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Israel-Elgali I, Pan H, Oved K, Pillar N, Levy G, Barak B, Carneiro A, Gurwitz D, Shomron N. Impaired myelin ultrastructure is reversed by citalopram treatment in a mouse model for major depressive disorder. J Psychiatr Res 2023; 166:100-114. [PMID: 37757703 DOI: 10.1016/j.jpsychires.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/24/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023]
Abstract
Major depressive disorder (MDD) is the most common and widespread mental disorder. Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for MDD. The relation between the inhibition of serotonin reuptake in the central nervous system and remission from MDD remains controversial, as reuptake inhibition occurs rapidly, but remission from MDD takes weeks to months. Myelination-related deficits and white matter abnormalities were shown to be involved in psychiatric disorders such as MDD. This may explain the delay in remission following SSRI administration. The raphe nuclei (RN), located in the brain stem, consist of clusters of serotonergic (5-HT) neurons that project to almost all regions of the brain. Thus, the RN are an intriguing area for research of the potential effect of SSRI on myelination, and their involvement in MDD. MicroRNAs (miRNAs) regulate many biological features that might be altered by antidepressants. Two cohorts of chronic unpredictable stress (CUS) mouse model for depression underwent behavioral tests for evaluating stress, anxiety, and depression levels. Following application of the CUS protocol and treatment with the SSRI, citalopram, 48 mice of the second cohort were tested via magnetic resonance imaging and diffusion tensor imaging for differences in brain white matter tracts. RN and superior colliculus were excised from both cohorts and measured for changes in miRNAs, mRNA, and protein levels of candidate genes. Using MRI-DTI scans we found lower fractional anisotropy and axial diffusivity in brains of stressed mice. Moreover, both miR-30b-5p and miR-101a-3p were found to be downregulated in the RN following CUS, and upregulated following CUS and citalopram treatment. The direct binding of these miRNAs to Qki, and the subsequent effects on mRNA and protein levels of myelin basic protein (Mbp), indicated involvement of these miRNAs in myelination ultrastructure processes in the RN, in response to CUS followed by SSRI treatment. We suggest that SSRIs are implicated in repairing myelin deficits resulting from chronic stress that leads to depression.
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Affiliation(s)
- Ifat Israel-Elgali
- Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hope Pan
- Department of Pharmacology, Center for Molecular Neuroscience, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Keren Oved
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Pillar
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilad Levy
- Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel
| | - Boaz Barak
- Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel; Faculty of Social Sciences, School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Ana Carneiro
- Department of Pharmacology, Center for Molecular Neuroscience, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - David Gurwitz
- Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Noam Shomron
- Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Edmond J Safra Center for Bioinformatics, Tel Aviv University, Tel Aviv, Israel; Tel Aviv University Innovation Laboratories (TILabs), Tel Aviv, Israel.
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2
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Type I interferon therapies of multiple sclerosis and hepatitis C virus infection. POSTEP HIG MED DOSW 2021. [DOI: 10.2478/ahem-2021-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Interferons type I (IFN-I), activated following a bacterial or viral infection, play a major role in the induction and regulation of the immune system. The immune response results in viral RNA and binds to receptors such as RIG-I-like receptors (RLRs) or Toll-like receptors, leading to the IFN-I signaling cascade. Thanks to its cellular function, IFN-I is widely used in therapies for such diseases as multiple sclerosis (MS) and hepatitis C disease (HCD).
MS is a neurological, autoimmune, chronic inflammatory disease of the central nervous system (CNS). During MS, nerve cell demyelination is observed due to the myelin heaths and oligodendrocyte damage. As a result, neuronal signal and neuron communication are attenuated. The mechanism of MS is still unknown. MS therapy applies interferon-β (IFN-β). IFN-β therapy has been used since the last century, but the therapeutic mechanism of IFN-β has not been completely understood. MS can lead to four syndromes: clinically isolated syndrome (CIS), relapsing-remitting MS (RRMS), primary progressive MS (PPMS), and secondary progressive MS (SPMS).
HCD occurs as a result of infection with the hepatitis C virus (HCV), belonging to the Flaviviridae family. HCV is a blood-borne virus with a positive single-stranded RNA. A vaccine for HCV is not available yet. HCD can lead to liver damage or cancer. In HCD interferon-α therapy (IFN-α) is applied. As with MS, the mechanism of IFN-α therapy is not completely known.
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Joseph B, Nandakumar AL, Ahmed AT, Gopal N, Murad MH, Frye MA, Tobin WO, Singh B. Prevalence of bipolar disorder in multiple sclerosis: a systematic review and meta-analysis. EVIDENCE-BASED MENTAL HEALTH 2021; 24:88-94. [PMID: 33328183 PMCID: PMC10231514 DOI: 10.1136/ebmental-2020-300207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/09/2020] [Accepted: 11/30/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic disabling, demyelinating disease of the central nervous system and is often associated with psychiatric comorbidities. Some studies suggest increased prevalence of bipolar disorder (BD) in MS. OBJECTIVE To conduct a systematic review and meta-analysis assessing the prevalence of BD in adults with MS. METHODS We registered this review with PROSPERO and searched electronic databases (Ovid MEDLINE, Central, Embase, PsycINFO and Scopus) for eligible studies from earliest inception to October 2020. Prevalence data of BD in adult patients with MS were extracted. Meta-analysis was conducted using random-effects model. FINDINGS Of the 802 articles that were screened, 23 studies enrolling a total of 68 796 patients were included in the systematic review and meta-analysis. The pooled prevalence rate of BD in patients with MS was 2.95% (95% CI 2.12% to 4.09%) with higher prevalence in the Americas versus Europe. The lifetime prevalence of BD was 8.4% in patients with MS. Subgroup analysis showed a higher prevalence of BD in MS in females (7.03%) than in males (5.64%), which did not reach statistical significance (p=0.53). CONCLUSIONS This meta-analysis suggests a high lifetime prevalence of BD in patients with MS. Patients with MS should be routinely screened for BD. Further assessment of bipolar comorbidity in MS through prospective studies may help in developing effective management strategies and may improve treatment outcomes in patients with MS.
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Affiliation(s)
- Boney Joseph
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Ahmed T Ahmed
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Clinical and Translational Science Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota, USA
| | - Neethu Gopal
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - M Hassan Murad
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota, USA
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - W Oliver Tobin
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Balwinder Singh
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
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4
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Raimo S, Santangelo G, Trojano L. The emotional disorders associated with multiple sclerosis. HANDBOOK OF CLINICAL NEUROLOGY 2021; 183:197-220. [PMID: 34389118 DOI: 10.1016/b978-0-12-822290-4.00009-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Multiple sclerosis (MS) is associated with a high prevalence of emotional and mood disorders. Emotional disorders may worsen during illness progression and affect the quality of life of patients and their families. MS is often associated with depression, with an increased risk of suicide, poor adherence to treatment, decreased functional status, and quality of life. The diagnosis and treatment of emotional and mood disorders in these patients is often challenging since several symptoms of these disorders overlap with those of MS. Other prevalent emotional disorders in MS include bipolar disorder, anxiety disorders, emotional blunting (apathy), and pseudobulbar affect. Early recognition and treatment of these comorbidities could contribute to the reduction of disability and even to decreased mortality. The aim of this chapter is to provide an up-to-date review of mood and emotional disorders that are often associated with MS, focusing on their epidemiology, clinical features, pathogenesis, assessment, and treatment. The interplay between the psychosocial impact of the chronic disability and the demyelinating structural lesions of the brain in precipitating emotional and mood disorders is discussed, as well as its implications for diagnosis and treatment.
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Affiliation(s)
- Simona Raimo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy.
| | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Luigi Trojano
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
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Ormstad H, Simonsen CS, Broch L, Maes DM, Anderson G, Celius EG. Chronic fatigue and depression due to multiple sclerosis: Immune-inflammatory pathways, tryptophan catabolites and the gut-brain axis as possible shared pathways. Mult Scler Relat Disord 2020; 46:102533. [PMID: 33010585 DOI: 10.1016/j.msard.2020.102533] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/03/2020] [Accepted: 09/25/2020] [Indexed: 02/07/2023]
Abstract
Chronic fatigue and major depression (MDD)-like symptoms are common manifestations of multiple sclerosis (MS), both with huge impact on quality of life. Depression can manifest itself as fatigue, and depressive symptoms are often mistaken for fatigue, and vice versa. The two conditions are sometimes difficult to differentiate, and their relationship is unclear. Whether chronic fatigue and depression occur primarily, secondarily or coincidentally with activated immune-inflammatory pathways in MS is still under debate. We have carried out a descriptive review aiming to gain a deeper understanding of the relationship between chronic fatigue and depression in MS, and the shared pathways that underpin both conditions. This review focuses on immune-inflammatory pathways, the kynurenine pathway and the gut-brain axis. It seems likely that proinflammatory cytokines, tryptophan catabolites (the KYN pathway) and the gut-brain axis are involved in the mechanisms causing chronic fatigue and MDD-like symptoms in MS. However, the evidence base is weak, and more research is needed. In order to advance our understanding of the underlying pathological mechanisms, MS-related fatigue and depression should be examined using a longitudinal design and both immune-inflammatory and KYN pathway biomarkers should be measured, relevant clinical characteristics judiciously registered, and self-report instruments for both fatigue and depression should be used.
