Évènements psychotiques inauguraux de sclérose en plaques ?

Psychoses onset in multiple sclerosis: A systematic review and meta-analysis

BACKGROUND

Psychotic symptoms in multiple sclerosis (MS) have been infrequently studied, despite the existence of numerous case reports showing inconsistent findings. Our aim was to assess the timing of psychosis onset and examine its characteristics in MS cases.

MATERIAL AND METHODS

We conducted a systematic review and meta-analysis according to PRISMA 2020. We searched for case reports and case series of psychosis in MS on MEDLINE through PubMed, Google Scholar, Web of Science, and Cochrane. SPSS 26 was used to perform the data analysis.

RESULTS

Overall, 43 cases were reviewed. Bipolar disorder and schizophrenia (SCZ) were the most frequently observed types. Psychosis was often present before or at the time of MS diagnosis. For patients with prior psychosis before MS diagnosis, those with SCZ were less likely to develop neurologic symptoms compared to those with other psychosis types. Polymorphic delusions were significantly associated with psychosis onset either after or concurrently with MS. Extensive periventricular white matter lesions, cerebellar peduncles, and cerebellar lesions were significantly associated with the onset of psychosis following MS diagnosis. Resistant-treatment psychosis occurred in 59.4% of cases. A favorable outcome was significantly more common in patients with relapsing-remitting MS compared to those with other forms of MS.

CONCLUSION

Our study highlights the importance of considering MS in patients with psychoses, especially those with SCZ or treatment-resistant psychosis. Some white matter lesions may trigger psychosis after MS diagnosis. While managing psychosis in MS can be challenging, MS-specific treatments have proven effective.

Neuropsychological profile of a patient with multiple sclerosis and psychiatric symptoms that masked and delayed the diagnosis. A case report using teleneuropsychology

Objective: Multiple sclerosis (MS) may include not only severe neurological signs and symptoms, but also cognitive and psychiatric disturbances. When psychiatric symptoms precede or are comorbid with MS, it poses a clinical challenge, because it may lead to a mistaken diagnosis of MS as a psychiatric disorder, delaying proper treatment. We describe the neuropsychological profile of a female patient with MS whose diagnosis was delayed due to neuropsychiatric symptoms. Method: A comprehensive analysis of the medical history and the results of a teleneuropsychological assessment of a 36-year-old Mexican woman with a diagnosis of relapsing--remitting MS (RRMS) was performed. Results: The patient indicates a long history of psychotic, anxious, and depressive features years before the first neurological symptom that led to MS going unnoticed for several years. Language, attentional, perceptual, motor, and learning skills were found to be preserved. Short-term memory and spatial orientation problems were identified, with decreased processing speed and executive dysfunction, including working memory and planning deficits. Conclusions: The patient has a non-typical presentation of neuropsychological alterations with cognitive and behavioral symptoms that resemble dorsolateral frontal lobe syndrome. This case study highlights the importance of considering MS in differential diagnosis of patients with psychiatric symptoms, even in the absence of obvious neurological signs.

Brain anomalies in early psychosis: From secondary to primary psychosis

Brain anomalies are frequently found in early psychoses. Although they may remain undetected for many years, their interpretation is critical for differential diagnosis. In secondary psychoses, their identification may allow specific management. They may also shed light on various pathophysiological aspects of primary psychoses. Here we reviewed cases of secondary psychoses associated with brain anomalies, reported over a 20-year period in adolescents and young adults aged 13-30 years old. We considered age at first psychotic symptoms, relevant medical history, the nature of psychiatric symptoms, clinical red flags, the nature of the brain anomaly reported, and the underlying disease. We discuss the relevance of each brain area in light of normal brain function, recent case-control studies, and postulated pathophysiology. We show that anomalies in all regions, whether diffuse, multifocal, or highly localized, may lead to psychosis, without necessarily being associated with non-psychiatric symptoms. This underlines the interest of neuroimaging in the initial workup, and supports the hypothesis of psychosis as a global network dysfunction that involves many different regions.

