Multiple sclerosis (MS) is a chronic autoimmune disorder of the central nervous system which is associated with numerous comorbidities. These include cardiovascular disease, psychiatric and neurologic disturbances, restless leg syndrome, migraine, cancer, autoimmune diseases, and metabolic disorders. Comorbid disease is an important consideration for clinicians treating patients with MS; early presentation of comorbidities can obscure or delay MS diagnosis, as well as significantly impacting the disease course. Improved understanding of comorbidities and their emergence in MS populations is important for improving the quality of life and optimizing treatment for patients. Therefore, we evaluated published studies reporting epidemiologic data on comorbidities and their associated impact on disease progression in patients with MS (PwMS). The prevalence of neurologic, cardiovascular, metabolic, and autoimmune comorbidities was elevated in PwMS in general, and furthermore, this adversely affected a broad range of outcomes. Compared with PwMS, cancer rates in people without MS or the general population were lower, which should prompt further studies into the mechanisms of both diseases. Studies were under-represented in many regions owing to the latitudinal gradient of MS and possible underfunding of studies.

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Section: Psychiatric/neurologic Comorbiditiesmentioning

confidence: 99%

A global view of comorbidity in multiple sclerosis: a systematic review with a focus on regional differences, methodology, and clinical implications

2020

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“…Additionally, the cMRI Swanton criteria for dissemination in time and space were not fulfilled and the MRZ reaction, a polyspecific, intrathecal humoral immune response against neurotropic agents (measles, rubella, and varicella zoster virus), which is possibly the most specific available CSF marker for MS (26), was also negative. Therefore, we were not able to diagnose MS or an early stage of this disease although previous studies showed an association between BD and MS (27, 28). The OCBs could also be an “immunological scar” after a previous CNS infection; however, a history of previous CNS infections was negative.…”

Section: Discussionmentioning

confidence: 87%

Alterations in Cerebrospinal Fluid in Patients with Bipolar Syndromes

et al. 2016

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Bipolar disorder (BD) is a severe and lifelong condition. Primary endogenic polygenetic forms are common. Secondary organic forms have received increasing interest recently due to the detection of immunological encephalopathies that mimic various psychiatric syndromes, including BD. However, only limited data about routine findings of cerebrospinal fluid (CSF) analyses in BD are available. Therefore, we investigated the frequency of alterations in the CSF in patients with BD and the association with autoantibodies, cerebral magnetic resonance imaging, and electroencephalography findings. CSF samples of patients with BD collected from January 1998 until December 2015 were analyzed retrospectively. Patients with preexisting causes for alterations in the CSF (e.g., patients with obvious past or current neurological disorders) were excluded. In total, 63 patients with BD fulfilled the inclusion criteria for the study. In 1.6% of the patients with BD, an increased white blood cell count was found in the CSF. Increased albumin quotients were found in 12.9% of the patients, oligoclonal bands (OCBs) in 1.6%, and increased immunoglobulin (Ig) G indices in 3.2% (OCBs were not measured in case of increased IgG indices). No significant differences in CSF findings were found between patients with manic and depressive episodes. The main findings of this open uncontrolled study are that alterations in the CSF may be found in a small, but potentially relevant, subgroup of patients with BD. These findings are discussed in light of the new concepts of mild encephalitis and immunological encephalopathy. The detection of patients with possibly secondary organic bipolar syndromes could open up new causal treatment options with immunomodulatory medication.

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“…However, several studies found no association between schizophrenia and MS. A study from Taiwan found a non-significant increased risk of schizophrenia in patients with MS ( 9 ) and another Danish study found no higher than expected prevalence of MS in individuals with schizophrenia ( 10 ). Several studies comparing the prevalence of bipolar disorder in MS patients to a comparator population found that bipolar disorder was more common in the MS population ( 5 , 11 , 12 ).…”

Section: Introductionmentioning

confidence: 99%

Risk of Schizophrenia and Bipolar Disorder in Patients With Multiple Sclerosis: Record-Linkage Studies

et al. 2020

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Background: The epidemiology of psychiatric comorbidity in multiple sclerosis (MS) remains poorly understood. Objective: We aimed to determine the risk of schizophrenia and bipolar disorder in MS patients. Material and Methods: Retrospective cohort analyses were performed using an all-England national linked Hospital Episode Statistics (HES) dataset (1999-2016) and to determine whether schizophrenia or bipolar disorder are more commonly diagnosed subsequently in people with MS (n=128,194), and whether MS is more commonly diagnosed subsequently in people with schizophrenia (n=384,188) or bipolar disorder (n=203,592), than would be expected when compared with a reference cohort (~15 million people) after adjusting for age and other factors. Adjusted hazard ratios (aHRs) were calculated using Cox proportional hazards models. Results: Findings were dependent on whether the index and subsequent diagnoses were selected as the primary reason for hospital admission or were taken from anywhere on the hospital record. When searching for diagnoses anywhere on the hospital record, there was a significantly elevated risk of subsequent schizophrenia (aHR 1.51, 95% confidence interval (CI) 1.40 to 1.60) and of bipolar disorder (aHR 1.14, 95% CI 1.04 to 1.24) in people with prior-recorded MS and of subsequent MS in people with prior-recorded schizophrenia (aHR 1.26, 1.15-1.37) or bipolar disorder (aHR 1.73, 1.57-1.91), but most of these associations were reduced to null when analyses were confined to diagnoses recorded as the primary reason for admission. Conclusion: Further research is needed to investigate the potential association between MS and schizophrenia and/or bipolar disorder as it may shed light on underlying pathophysiology and help identify potential shared risk factors.

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The Prevalence of Bipolar Disorders and Association With Quality of Life in a Cohort of Patients With Multiple Sclerosis

Cited by 15 publications

References 59 publications

A global view of comorbidity in multiple sclerosis: a systematic review with a focus on regional differences, methodology, and clinical implications

A global view of comorbidity in multiple sclerosis: a systematic review with a focus on regional differences, methodology, and clinical implications

Alterations in Cerebrospinal Fluid in Patients with Bipolar Syndromes

Risk of Schizophrenia and Bipolar Disorder in Patients With Multiple Sclerosis: Record-Linkage Studies

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