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Affiliation(s)
- Heidi Ormstad
- University of South-Eastern Norway and University Oslo Metropolitan University.
| | | | | | - Dr Michael Maes
- Chulalongkorn University, Bangkok, Thailand; Medical University of Plovdiv, Plovdiv, Bulgaria; IMPACT Strategic Center, Deakin University, Australia
| | - George Anderson
- CRC Scotland & London, Eccleston Square, London, United Kingdom
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Pereira GM, Becker J, Soares NM, de Azeredo LA, Grassi-Oliveira R, Rysdyk A, de Almeida RMM. Hair cortisol concentration, cognitive, behavioral, and motor impairment in multiple sclerosis. J Neural Transm (Vienna) 2019; 126:1145-1154. [PMID: 31250284 DOI: 10.1007/s00702-019-02040-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 06/22/2019] [Indexed: 12/16/2022]
Abstract
Multiple sclerosis (MS) is an autoimmune neurodegenerative disease that is characterized by the demyelinated inflammatory processes that occur within the central nervous system. Hypothalamus-pituitary-adrenal axis (HPA axis) dysfunctions have been associated with the triggering or increase in MS symptoms. We thus aimed at evaluating motor and behavioral functions, planning skills, processing speed, and their relationship with stress through measuring hair cortisol concentration from patients with MS. The sample was composed of 40 volunteers that were clinically diagnosed with MS, along with 33 healthy adults. Evaluations included: Clinical Evaluation Form, Mini-Mental State Exam, Hamilton Depression Rating Scale, Multiple Sclerosis Functional Composite Measure, Expanded Disability Status Scale, Berg Balance Scale, Perceived Stress Scale, Zoo Map task, and a hair sample to analyze cortisol levels in the last 30 days. MS patients showed highly elevated hair cortisol levels in comparison to the control group (p = 0.048). All groups presented some degree of depressive and anxiety symptoms, aside from considerable perceived stress levels. The MS group presented deficits in gait, balance, manual skills and processing speed, and this was particularly so in individuals with moderate impairments when compared to control group (p < 0.001). Individuals with MS spent less time planning on ZooMap1 (p = 0.024) and made more mistakes (p < 0.001). No correlation was found between hair cortisol and the symptoms we assessed. However, depressive symptoms and anxiety were related to perceived stress, and higher hair cortisol suggests a change in levels in the HPA axis in MS. Nevertheless, future studies will be necessary to further understand how basal hair cortisol is related to MS symptoms.
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Affiliation(s)
- Gabriela Magalhães Pereira
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-003, Brazil. .,Instituto de Psicologia, Laboratório de Psicologia Experimental, Neurociências e Comportamento (LPNeC), Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2600, Sala 116, Santa Cecilia, Porto Alegre, RS, 90035-003, Brazil. .,Hospital de Clinicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, Porto Alegre, RS, 90035-003, Brazil.
| | - Jefferson Becker
- Escola de Medicina, Neurologia, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, 90619-900, Brazil.,Instituto do Cérebro do Rio Grande do Sul (InsCer), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Hospital São Lucas da PUCRS, 90610-000, Porto Alegre, Brazil
| | - Nayron Medeiros Soares
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-003, Brazil.,Instituto de Psicologia, Laboratório de Psicologia Experimental, Neurociências e Comportamento (LPNeC), Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2600, Sala 116, Santa Cecilia, Porto Alegre, RS, 90035-003, Brazil.,Hospital de Clinicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, Porto Alegre, RS, 90035-003, Brazil
| | - Lucas Araújo de Azeredo
- Instituto do Cérebro do Rio Grande do Sul (InsCer), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Hospital São Lucas da PUCRS, 90610-000, Porto Alegre, Brazil.,Escola de Medicina, Programa de Pós-Graduação em Medicina e Ciências da Saúde, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, 90619-900, Brazil
| | - Rodrigo Grassi-Oliveira
- Instituto do Cérebro do Rio Grande do Sul (InsCer), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Hospital São Lucas da PUCRS, 90610-000, Porto Alegre, Brazil.,Escola de Medicina, Programa de Pós-Graduação em Medicina e Ciências da Saúde, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, 90619-900, Brazil
| | - Andreo Rysdyk
- Instituto de Psicologia, Laboratório de Psicologia Experimental, Neurociências e Comportamento (LPNeC), Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2600, Sala 116, Santa Cecilia, Porto Alegre, RS, 90035-003, Brazil
| | - Rosa Maria Martins de Almeida
- Instituto de Psicologia, Laboratório de Psicologia Experimental, Neurociências e Comportamento (LPNeC), Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2600, Sala 116, Santa Cecilia, Porto Alegre, RS, 90035-003, Brazil.
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Abstract
Depressive disorders occur in up to 50% of people living with multiple sclerosis (MS). Prevalence estimates are generally 2-3-times higher than those of the general population. Myriad aetiologic factors may contribute to the aetiology of depression in MS including biological mechanisms (e.g. hippocampal microglial activation, lesion burden, regional atrophy), as well as the stressors, threats, and losses that accompany living with an unpredictable and often disabling disease. Some prominent risk factors for depression such as (younger) age, (female) sex, and family history of depression are less consistently associated with depression in MS than they are in the general population. Management of depression in MS has not been well studied, but available data on detection and treatment align with general principles of depression management. While the validity of standard measurement scales has often been questioned, available evidence suggests that standard scales provide valid ratings. Evidence for the effectiveness of depression treatments in MS is limited, but available evidence supports the effectiveness of standard treatment approaches, including both cognitive behavioural therapies and antidepressant medications.
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Affiliation(s)
- Scott B Patten
- a Department of Community Health Sciences , University of Calgary, Calgary , Alberta , Canada
| | - Ruth Ann Marrie
- b Department of Internal Medicine (Neurology) , University of Manitoba , Manitoba , Canada.,c Department of Community Health Sciences , University of Manitoba , Manitoba , Canada
| | - Mauro G Carta
- d Department of Medical Sciences and Public Health , Quality of Care, University of Cagliari , Cagliari , Italy
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Hansen S, Lautenbacher S. Neuropsychological Assessment in Multiple Sclerosis. ZEITSCHRIFT FUR NEUROPSYCHOLOGIE 2017. [DOI: 10.1024/1016-264x/a000197] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Abstract. Neuropsychological deficits in multiple sclerosis (MS) are common. Over the past decades, many different procedures have been employed in diagnosing these deficits. Even though certain aspects of cognitive performance such as information processing speed and working memory may be affected more frequently than other cognitive functions, no specific deficit profile has been established in MS. This article provides an overview of the neuropsychological diagnostic procedures in MS and allows the reader to reach an informed decision on the applicability of specific procedures and the availability of study data in the context of MS. Additionally, it makes recommendations on the compilation of both screening procedures and extensive test batteries.
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Affiliation(s)
- Sascha Hansen
- Klinikum Bayreuth GmbH, Betriebsstätte Hohe Warte, Department of Neurology, Bayreuth, Germany
- Otto-Friedrich-University, Department of Physiological Psychology, Bamberg, Germany
| | - Stefan Lautenbacher
- Otto-Friedrich-University, Department of Physiological Psychology, Bamberg, Germany
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10
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Greeke EE, Chua AS, Healy BC, Rintell DJ, Chitnis T, Glanz BI. Depression and fatigue in patients with multiple sclerosis. J Neurol Sci 2017; 380:236-241. [DOI: 10.1016/j.jns.2017.07.047] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 07/24/2017] [Accepted: 07/29/2017] [Indexed: 10/19/2022]
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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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12
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Ensari I, Kinnett-Hopkins D, Motl RW. Social cognitive correlates of physical activity among persons with multiple sclerosis: Influence of depressive symptoms. Disabil Health J 2017; 10:580-586. [PMID: 28363457 DOI: 10.1016/j.dhjo.2017.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 02/13/2017] [Accepted: 03/09/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Physical inactivity and elevated depressive symptoms are both highly prevalent and correlated among persons with multiple sclerosis (MS). Variables from Social Cognitive Theory (SCT) might be differentially correlated with physical activity in persons with MS who have elevated depressive symptoms. PURPOSE This study investigated the influence of elevated depressive symptoms on correlates of physical activity based on SCT in persons with MS. METHODS Participants (mean age = 50.3 years, 87% female, 69% Caucasian) completed questionnaires on physical activity, depressive symptoms, self-efficacy, social support, outcome expectations, functional limitations, and goal setting. The questionnaires were delivered and returned through the U.S. Postal Service. The sample (N = 551) was divided into 2 subgroups (i.e., elevated vs non-elevated levels of depressive symptoms) for statistical analyses. Bivariate correlations and stepwise multiple regressions were conducted using SPSS. RESULTS Self-efficacy (r = 0.16), functional limitations (r = 0.22) and goal-setting (r = 0.42) were significantly (p < 0.05) associated with physical activity among the elevated depressive sample. The regression analysis indicated that self-efficacy predicted physical activity in Step 1 (β = 0.16, p < 0.05), but was no longer significant when goal-setting (β = 0.06, p > 0.05) entered the model. All social cognitive variables were significantly associated with physical activity levels (r = 0.16-0.40, p < 0.001) among the non-elevated depressive sample. Self-efficacy predicted physical activity in Step 1 (β = 0.24, p < 0.001), but it was no longer significant once goal-setting, functional limitations, and self-evaluative outcome expectations entered the model. CONCLUSION Based on SCT, self-efficacy and goal-setting represent possible targets of behavior interventions for increasing physical activity among persons with MS who have elevated depressive symptoms. There is a larger set of targets among those with MS who do not have elevated symptoms.