Emotional experience is increased and emotion recognition decreased in multiple sclerosis

Emotional disorders in multiple sclerosis (MS) are frequently described as difficulties in recognizing facial expressions, rarely in the experience dimension. Moreover, interaction between emotional disorders and cognitive or psychological disorders remains little documented. The aim of this study is to explore emotions in MS in emotion recognition and emotional experience and compare these data with cognitive, psychological, and disease aspects. Twenty-five women with MS (MS group) and 27 healthy controls (control group) matched for age, sex, and education were assessed for emotion recognition (Florida Affect Battery) and emotional experience (International Affective Picture System Photographs). Participants were also assessed for cognitive and psychological aspects. Compared to the control group, the MS group had more difficulty in recognizing emotions, and their subjective evaluations when presented IAPS pictures were more scattered, globally increased. Emotional dimensions were each correlated with executive functions but neither correlated with alexithymia, depression, anxiety, or MS characteristics. In conclusion, MS patients present difficulties in identifying emotion and their emotional experience appears to be increased. These disorders are correlated with cognition but remain independent of psychological or disease aspects. Considering the implications that emotional disorders may have, it seems essential to take these aspects into account in clinical practice.

Manic episode in patient with bipolar disorder and recent multiple sclerosis diagnosis: A case report

INTRODUCTION/RATIONALE

Multiple sclerosis (MS) is associated with a higher prevalence of mood and psychiatric disorders, such as bipolar disorder (BD). While mania is most often associated with BD, MS can also induce manic symptoms. However, it is crucial to distinguish which condition is causing mania since medical management is different based on its etiology. Herein, we report a case of a manic episode in a middle-aged female with a prolonged history of BD who received a recent diagnosis of MS 1 year ago.

PATIENT CONCERNS

A 56-year-old female presented with an episode of mania and psychosis while receiving a phenobarbital taper for chronic lorazepam use. She had a prolonged history of bipolar type 1 disorder and depression. She showed optic neuritis and was diagnosed with MS a year prior.

DIAGNOSES

The patient was diagnosed with BD-induced mania based on the absence of increased demyelination compared to previous MRI and lack of new focal or lateralizing neurologic findings of MS.

INTERVENTIONS

Lithium was given for mood stabilization and decreased dosage of prior antidepressant medication. Risperidone was given for ongoing delusions.

OUTCOMES

After 8 days of hospitalization, patient's mania improved but demonstrated atypical features and ongoing delusions. She was discharged at her request to continue treatment in an outpatient setting.

CONCLUSION/LESSON

In BD patients with an episode of mania, MS should be included in the differential, since both conditions can cause manic symptoms. The origin of mania should be delineated through a detailed neurological exam, neuroimaging, and thorough patient-family psychiatric history for appropriate clinical treatment.

Psychiatric event in multiple sclerosis: could it be the tip of the iceberg?

Multiple sclerosis (MS) is a chronic progressive inflammatory disease of the central nervous system. Psychiatric comorbidities are highly prevalent in patients with MS, and can have drastic impact on quality of life and interpersonal relationships. Despite this high prevalence, whether psychiatric manifestations may represent the first signs of MS is still debatable. This constitutes an important issue, since early diagnosis of "psychiatric-onset MS" would result in prompt management, which usually ameliorates long-term prognosis. Here, we discuss clinical and radiological hints that suggest a diagnosis of psychiatric-onset MS. Briefly, this entity should be considered in healthy patients presenting with late-onset psychiatric symptoms, with or without cognitive decline, and with negative family history of psychiatric diseases. A thorough neurological exam is crucial to detect any subtle neurological signs. Brain magnetic resonance imaging is recommended to rule out frontotemporal lesions that might explain the clinical picture. Poor response to standard psychiatric treatments provides additional evidence for the diagnosis of an organic disease (e.g., MS). Combining psychopharmaceuticals with intravenous corticosteroids would result in good outcomes, but patients should be monitored carefully for possible psychiatric exacerbation, a common side effect of steroids.