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Affiliation(s)
- Ipek Ensari
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA.
| | - Dominique Kinnett-Hopkins
- University of Illinois at Urbana-Champaign, Department of Kinesiology and Community Health, 906S Goodwin Ave, 233 Freer Hall, Urbana, IL 61801, USA.
| | - Robert W Motl
- University of Alabama at Birmingham, Department of Physical Therapy, 1705 University Blvd SHPB 336, Birmingham, AL 35233-1212, USA.
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13
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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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14
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Powers A, Almli L, Smith A, Lori A, Leveille J, Ressler KJ, Jovanovic T, Bradley B. A genome-wide association study of emotion dysregulation: Evidence for interleukin 2 receptor alpha. J Psychiatr Res 2016; 83:195-202. [PMID: 27643478 PMCID: PMC5896292 DOI: 10.1016/j.jpsychires.2016.09.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 07/01/2016] [Accepted: 09/08/2016] [Indexed: 11/26/2022]
Abstract
Emotion dysregulation has been implicated as a risk factor for many psychiatric conditions. Therefore, examining genetic risk associated with emotion dysregulation could help inform cross-disorder risk more generally. A genome-wide association study (GWAS) of emotion dysregulation using single nucleotide polymorphism (SNP) array technology was conducted in a highly traumatized, minority, urban sample (N = 2600, males = 774). Post-hoc analyses examined associations between SNPs identified in the GWAS and current depression, posttraumatic stress disorder (PTSD), and history of suicide attempt. Methylation quantitative trait loci were identified and gene set enrichment analyses were used to broadly determine biological processes involved with these SNPs. Among males, SNP rs6602398, located within the interleukin receptor 2A gene, IL2RA, was significantly associated with emotion dysregulation (p = 1.1 × 10-8). Logistic regression analyses revealed this SNP was significantly associated with depression (Exp(B) = 2.67, p < 0.001) and PTSD (Exp(B) = 2.07, p < 0.01). This SNP was associated with differential DNA methylation (p < 0.05) suggesting it may be functionally active. Finally, through gene set enrichment analyses, ten psychiatric disease pathways (adjusted p < 0.01) and the calcium signaling pathway (adjusted p = 0.008) were significantly associated with emotion dysregulation. We found initial evidence for an association between emotion dysregulation and genetic risk loci that have already been implicated in medical disorders that have high comorbidity with psychiatric disorders. Our results provide further evidence that emotion dysregulation can be understood as a potential psychiatric cross-disorder risk factor, and that sex differences across these phenotypes may be critical. Continued research into genetic and biological risk associated with emotion dysregulation is needed.
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Affiliation(s)
- Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, United States.
| | - Lynn Almli
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Alicia Smith
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Adriana Lori
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Jen Leveille
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Kerry J. Ressler
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine,McLean Hospital, Harvard Medical School
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Bekh Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine,Atlanta VA Medical Center
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Abstract
Multiple sclerosis (MS) patients are known to be at increased risk from mood disorders and suicidal ideation. A lthough these are often associated with alcohol disorders, the drinking habits of MS patients have not been well studied to date. O ur study assessed drinking patterns in 140 MS patients, focusing on a possible link between problem drinking and mood and anxiety disorders. Lifetime psychiatric diagnoses were ascertained using the Structured C linical Interview for DSM-IV disorders (SCID-IV). Results demonstrate that one in six MS patients drink to excess over the course of their lifetime. Those with a history of problem drinking display a higher lifetime prevalence of anxiety (P =0.006), but not mood disorders. There were also significant associations between problem drinking and a lifetime prevalence of suicidal ideation (P =0.006), substance abuse (P =0.001), and a family history of mental illness (P =0.008). C linicians should be aware of the possibility of problem drinking in MS patients, and how this may complicate the course of their disease. C lues to problem drinking in MS patients are the presence of a positive family history of mental illness and prominent anxiety.
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Affiliation(s)
- Susan Quesnel
- Department of Psychiatry, University of Toronto and Sunnybrook and Women's College Health Science Centre, 2075 Bayview Ave, Ontario, Canada, M4N 3M5
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16
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Patten SB, Francis G, Metz LM, Lopez-Bresnahan M, Chang P, Curtin F. The relationship between depression and interferon beta-1a therapy in patients with multiple sclerosis. Mult Scler 2016; 11:175-81. [PMID: 15794391 DOI: 10.1191/1352458505ms1144oa] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
It has been suggested that interferons (IFN) may cause depressionde novo or worsen pre-existing depression. Depression data collected using validated instruments from individual clinical trials in multiple sclerosis, however, have consistently failed to identify an association. In this study, pooled data from 6 controlled studies and 17 noncontrolled clinical trials of subcutaneous IFN beta-1a were assessed to determine the relationship between IFN therapy with physician reports of depression and suicide. In distinction to the negative findings for depressive symptom ratings, pooling of physician-reported side effect data from these clinical trials identified a statistically significant association between depression and IFN use during the first six months of treatment. There was an association between these reported episodes of depression and discontinuation of IFN therapy, but IFN treatment was not associated with suicide attempts. IFN β-1a may induce a constellation of symptoms, particularly early in therapy, that may be labelled as depression by physicians. However, the lack of an increase in depression-rating scale scores and the lack of association with suicide risk suggests that the syndrome may be an atypical one.
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Affiliation(s)
- Scott B Patten
- Department of Community Health Sciences and Psychiatry, University of Calgary, Calgary, Alberta, Canada T2N 4N1.
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17
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Patten SB, Fridhandler S, Beck CA, Metz LM. Depressive symptoms in a treated multiple sclerosis cohort. Mult Scler 2016; 9:616-20. [PMID: 14664476 DOI: 10.1191/1352458503ms960oa] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background: Recent side effect data from clinical trials of interferon beta in multiple sclerosis (MS) have failed to confirm that these medications are associated with an increased risk of depression. However, these studies have used highly selected samples and the results may not be generalizable to real world settings. Methods: C linical data on subjects from southern A lberta who have applied for, or are receiving, public reimbursement for MS treatment are maintained in a database at the University of C algary Multiple Sclerosis C linic. Depression ratings obtained using the C enter for Epidemiological Studies Depression Rating Scale (C ES-D) are included in this database. In the current analysis, these longitudinal data were used to determine whether depressive symptoms were associated with disease-modifying treatments. Results: A t baseline, ratings were available for 163 subjects. Those choosing interferon beta resembled those choosing glatiramer acetate in most respects. During follow-up, no differences were observed in the prevalence or incidence of depression and C ES-D scores were not found to differ between the treatment groups. Conclusions: The failure to identify higher rates of depression both in previous intervention studies and in the current observational study provides confirmation that these drugs are not substantially associated with the occurrence of depression.
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Affiliation(s)
- Scott B Patten
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.
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18
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Edwards LJ, Constantinescu CS. A prospective study of conditions associated with multiple sclerosis in a cohort of 658 consecutive outpatients attending a multiple sclerosis clinic. Mult Scler 2016; 10:575-81. [PMID: 15471376 DOI: 10.1191/1352458504ms1087oa] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The cause of multiple sclerosis (MS) remains unknown. It is largely regarded as being an inflammatory autoimmune disease and has been reported in association with other inflammatory/autoimmune diseases. We performed a prospective study in 658 consecutive patients diagnosed with MS attending our outpatient MS management clinic between June 2002 and June 2003. Prevalence of associated conditions in these patients was calculated and compared with values from population studies using chi-square tests, odds ratios and confidence intervals. The MS population had significantly increased rates of asthma, inflammatory bowel disease, type I diabetes mellitus, pernicious anaemia, autoimmune thyroid disease, uveitis, seronegative spondyloarthropathies, bipolar disorder and melanoma compared to the general population. Both T helper type 1 (Th1)-mediated and T helper type 2 (Th2)-mediated diseases were significantly increased compared to the general population. There were also interesting associations seen with polyglandular autoimmune syndrome and rare single case associations. MS is associated with several other conditions. This work does not give evidence for the hypothesis that MS and atopy, reflecting Th1 and Th2 polarization, respectively, are mutually exclusive. Further work, ideally with a matched control population, is indicated.
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Affiliation(s)
- L J Edwards
- Division of Clinical Neurology, Queen's Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
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19
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Herndon RM, Rudick RA, Munschauer FE, Mass MK, Salazar AM, Coats ME, Labutta R, Richert JR, Cohan SL, Genain C, Goodkin D, Toal M, Riester K. Eight-year immunogenicity and safety of interferon beta-1a-Avonex®treatment in patients with multiple sclerosis. Mult Scler 2016; 11:409-19. [PMID: 16042223 DOI: 10.1191/1352458505ms1209oa] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
An open-label extension study of the phase III trial of intramuscular interferon beta-1a (IFNβ-1a-Avonex) was conducted to evaluate the immunogenicity and safety of IFNβ-1a-Avonex over six years in patients with relapsing multiple sclerosis (MS). Patients who participated in the pivotal phase III study were offered enrolment; entry was also open to patients who had not participated. All patients received IFNβ-1a-Avonex 30 mg intramuscularly once weekly for six years, for a treatment duration of up to eight years in patients who received IFNβ-1a-Avonex in the phase III trial. Serum levels of IFNβ antibodies were measured every six months using a screening enzyme-linked immunosorbent assay (ELISA) followed by an antiviral cytopathic effect assay to detect neutralizing antibodies (NAbs) in serum samples positive on ELISA. The incidence of adverse events and laboratory test results assessed safety. Of 382 total patients, 218 had participated in the phase III study (103 placebo, 115 IFNβ-1a-Avonex) and 164 had not participated; 24 of the 164 were IFNβ-naïve. At baseline, 281 patients were negative for IFNβ antibodies (NAb-). NAbs (titre≥ 20) developed at any time over six years in 5% of these patients. Of 140 patients who had been on IFNβ-1b-Betaseron, 49 were positive for NAbs (NAb+) at baseline; 11 of 115 who had been on IFNβ-1a-Avonex were NAb+ at baseline. Thirty-nine of 49 patients who had been on Betaseron and were NAb+ had titres <100; 36 of these 39 seroconverted to NAb-while on IFNβ-1a-Avonex, with a median time of approximately six months. Ten patients who had been on Betaseron had NAb titres ≥ 100; five remained NAb+ during six years on IFNβ-1a-Avonex and five seroconverted to NAb-, but only after at least two years. Five patients who had been on IFNβ-1a-Avonex during the clinical trial were NAb+ with titres <100 at baseline; four seroconverted to NAb-, with a median time of two to three years. Six patients who had been on IFNβ-1a-Avonex had NAb titres ≥100; five of these remained NAb+ at six years. No patient with a NAb titre >1000 seroconverted to NAb-, whether initially treated with IFNβ-1a-Avonex or -Betaseron. Adverse events were similar to those observed in the pivotal phase III trial. Results from this trial indicated that IFNβ-1a-Avonex was associated with a low incidence of NAbs and was well tolerated for up to eight years. Further, the results indicate that persistence of NAbs is dependent on titre and IFNβ product.
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Affiliation(s)
- Robert M Herndon
- University of Mississippi, VA Medical Center, Jackson, MS 39216, USA.
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20
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Thornton EW, Tedman S, Rigby S, Bashforth H, Young C. Worries and concerns of patients with multiple sclerosis: development of an assessment scale. Mult Scler 2016; 12:196-203. [PMID: 16629423 DOI: 10.1191/135248506ms1273oa] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study examined the nature of worry in adult patients with multiple sclerosis (MS) in the UK. A measure of worry in MS was developed and the relationship between worry and standard scale measures of anxiety and depression was examined. Thirty-nine patients with MS and 40 controls completed the new worry scale (WQMS) that was psychometrically evaluated, together with the Penn State Worry Questionnaire (PSWQ), the Hospital Anxiety and Depression Scale (HAD) and a previously developed scale to assess self-efficacy in MS (SESMS). The scores for both anxiety ( t=2.34; p<0.05) and depression ( t=5.52; p<0.01) were higher in MS patients than controls, as was the new scale for worry - the WQMS. A factor analysis (explaining 65.73% of the variance) suggests that the worries of patients may be dichotomized into those concerned with the physical effects of the disease and those relating to the impact on social interaction, family relationships and daily activity in the home and/or work. Worry in patients with MS was associated with a decreased sense of being able to produce positive activities or effect positive outcomes (low self-efficacy). The questionnaire provides a framework for investigation in clinic of specific concerns and level of worry they engender.
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Affiliation(s)
- E W Thornton
- School of Psychology, University of Liverpool, UK.
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21
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Stepleman LM, Lopez EJ, Stutts LA, Hudson WH, Rutter Goodworth MC, Rahn R. Physician–Patient Communication About Sexual Functioning in Patients with Multiple Sclerosis. SEXUALITY AND DISABILITY 2016. [DOI: 10.1007/s11195-016-9444-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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22
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Update on monitoring and adverse effects of first generation disease modifying therapies and their recently approved versions in relapsing forms of multiple sclerosis. Curr Opin Neurol 2016; 29:272-7. [DOI: 10.1097/wco.0000000000000320] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Ensari I, Sandroff BM, Motl RW. Intensity of treadmill walking exercise on acute mood symptoms in persons with multiple sclerosis. ANXIETY STRESS AND COPING 2016; 30:15-25. [DOI: 10.1080/10615806.2016.1146710] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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24
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Freedman MS, Patry DG, Grand'Maison F, Myles ML, Paty DW, Selchen DH. Treatment Optimization in Multiple Sclerosis. Can J Neurol Sci 2016; 31:157-68. [PMID: 15198439 DOI: 10.1017/s0317167100053804] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThe treatment of multiple sclerosis has finally become possible with the advent of the current disease-modifying therapies (DMTs) that have had a significant impact on those living with this disease. Though demonstrating clear efficacy on a number of short-term outcome measures, unfortunately, these agents are not “cures” and many patients with multiple sclerosis continue to experience disease activity in spite of treatment. Clinicians are becoming more comfortable initiating therapy with DMTs, but it is now important to focus attention on monitoring the results of the chosen therapy and deciding whether or not a patient is responding well to treatment. At present, however, clinicians lack criteria for defining optimal versus suboptimal responses to DMTs as well as evidence-based guidelines on how to improve treatment outcomes. Using a recently published model as a framework, The Canadian Multiple Sclerosis Working Group developed practical recommendations on how neurologists can assess the status of patients on DMTs and decide when it may be necessary to modify treatment in order to optimize outcomes. The Canadian Multiple Sclerosis Working Group's recommendations are based on monitoring relapses, neurological progression and MRI activity. Other possible causes of suboptimal treatment responses or treatment failure are also considered.
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Affiliation(s)
- Mark S Freedman
- MS Research Clinic, University of Ottawa, Ottawa Hospital General Campus, Ottawa, Ontario, Canada
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25
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26
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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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27
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Ensari I, Sandroff BM, Motl RW. Effects of Single Bouts of Walking Exercise and Yoga on Acute Mood Symptoms in People with Multiple Sclerosis. Int J MS Care 2016; 18:1-8. [PMID: 26917992 PMCID: PMC4766946 DOI: 10.7224/1537-2073.2014-104] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Little is known about the acute or immediate effects of walking exercise and yoga on mood in people with multiple sclerosis (MS). Such an examination is important for identifying an exercise modality for inclusion in exercise-training interventions that yields mood benefits in MS. We examined the effects of single bouts of treadmill walking and yoga compared with a quiet, seated-rest control condition on acute mood symptoms in MS. METHODS Twenty-four participants with MS completed 20 minutes of treadmill walking, yoga, or quiet rest in a randomized, counterbalanced order with 1 week between sessions. Participants completed the Profile of Mood States questionnaire before and immediately after each condition. Total mood disturbance (TMD) and the six subscales of the Profile of Mood States were analyzed using repeated-measures analysis of variance and paired-samples t tests. RESULTS There was a significant condition × time interaction on TMD scores (ηp (2) = 0.13). Walking and yoga conditions yielded comparable reductions in TMD scores. There was a significant condition × time interaction on vigor (ηp (2) = 0.23) whereby walking but not yoga yielded an improvement in vigor. There was a significant main effect of time on anger, confusion, depression, and tension (P < .05) but not on fatigue. CONCLUSIONS Walking and yoga yielded similar improvements in overall acute mood symptoms, and walking improved feelings of vigor. These effects should be further investigated in long-term exercise-training studies.
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Affiliation(s)
- Ipek Ensari
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Brian M Sandroff
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Robert W Motl
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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28
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Moore P, Methley A, Pollard C, Mutch K, Hamid S, Elsone L, Jacob A. Cognitive and psychiatric comorbidities in neuromyelitis optica. J Neurol Sci 2015; 360:4-9. [PMID: 26723962 DOI: 10.1016/j.jns.2015.11.031] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/05/2015] [Accepted: 11/16/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Our primary objective was to examine the neuropsychological and psychopathological profile of patients with neuromyelitis optica (NMO) and compare these to multiple sclerosis (MS) and healthy control (HC) groups. We also examined for relationships between cognitive and psychiatric variables and clinical factors including accumulated neurological disability and disease duration. METHODS A neuropsychological test battery was administered along with a structured psychiatric interview and quantitative measures of mood symptoms. RESULTS 42 NMO, 42 MS and 42 HC participants were assessed. Cognitive impairments were observed in 67% of NMO patients. The prevalence and profile of cognitive impairments and lifetime prevalence of depression was similar between NMO and MS groups. However, significantly higher rates of recurrent depression and suicidality were observed in NMO patients. Correlational analyses revealed higher levels of anxiety symptoms were associated with shorter disease duration in NMO, while higher depression symptom levels were associated with higher neurological disability and poorer cognition. CONCLUSIONS Our results demonstrate substantial cognitive and psychiatric comorbidities in NMO patients. Similar rates of lifetime and current depression between NMO and MS appear to mask greater underlying psychiatric burden in NMO and further understandings of the course of neurobehavioural comorbidities is required to better comprehend the additional morbidity in NMO. Our data support a role for cognitive and psychiatric assessments in the comprehensive care of NMO patients.