Should a psychotic or manic episode be considered an early manifestation of Multiple Sclerosis? A multiple case study

BACKGROUND

Early manifestations of Multiple Sclerosis (MS) can be atypical and misleading, and several case report studies have highlighted that MS onset sometimes takes the form of a psychotic or manic episode.

METHODS

All neurologists belonging to the French Multiple Sclerosis Observatory network were contacted by email and were asked to find patients with MS who presented with a history of psychiatric episode(s) near MS onset.

RESULTS

Seventeen patients were selected that met the criteria of presenting with psychotic or manic symptoms either before the diagnosis of MS (N=8), or at the time of the first neurological episode or shortly after (N=9). Patients with a history of a psychiatric episode occurring before the first neurological episode were diagnosed on average 7 years later than patients with either a first neurological or a mixed (both neurological and psychiatric) episode. However, psychiatric symptoms in the first group and the first neurological symptoms of MS in the second group occurred at a similar age.

CONCLUSION

Based on this multiple case study, we question whether past psychotic or manic episode should be considered equivalent to a first manifestation of MS.

A manic episode with psychotic features improved by methylprednisolone in a patient with multiple sclerosis

Several studies have reported a higher prevalence of unipolar depression and bipolar disorder among patients with multiple sclerosis (MS). However, only a few studies have reported manic episodes concomitant with new lesions enhanced by gadolinium on brain magnetic resonance imaging (MRI). Here we report the case of a 47-year-old woman suffering from MS admitted for a manic episode with psychotic features. Brain MRI revealed three new T2 lesions enhanced by gadolinium located in the corpus callosum and in ventromedial prefrontal regions. She rapidly recovered with intravenous methylprednisolone in combination with risperidone. In conclusion, in this patient, the fact that gadolinium-enhancing lesion coincided with new symptoms which responded quickly to corticosteroids suggests that the manic episode was an acute manifestation of MS.

Psychiatric disorders revealing multiple sclerosis after 20 years of evolvement

Previous research indicates that the onset of psychiatric disorders is sometimes associated with multiple sclerosis (MS) evolving several years later. However, information on why this might occur, and on the outcomes of such patients, is still lacking. We aim to discuss these limitations with the current paper. We describe a 51-year-old female who demonstrated severe anxiety disorder and depression years before developing MS neurological symptoms. The patient was treated for these psychiatric disorders over 20 years. In the last 3 years of her treatment, the patient demonstrated a choreic-type of movement disorder in all her limbs. This disorder is consistent with relapsing-remitting MS. Clinical and magnetic resonance imaging (MRI) examinations demonstrated aspects of MS, without MS being diagnosed conclusively. The visual evoked potential indicated a diagnosis of conduction abnormalities. The established diagnosis was slow relapsing MS. The patient underwent methylprednisolone bolus (1 g/day). This case-study suggests that health professionals should conduct a full neurological assessment when they find atypical psychiatric symptoms in a patient. This would make sure that patients receive a better standard of care, and thus experience a better quality of life.

Bipolar disorder and multiple sclerosis: a case series

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.

[Neuropsychiatric manifestations in multiple sclerosis (MS): Might psychotic symptoms signal the onset of the disease?]

Patients suffering from multiple sclerosis (MS) can often dysplay psychiatric symptoms throughout the disease. The frequency of those symptoms could be two or three times greater in MS patients compared to the general population. Psychotic symptoms could be an early sign of MS. At first, neurological symptoms can either be mild or altogether absent. MRI brain scans show cerebral lesions in frontal and temporal regions. New MRI sequencing techniques support the hypothesis that disseminated defects in the grey matter occur in MS. These defects could in turn be responsible for cognitive disorders. Patients presenting a first-episode psychosis must have a neurological examination. MS should be considered as an alternative diagnosis of psychosis, particularly in atypical cases where family history of psychosis is absent and where there is bad response to standard psychotropic treatment. Collaboration between neurologists and psychiatrists whilst caring for patients displaying neuropsychiatric manifestations of MS is crucial to enable more accurate diagnoses and try to improve treatment and overall prognosis.