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Affiliation(s)
- Perry Moore
- The Walton Centre NHS Foundation Trust, Liverpool, UK.
| | | | | | - Kerry Mutch
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Shahd Hamid
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Liene Elsone
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Anu Jacob
- The Walton Centre NHS Foundation Trust, Liverpool, UK
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29
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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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30
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Marrie RA, Fisk JD, Tremlett H, Wolfson C, Warren S, Tennakoon A, Leung S, Patten SB. Differences in the burden of psychiatric comorbidity in MS vs the general population. Neurology 2015; 85:1972-9. [PMID: 26519542 PMCID: PMC4664123 DOI: 10.1212/wnl.0000000000002174] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 08/06/2015] [Indexed: 11/20/2022] Open
Abstract
Objective: We aimed to compare the incidence and prevalence of psychiatric comorbidity in the multiple sclerosis (MS) population and in controls matched for age, sex, and geographic area. Methods: Using population-based administrative health data from 4 Canadian provinces, we identified 2 cohorts: 44,452 persons with MS and 220,849 controls matched for age, sex, and geographic area. We applied validated case definitions to estimate the incidence and prevalence of depression, anxiety, bipolar disorder, and schizophrenia from 1995 to 2005. We pooled the results across provinces using meta-analyses. Results: Of the MS cases, 31,757 (71.3%) were women with a mean (SD) age at the index date of 43.8 (13.7) years. In 2005, the annual incidence of depression per 100,000 persons with MS was 979 while the incidence of anxiety was 638, of bipolar disorder was 328, and of schizophrenia was 60. The incidence and prevalence estimates of all conditions were higher in the MS population than in the matched population. Although the incidence of depression was higher among women than men in both populations, the disparity in the incidence rates between the sexes was lower in the MS population (incidence rate ratio 1.26; 95% confidence interval: 1.07–1.49) than in the matched population (incidence rate ratio 1.50; 95% confidence interval: 1.21–1.86). Incidence rates were stable over time while prevalence increased slightly. Conclusions: Psychiatric comorbidity is common in MS, and more frequently affected the MS population than a matched population, although the incidence was stable over time. Men with MS face a disproportionately greater relative burden of depression when they develop MS than women.
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Affiliation(s)
- Ruth Ann Marrie
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., S.L.), University of Manitoba, Winnipeg; Departments of Psychiatry and Medicine (J.D.F.), Dalhousie University, Halifax; Department of Medicine (Neurology) (H.T.), University of British Columbia, Vancouver; Department of Epidemiology and Biostatistics and Occupational Health (C.W.), McGill University, Montreal; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Department of Community Health Sciences (S.B.P.), University of Calgary, Canada.
| | - John D Fisk
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., S.L.), University of Manitoba, Winnipeg; Departments of Psychiatry and Medicine (J.D.F.), Dalhousie University, Halifax; Department of Medicine (Neurology) (H.T.), University of British Columbia, Vancouver; Department of Epidemiology and Biostatistics and Occupational Health (C.W.), McGill University, Montreal; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Department of Community Health Sciences (S.B.P.), University of Calgary, Canada
| | - Helen Tremlett
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., S.L.), University of Manitoba, Winnipeg; Departments of Psychiatry and Medicine (J.D.F.), Dalhousie University, Halifax; Department of Medicine (Neurology) (H.T.), University of British Columbia, Vancouver; Department of Epidemiology and Biostatistics and Occupational Health (C.W.), McGill University, Montreal; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Department of Community Health Sciences (S.B.P.), University of Calgary, Canada
| | - Christina Wolfson
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., S.L.), University of Manitoba, Winnipeg; Departments of Psychiatry and Medicine (J.D.F.), Dalhousie University, Halifax; Department of Medicine (Neurology) (H.T.), University of British Columbia, Vancouver; Department of Epidemiology and Biostatistics and Occupational Health (C.W.), McGill University, Montreal; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Department of Community Health Sciences (S.B.P.), University of Calgary, Canada
| | - Sharon Warren
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., S.L.), University of Manitoba, Winnipeg; Departments of Psychiatry and Medicine (J.D.F.), Dalhousie University, Halifax; Department of Medicine (Neurology) (H.T.), University of British Columbia, Vancouver; Department of Epidemiology and Biostatistics and Occupational Health (C.W.), McGill University, Montreal; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Department of Community Health Sciences (S.B.P.), University of Calgary, Canada
| | - Aruni Tennakoon
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., S.L.), University of Manitoba, Winnipeg; Departments of Psychiatry and Medicine (J.D.F.), Dalhousie University, Halifax; Department of Medicine (Neurology) (H.T.), University of British Columbia, Vancouver; Department of Epidemiology and Biostatistics and Occupational Health (C.W.), McGill University, Montreal; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Department of Community Health Sciences (S.B.P.), University of Calgary, Canada
| | - Stella Leung
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., S.L.), University of Manitoba, Winnipeg; Departments of Psychiatry and Medicine (J.D.F.), Dalhousie University, Halifax; Department of Medicine (Neurology) (H.T.), University of British Columbia, Vancouver; Department of Epidemiology and Biostatistics and Occupational Health (C.W.), McGill University, Montreal; Faculty of Rehabilitation Medicine (S.W.), University of Alberta, Edmonton; and Department of Community Health Sciences (S.B.P.), University of Calgary, Canada
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Al-Asmi A, Al-Rawahi S, Al-Moqbali ZS, Al-Farsi Y, Essa MM, El-Bouri M, Koshy RP, Gujjar AR, Jacob PC, Al-Hodar A, Al Adawi S. Magnitude and concurrence of anxiety and depression among attendees with multiple sclerosis at a tertiary care Hospital in Oman. BMC Neurol 2015; 15:131. [PMID: 26242758 PMCID: PMC4526206 DOI: 10.1186/s12883-015-0370-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 06/30/2015] [Indexed: 11/08/2022] Open
Abstract
Background Anxiety, depression and functional impairments are commonly reported by persons with multiple sclerosis (PwMS) but no data, to our knowledge, has emerged from an Arab Islamic population. The study aims to investigate the prevalence of anxiety, depression and related disabilities among PwMS attending tertiary care in Sultan Qaboos University Hospital (SQUH), one of the urban hospitals in Oman. Methods Consecutive and consenting PwMS (n = 57) and healthy subjects (n = 53) completed the following measures: Hospital Anxiety and Depression Scale (HADS) which was used to measure anxiety (cut-point >7) and depression (>7); and Expanded Disability Status Scale (EDSS) to measure the level of disability (≥5). Characteristics such as socio-demographic and clinical variables were also explored. Results Fifty seven subjects with multiple sclerosis (MS) met the inclusion criteria. The majority of them were females who were 40 years old or younger and the majority were employed and unmarried. Approximately 86 % of the participants were using beta interferon, 96 % scored ≥5 in EDSS. MS of the Relapsing-Remitting type constituted the majority of the cohort (94 %). Approximately 35 % and 51 % endorsed symptoms of anxiety and depression respectively. The MS group scored significantly higher than controls on HADS measurements of depression and anxiety. Conclusion Disability and symptoms of anxiety and depression are common among the PwMS attendees of tertiary care hospital in Oman. Such psychosocial variables have been largely unreported emerging from non-western populations. As these variables are strong indicators of the burden of MS, resolute effort is needed to address such psychosocial dysfunctions in the algorithms of care for PwMS in the Arab Islamic part of the world.
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Affiliation(s)
- Abdullah Al-Asmi
- Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
| | - Salim Al-Rawahi
- Department of Behavioral Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, P.O. Box 35, Al-Khoudh 123, Muscat, Sultanate of Oman.
| | - Zahir Saif Al-Moqbali
- Department of Behavioral Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, P.O. Box 35, Al-Khoudh 123, Muscat, Sultanate of Oman.
| | - Yahya Al-Farsi
- Department of Family Medicine and Public Health, Sultan Qaboos University, College of Medicine and Health Sciences, Muscat, Oman.
| | - Musthafa M Essa
- Department of Food Science and Nutrition, College of Agricultural and Marine Sciences, Sultan Qaboos University, Muscat, Oman.
| | - May El-Bouri
- Department of Behavioral Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, P.O. Box 35, Al-Khoudh 123, Muscat, Sultanate of Oman.
| | - Roopa P Koshy
- Department of Behavioral Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, P.O. Box 35, Al-Khoudh 123, Muscat, Sultanate of Oman.
| | - Arunodaya R Gujjar
- Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
| | - P C Jacob
- Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
| | - Abeer Al-Hodar
- Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
| | - Samir Al Adawi
- Department of Behavioral Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, P.O. Box 35, Al-Khoudh 123, Muscat, Sultanate of Oman.
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Neuropsychological correlates of multiple sclerosis across the lifespan. Mult Scler 2015; 21:1355-64. [DOI: 10.1177/1352458515586088] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 04/13/2015] [Indexed: 11/15/2022]
Abstract
Multiple sclerosis can adversely affect cognitive functioning whether the disease has an adult or pediatric onset. The research thus far suggests that pediatric MS shares many features with adult MS but is also unique in several respects. One particular characteristic of pediatric MS is that, while physical disability develops more slowly as compared with adult patients, the impact of cognitive deficits in children may be more substantial as they are in a period of life during which they acquire many skills that are needed to transition into independently functioning adults. Our review takes a lifespan approach to MS, comparing and contrasting the neuropsychology (i.e., cognitive, psychological, and psychosocial factors) of these two populations. Understanding how MS manifests across the lifespan has important implications for tailoring assessment and treatment for individuals with MS as they transition from childhood to adulthood, and later life.
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Hoang H, Laursen B, Stenager EN, Stenager E. Psychiatric co-morbidity in multiple sclerosis: The risk of depression and anxiety before and after MS diagnosis. Mult Scler 2015; 22:347-53. [PMID: 26041803 DOI: 10.1177/1352458515588973] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 05/06/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studies of depression and anxiety in multiple sclerosis (MS) patients have reported higher rates in MS patients than the general population. OBJECTIVE To estimate the risk of depression and anxiety and the use of tricyclic antidepressant and selective serotonin reuptake inhibitors (SSRI) prescriptions, in the pre-diagnostic and the post-diagnostic period of MS compared to the background population. METHODS A cohort of 5084 MS patients was included and matched with a control population of 24,771 persons linked to nationwide registers. Logistic regression analyses were performed estimating odds ratios (OR). RESULTS In the pre-diagnostic period, the OR for having a diagnosis of depression and anxiety is 1.4 (95% confidence interval (CI) =1.05-1.88), and the OR of redemption prescriptions of TCAs is 1.90 (CI=1.54-2.34) and OR is 1.34 (CI= 1.20-1.51) for SSRI. In the post-diagnostic period the OR is 1.23 (CI= 0.92-1.64) for depression and anxiety diagnosis. The OR is 6.70 (CI=5.81-7.72) for TCA and OR is 2.46 (CI= 2.25-2.69) for SSRI. CONCLUSION During both the pre- diagnostic and post-diagnostic period, MS patient have increased risk of depression and anxiety diagnoses and redemption of antidepressant and anxiolytic prescriptions, compared to the background population.
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Affiliation(s)
- Huong Hoang
- Institute of Regional Health Research. University of Southern Denmark/ MS-clinic (Sønderborg, Esbjerg, Vejle) of Southern Jutland, Department of Neurology, Sønderborg, Denmark. Research Unit of Mental Health, Odense,Åbenrå, Denmark
| | - Bjarne Laursen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Elsebeth N Stenager
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark/ Research Unit of Mental Health, Åbenrå, Odense, Denmark. Åbenrå, Denmark
| | - Egon Stenager
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark/ MS-clinic (Sønderborg, Esbjerg, Vejle) of Southern Jutland, Department of Neurology, Sønderborg, Denmark
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Marrie RA, Cohen J, Stuve O, Trojano M, Sørensen PS, Reingold S, Cutter G, Reider N. A systematic review of the incidence and prevalence of comorbidity in multiple sclerosis: overview. Mult Scler 2015; 21:263-81. [PMID: 25623244 PMCID: PMC4361468 DOI: 10.1177/1352458514564491] [Citation(s) in RCA: 237] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background: Comorbidity is an area of increasing interest in multiple sclerosis (MS). Objective: The objective of this review is to estimate the incidence and prevalence of comorbidity in people with MS and assess the quality of included studies. Methods: We searched the PubMed, SCOPUS, EMBASE and Web of Knowledge databases, conference proceedings, and reference lists of retrieved articles. Two reviewers independently screened abstracts. One reviewer abstracted data using a standardized form and the abstraction was verified by a second reviewer. We assessed study quality using a standardized approach. We quantitatively assessed population-based studies using the I2 statistic, and conducted random-effects meta-analyses. Results: We included 249 articles. Study designs were variable with respect to source populations, case definitions, methods of ascertainment and approaches to reporting findings. Prevalence was reported more frequently than incidence; estimates for prevalence and incidence varied substantially for all conditions. Heterogeneity was high. Conclusion: This review highlights substantial gaps in the epidemiological knowledge of comorbidity in MS worldwide. Little is known about comorbidity in Central or South America, Asia or Africa. Findings in North America and Europe are inconsistent. Future studies should report age-, sex- and ethnicity-specific estimates of incidence and prevalence, and standardize findings to a common population.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, University of Manitoba, Canada/Department of Community Health Sciences, University of Manitoba, Health Sciences Center, Canada
| | - Jeffrey Cohen
- Mellen Center for MS Treatment and Research, Cleveland Clinic, USA
| | - Olaf Stuve
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern, USA
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Italy
| | | | | | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, USA
| | - Nadia Reider
- Department of Internal Medicine, University of Manitoba, Canada
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Marrie RA, Reingold S, Cohen J, Stuve O, Trojano M, Sorensen PS, Cutter G, Reider N. The incidence and prevalence of psychiatric disorders in multiple sclerosis: a systematic review. Mult Scler 2015; 21:305-17. [PMID: 25583845 PMCID: PMC4429164 DOI: 10.1177/1352458514564487] [Citation(s) in RCA: 310] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Psychiatric comorbidity is associated with lower quality of life, more fatigue, and reduced adherence to disease-modifying therapy in multiple sclerosis (MS). OBJECTIVES The objectives of this review are to estimate the incidence and prevalence of selected comorbid psychiatric disorders in MS and evaluate the quality of included studies. METHODS We searched the PubMed, PsychInfo, SCOPUS, and Web of Knowledge databases and reference lists of retrieved articles. Abstracts were screened for relevance by two independent reviewers, followed by full-text review. Data were abstracted by one reviewer, and verified by a second reviewer. Study quality was evaluated using a standardized tool. For population-based studies we assessed heterogeneity quantitatively using the I² statistic, and conducted meta-analyses. RESULTS We included 118 studies in this review. Among population-based studies, the prevalence of anxiety was 21.9% (95% CI: 8.76%-35.0%), while it was 14.8% for alcohol abuse, 5.83% for bipolar disorder, 23.7% (95% CI: 17.4%-30.0%) for depression, 2.5% for substance abuse, and 4.3% (95% CI: 0%-10.3%) for psychosis. CONCLUSION This review confirms that psychiatric comorbidity, particularly depression and anxiety, is common in MS. However, the incidence of psychiatric comorbidity remains understudied. Future comparisons across studies would be enhanced by developing a consistent approach to measuring psychiatric comorbidity, and reporting of age-, sex-, and ethnicity-specific estimates.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, University of Manitoba, Canada/Department of Community Health Sciences, University of Manitoba, Canada
| | | | - Jeffrey Cohen
- Mellen Center for MS Treatment and Research, Cleveland Clinic, USA
| | - Olaf Stuve
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern, USA
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Italy
| | | | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, USA
| | - Nadia Reider
- Department of Community Health Sciences, University of Manitoba, Canada
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Patten SB, Williams JVA, Lavorato DH, Koch M, Metz LM. Depression as a predictor of occupational transition in a multiple sclerosis cohort. FUNCTIONAL NEUROLOGY 2014; 28:275-80. [PMID: 24598395 DOI: 10.11138/fneur/2013.28.4.275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In MS, transitions between working and not-working status may occur in association with depression. This can complicate patients' ability to promptly obtain disability support due to an expectation that their functioning will improve after the depression resolves, a viewpoint that sees depression assuming a role as a causal determinant of disability. In this study, prospective data were used to model the relationship between depressive symptoms and the transition out of employment. In unadjusted analyses, depression increased the risk of transition to non-working status, HR = 1.7 (95%CI 1.3-2.3). Adjustments for ambulation status, physical and mental quality of life composite scores and fatigue impact attenuated or eliminated the association. While depression commonly occurs around the time of occupational transitions in MS, it does not appear to be an independent or direct cause of such transitions.
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Brenner P, Alexanderson K, Björkenstam C, Hillert J, Jokinen J, Mittendorfer-Rutz E, Tinghög P. Psychiatric diagnoses, medication and risk for disability pension in multiple sclerosis patients; a population-based register study. PLoS One 2014; 9:e104165. [PMID: 25093730 PMCID: PMC4122497 DOI: 10.1371/journal.pone.0104165] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 07/04/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Psychiatric comorbidity is common among multiple sclerosis (MS) patients. The majority of MS patients of working ages are on disability pension. The aims of this study were to chart the prevalences of psychiatric diagnoses and medications among MS patients of working ages, and to investigate their association with the risk for future disability pension. METHODS This nationwide, population-based prospective cohort study includes 10,750 MS patients and 5,553,141 non-MS individuals who in 2005 were aged 17-64 years. Psychiatric diagnoses and medications were identified using nationwide registers. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated adjusting for socio-demographics. Furthermore, a survival analysis with five-year follow-up was performed among the 4,571 MS patients not on disability pension in 2005, with psychiatric diagnoses and medication as risk factors, and disability pension as the outcome. RESULTS Among MS patients, 35% had been prescribed psychiatric medication compared to 10% of non-MS individuals, adjusted OR 3.72 (95% CI 3.57 to 3.88). Ten percent of MS patients had received a psychiatric diagnosis, compared to 5.7% of non-MS individuals, OR 1.82 (95% CI 1.71 to 1.94). Serotonin reuptake inhibitors (SSRIs), were the most commonly prescribed drugs (17%) among MS patients, while depression (4.8%) was the most common psychiatric diagnosis. In the survival analysis, MS patients with any psychiatric diagnosis had a hazard ratio (HR) of 1.83 (95% CI 1.53 to 2.18) for disability pension compared to other MS patients. MS patients with any psychiatric drug prescription had a HR for disability pension of 2.09 (95% CI 1.84 to 2.33). CONCLUSION Psychiatric diagnoses and medications are common among MS patients and adversely affect risk for disability pension. This highlights the importance of correct diagnosis and management of psychiatric comorbidity, in a clinical as well as in a societal perspective.
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Affiliation(s)
- Philip Brenner
- Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Kristina Alexanderson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Charlotte Björkenstam
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jan Hillert
- Division of Neuro, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Jussi Jokinen
- Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Petter Tinghög
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Wang J, Qiao J, Zhang Y, Wang H, Zhu S, Zhang H, Hartle K, Guo H, Guo W, He J, Kong J, Huang Q, Li XM. Desvenlafaxine prevents white matter injury and improves the decreased phosphorylation of the rate-limiting enzyme of cholesterol synthesis in a chronic mouse model of depression. J Neurochem 2014; 131:229-38. [PMID: 24934403 DOI: 10.1111/jnc.12792] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 06/11/2014] [Accepted: 06/12/2014] [Indexed: 01/07/2023]
Abstract
Serotonin/norepinephrine reuptake inhibitors antidepressants exert their effects by increasing serotonin and norepinephrine in the synaptic cleft. Studies show it takes 2-3 weeks for the mood-enhancing effects, which indicate other mechanisms may underlie their treatment effects. Here, we investigated the role of white matter in treatment and pathogenesis of depression using an unpredictable chronic mild stress (UCMS) mouse model. Desvenlafaxine (DVS) was orally administrated to UCMS mice at the dose of 10 mg/kg/day 1 week before they went through a 7-week stress procedure and lasted for over 8 weeks before the mice were killed. No significant changes were found for protein markers of neurons and astrocytes in UCMS mice. However, myelin and oligodendrocyte-related proteins were significantly reduced in UCMS mice. DVS prevented the stress-induced injury to white matter and the decrease of phosphorylated 5'-AMP-activated protein kinase and 3-hydroxy-3-methyl-glutaryl-CoA reductase protein expression. DVS increased open arm entries in an elevated plus-maze test, sucrose consumption in the sucrose preference test and decreased immobility in tail suspension and forced swimming tests. These findings suggest that stress induces depression-like behaviors and white matter deficits in UCMS mice. DVS may ameliorate the oligodendrocyte dysfunction by affecting cholesterol synthesis, alleviating the depression-like phenotypes in these mice. We examined the possible role of oligodendrocyte and myelin in the pathological changes of depression with an unpredictable chronic mild stress (UCMS) mouse model. Oligodendrocyte-related proteins in the mouse brain were specifically changed during the stress period. The depressive-like behaviors and oligodendrocyte deficits could be prevented by the administration of desvenlafaxine. Oligodendrocyte and myelin may be an essential target of desvenlafaxine for the treatment of depression.
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Affiliation(s)
- Junhui Wang
- Mental Health Center, Shantou University, Shantou, Guangdong, China.,Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Jinping Qiao
- Mental Health Center, Shantou University, Shantou, Guangdong, China.,Clinical Laboratory, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.,Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Yanbo Zhang
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Hongxing Wang
- Department of Clinical Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Shenghua Zhu
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Handi Zhang
- Mental Health Center, Shantou University, Shantou, Guangdong, China
| | - Kelly Hartle
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Huining Guo
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Wei Guo
- Department of Clinical Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Jue He
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Jiming Kong
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Qingjun Huang
- Mental Health Center, Shantou University, Shantou, Guangdong, China
| | - Xin-Min Li
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Abstract
AbstractA questionnaire containing the Multidimensional Health Locus of Control scale, a focus of coping scale, the Centre for Epidemiological Studies Depression scale, and the Hopelessness scale was posted to 50 male and 50 female Dublin members of the Multiple Sclerosis Society of Ireland. The aim of the study was to examine ways in which people with multiple sclerosis cope with their illness, and to determine whether the coping strategies used were effective or ineffective in terms of the relations between the scales that were used. Sex differences on each of the scales were also examined. Results indicated that there were some sex differences on the locus of control scale. However, no sex differences were found on the focus of coping, or on the depression and hopelessness scales. Rather, both sexes were found to have mean depression and hopelessness scores above what is considered to be the norm for both of these scales.
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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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Prevalence and risk factors for suicidal ideation in a multiple sclerosis population. J Psychosom Res 2014; 76:312-6. [PMID: 24630182 DOI: 10.1016/j.jpsychores.2013.12.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 12/21/2013] [Accepted: 12/23/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To estimate the prevalence, incidence and determinants of suicidal ideation in the multiple sclerosis (MS) population. METHODS A sample of 188 subjects were randomly selected from a community-based MS clinic registry and participated in as many as 13 interviews over 6 months. Thoughts of "being better off dead" or of "harming oneself" were assessed using item 9 on the Patient Health Questionnaire, Brief (PHQ-9). RESULTS At baseline, the 2-week period prevalence of suicidal ideation was 8.3%. Over the course of 6 months, 22.1% of respondents reported having such thoughts at least once. Survival analysis incorporating baseline PHQ-8 scores as a covariate confirmed that being age 65 and over (HR=4.3, 95% CI 1.7-11.3) and having lower quartile self-efficacy ratings (HR=3.5, 95% CI 1.5-8.2) predicted suicidal ideation. Lower levels of task-oriented coping (treated as a continuous variable) also predicted suicidal ideation after adjustment for depressive symptoms (p=0.015), as did self-reported bladder or bowel symptoms (HR=2.6, 95% CI 1.1-6.0) and difficulties with speaking and swallowing (HR=2.9, 95% CI 1.3-6.8). Associations with MS symptoms were not confounded by depressive symptoms. CONCLUSION This study identified several potentially modifiable factors that may be useful for preventing suicide in people with MS.
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McNamara RK, Rider T, Jandacek R, Tso P. Abnormal fatty acid pattern in the superior temporal gyrus distinguishes bipolar disorder from major depression and schizophrenia and resembles multiple sclerosis. Psychiatry Res 2014; 215:560-7. [PMID: 24439517 PMCID: PMC3949121 DOI: 10.1016/j.psychres.2013.12.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 11/08/2013] [Accepted: 12/14/2013] [Indexed: 12/20/2022]
Abstract
This study investigated the fatty acid composition of the postmortem superior temporal gyrus (STG), a cortical region implicated in emotional processing, from normal controls (n=15) and patients with bipolar disorder (BD, n=15), major depressive disorder (MDD, n=15), and schizophrenia (SZ, n=15). For comparative purposes, STG fatty acid composition was determined in a separate cohort of multiple sclerosis patients (MS, n=15) and normal controls (n=15). Compared with controls, patients with BD, but not MDD or SZ, exhibited abnormal elevations in the saturated fatty acids (SFA) palmitic acid (16:0), stearic acid (18:0), the polyunsaturated fatty acids (PUFA) linoleic acid (18:2n-6), arachidonic acid (20:4n-6), and docosahexaenoic acid (22:6n-3), and reductions in the monounsaturated fatty acid (MUFA) oleic acid (18:1n-9). The total MUFA/SFA and 18:1/18:0 ratios were lower in the STG of BD patients and were inversely correlated with total PUFA composition. MS patients exhibited a pattern of fatty acid abnormalities similar to that observed in BD patients including elevated PUFA and a lower 18:1/18:0 ratio. Collectively, these data demonstrate that BD patients exhibit a pattern of fatty acid abnormalities in the STG that is not observed in MDD and SZ patients and closely resembles MS patients.
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Affiliation(s)
- Robert K. McNamara
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH 45267
,Department of Psychiatry and Behavioral Neuroscience University of Cincinnati College of Medicine 260 Stetson Street Cincinnati, OH 45219-0516 PH: 513-558-5601 FAX: 513-558-4805
| | - Therese Rider
- Department of Pathology, University of Cincinnati, Cincinnati OH 45237
| | - Ronald Jandacek
- Department of Pathology, University of Cincinnati, Cincinnati OH 45237
| | - Patrick Tso
- Department of Pathology, University of Cincinnati, Cincinnati OH 45237
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Bipolar disorder and multiple sclerosis: a case series. Behav Neurol 2014; 2014:536503. [PMID: 24825960 PMCID: PMC4006599 DOI: 10.1155/2014/536503] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 07/21/2013] [Indexed: 11/26/2022] Open
Abstract
Background. The prevalence of psychiatric disturbance for patients with multiple sclerosis (MS) is higher than that observed in other chronic health conditions. We report three cases of MS and bipolar disorder and we discuss the possible etiological hypothesis and treatment options. Observations. All patients fulfilled the McDonald criteria for MS. Two patients were followed up in psychiatry for manic or depressive symptoms before developing MS. A third patient was diagnosed with MS and developed deferred psychotic symptoms. Some clinical and radiological features are highlighted in our patients: one manic episode induced by high dose corticosteroids and one case of a new orbitofrontal MRI lesion concomitant with the emergence of psychiatric symptoms. All patients needed antipsychotic treatment with almost good tolerance for high dose corticosteroids and interferon beta treatment. Conclusions. MRI lesions suggest the possible implication of local MS-related brain damage in development of pure “psychiatric fits” in MS. Genetic susceptibility is another hypothesis for this association. We have noticed that interferon beta treatments were well tolerated while high dose corticosteroids may induce manic fits.
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Kister I, Bacon TE, Chamot E, Salter AR, Cutter GR, Kalina JT, Herbert J. Natural history of multiple sclerosis symptoms. Int J MS Care 2014; 15:146-58. [PMID: 24453777 DOI: 10.7224/1537-2073.2012-053] [Citation(s) in RCA: 251] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The North American Research Committee on Multiple Sclerosis (NARCOMS) Registry is a database that contains information from over 35,000 patient volunteers on symptom severity in 11 domains commonly affected in multiple sclerosis (MS): mobility, hand function, vision, fatigue, cognition, bowel/bladder function, sensory, spasticity, pain, depression, and tremor/coordination. The Registry affords a unique opportunity to study the frequency and severity of domain-specific impairment in a contemporary, mostly treated MS cohort over the course of the disease. The objective of this work was to calculate symptom prevalence in each of the 11 domains for years 0 to 30 from symptom onset. The resulting "symptom prevalence tables" demonstrate that a majority of participants perceive at least some degree of impairment in most domains as early as the first year of disease. The severity of impairment increases with disease duration across all domains, but the patterns of disability accumulation differ. The symptom prevalence tables illustrate the magnitude of perceived impact of the disease and highlight the extent of unmet need in symptomatic management. The tables are easy to use and allow MS patients and their clinicians to compare an individual's own impairment in any of the 11 domains to that of NARCOMS participants with the same disease duration.
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Affiliation(s)
- Ilya Kister
- NYU Multiple Sclerosis Care Center, Department of Neurology, NYU School of Medicine, New York, NY, USA (IK, TEB, JTK, JH); and the Departments of Epidemiology (EC) and Biostatistics (ARS, GRC), University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Tamar E Bacon
- NYU Multiple Sclerosis Care Center, Department of Neurology, NYU School of Medicine, New York, NY, USA (IK, TEB, JTK, JH); and the Departments of Epidemiology (EC) and Biostatistics (ARS, GRC), University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Eric Chamot
- NYU Multiple Sclerosis Care Center, Department of Neurology, NYU School of Medicine, New York, NY, USA (IK, TEB, JTK, JH); and the Departments of Epidemiology (EC) and Biostatistics (ARS, GRC), University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Amber R Salter
- NYU Multiple Sclerosis Care Center, Department of Neurology, NYU School of Medicine, New York, NY, USA (IK, TEB, JTK, JH); and the Departments of Epidemiology (EC) and Biostatistics (ARS, GRC), University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Gary R Cutter
- NYU Multiple Sclerosis Care Center, Department of Neurology, NYU School of Medicine, New York, NY, USA (IK, TEB, JTK, JH); and the Departments of Epidemiology (EC) and Biostatistics (ARS, GRC), University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Jennifer T Kalina
- NYU Multiple Sclerosis Care Center, Department of Neurology, NYU School of Medicine, New York, NY, USA (IK, TEB, JTK, JH); and the Departments of Epidemiology (EC) and Biostatistics (ARS, GRC), University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Joseph Herbert
- NYU Multiple Sclerosis Care Center, Department of Neurology, NYU School of Medicine, New York, NY, USA (IK, TEB, JTK, JH); and the Departments of Epidemiology (EC) and Biostatistics (ARS, GRC), University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
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Toosy A, Ciccarelli O, Thompson A. Symptomatic treatment and management of multiple sclerosis. HANDBOOK OF CLINICAL NEUROLOGY 2014; 122:513-562. [PMID: 24507534 DOI: 10.1016/b978-0-444-52001-2.00023-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The range of symptoms which occur in multiple sclerosis (MS) can have disabling functional consequences for patients and lead to significant reductions in their quality of life. MS symptoms can also interact with each other, making their management challenging. Clinical trials aimed at identifying symptomatic therapies have generally been poorly designed and have tended to be underpowered. Therefore, the evidence base for the management of MS symptoms with pharmacologic therapies is not strong and tends to rely upon open-label studies, case reports, and clinical trials with small numbers of patients and poorly validated clinical outcome measures. Recently, there has been a growing interest in the management of MS symptoms with pharmacologic treatments, and better-designed, randomized, double-blind, controlled trials have been reported. This chapter will describe the evidence base predominantly behind the various pharmacologic approaches to the management of MS symptoms, which in most, if not all, cases, requires multidisciplinary input. Drugs routinely recommended for individual symptoms and new therapies, which are currently in the development pipeline, will be reviewed. More interventional therapies related to symptoms that are refractory to pharmacotherapy will also be discussed, where relevant.
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Affiliation(s)
- Ahmed Toosy
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, London, UK
| | - Olga Ciccarelli
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, London, UK
| | - Alan Thompson
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, London, UK.
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Minden SL, Feinstein A, Kalb RC, Miller D, Mohr DC, Patten SB, Bever C, Schiffer RB, Gronseth GS, Narayanaswami P. Evidence-based guideline: assessment and management of psychiatric disorders in individuals with MS: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 2013; 82:174-81. [PMID: 24376275 DOI: 10.1212/wnl.0000000000000013] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To make evidence-based recommendations for screening, diagnosing, and treating psychiatric disorders in individuals with multiple sclerosis (MS). METHODS We reviewed the literature (1950 to August 2011) and evaluated the available evidence. RESULTS AND RECOMMENDATIONS Clinicians may consider using the Center for Neurologic Study Emotional Lability Scale to screen for pseudobulbar affect (Level C). Clinicians may consider the Beck Depression Inventory and a 2-question tool to screen for depressive disorders and the General Health Questionnaire to screen for broadly defined emotional disturbances (Level C). Evidence is insufficient to support/refute the use of other screening tools, the possibility that somatic/neurovegetative symptoms affect these tools' accuracy, or the use of diagnostic instruments or clinical evaluation procedures for identifying psychiatric disorders in MS (Level U). Clinicians may consider a telephone-administered cognitive behavioral therapy program for treating depressive symptoms (Level C). Although pharmacologic and nonpharmacologic therapies are widely used to treat depressive and anxiety disorders in individuals with MS, evidence is insufficient to support/refute the use of the antidepressants and individual and group therapies reviewed herein (Level U). For pseudobulbar affect, a combination of dextromethorphan and quinidine may be considered (Level C). Evidence is insufficient to determine the psychiatric effects in individuals with MS of disease-modifying and symptomatic therapies and corticosteroids; risk factors for suicide; and treatment of psychotic disorders (Level U). Research is needed on the effectiveness in individuals with MS of pharmacologic and nonpharmacologic treatments frequently used in the non-MS population.
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Affiliation(s)
- Sarah L Minden
- From the Department of Psychiatry, Brigham and Women's Hospital (S.L.M.), and Department of Neurology, Beth Israel Deaconess Medical Center (P.N.), Harvard Medical School, Boston, MA; Department of Psychiatry (A.F.), University of Toronto, Canada; National Multiple Sclerosis Society (R.C.K.), New York; Mellen Center (D.M.), Cleveland Clinic, OH; Department of Preventive Medicine (D.C.M.), Northwestern University, Evanston, IL; Department of Community Health Sciences & Hotchkiss Brain Institute (S.B.P.), University of Calgary, Canada; VA Maryland Health Care System (C.B.), Baltimore, MD; Santa Fe, NM (R.B.S.); and Department of Neurology (G.S.G.), University of Kansas Medical Center, Kansas City
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Lichtblau N, Schmidt FM, Schumann R, Kirkby KC, Himmerich H. Cytokines as biomarkers in depressive disorder: current standing and prospects. Int Rev Psychiatry 2013; 25:592-603. [PMID: 24151804 DOI: 10.3109/09540261.2013.813442] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The frequently observed co-occurrence of depressive disorders and inflammatory diseases suggests a close connection between the nervous and the immune systems. Increased pro-inflammatory and type 1 cytokines, such as interleukin (IL)-1, tumour necrosis factor (TNF)-α and interferon (IFN)-γ, appear to be an important link. Cytokines are synthesized by immune cells in the blood and peripheral tissues and by glial cells in the central nervous system (CNS). Evidence suggests that the blood-brain barrier (BBB) is permeable to cytokines and immune cells, and that afferent nerves, e.g. the vagus nerve, mediate the communication between peripheral inflammatory processes and CNS. Cytokines such as IL-1ß, TNF-α and IFN-γ seem to contribute to the pathophysiology of depression by activating monoamine reuptake, stimulating the hypothalamic-pituitary-adrenocortical (HPA) axis and decreasing production of serotonin due to increased activity of indolamine-2,3-dioxygenase (IDO). However, critical appraisal of these hypotheses is required, because cytokine elevation is not specific to depression. Moreover, several effective antidepressants such as amitriptyline and mirtazapine have been shown to increase cytokine production. When applying immunomodulatory therapies, these drugs may increase the risk of specific side effects such as infections or interact with antidepressant drugs on important functions of the body such as the coagulation system.
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Affiliation(s)
- Nicole Lichtblau
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig , Leipzig Germany
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Zhornitsky S, Wee Yong V, Koch MW, Mackie A, Potvin S, Patten SB, Metz LM. Quetiapine fumarate for the treatment of multiple sclerosis: focus on myelin repair. CNS Neurosci Ther 2013; 19:737-44. [PMID: 23870612 DOI: 10.1111/cns.12154] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Revised: 06/20/2013] [Accepted: 06/26/2013] [Indexed: 02/03/2023] Open
Abstract
Multiple sclerosis (MS) is a central nervous system disorder that is associated with progressive oligodendrocyte and neuronal loss, axonal degeneration, and demyelination. Several medications that mitigate immune abnormalities reduce both the frequency of relapses and inflammation on magnetic resonance imaging, leading to improved outcomes for people with the relapsing-remitting form of MS. However, there are no treatments for the progressive forms of MS where neurons and axons continue to degenerate; here, neuroprotective therapies, or medications that rebuild myelin to confer axonal well-being, may be useful. Quetiapine fumarate is an atypical antipsychotic with reported remyelinating and neuroprotective properties in inflammatory and noninflammatory models of demyelination, including experimental autoimmune encephalomyelitis, and both cuprizone- and global cerebral ischemia-induced demyelination. Preclinical studies suggest that quetiapine may exert these effects by stimulating proliferation and maturation of oligodendrocytes, releasing neurotrophic factors, increasing antioxidant defences, scavenging for free radicals, and inhibiting activated microglia, astrocytes, and T lymphocytes. Additionally, quetiapine may be beneficial for psychiatric and nonpsychiatric symptoms of MS including depression, anxiety, insomnia, and possibly even pain. These data indicate that clinical trials are justified to determine the safety, tolerability, and efficacy of quetiapine fumarate in MS.
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Affiliation(s)
- Simon Zhornitsky
- Department of Clinical Neurosciences, Faculty of Medicine, Foothills Medical Centre, Calgary MS Clinic, University of Calgary, Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
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50
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Stepleman LM, Decker M, Rollock M, Casillas R, Brands T. Depression screening in Black Americans with multiple sclerosis. PSYCHOL HEALTH MED 2013; 19:33-9. [DOI: 10.1080/13548506.2013.775466] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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