1
|
Carvalho T, Sousa-Mendes A, Benedito L, Gomes C, da Motta C. A Self-Reported Study on Explanatory Variables of Stress in Multiple Sclerosis Patients: Exploring the Effect of Physical Conditions and Emotion Regulation Processes. Clin Psychol Psychother 2024; 31:e2992. [PMID: 38706169 DOI: 10.1002/cpp.2992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Multiple sclerosis (MS)-linked stress is frequent, multidetermined and facilitates the onset/exacerbation of MS. However, few explanatory models of stress analysed the joint explanatory effect of emotion regulation and clinical outcomes of MS in those patients. OBJECTIVE This study explored whether self-reported MS-related conditions (number of relapses, fatigue and global disability) and specific emotion regulation processes (experiential avoidance and self-compassion) explain stress symptoms in MS patients. METHODS The MS sample comprised 101 patients with MS diagnosis receiving treatment in hospitals and recruited through the Portuguese MS Society. The no-MS sample included 134 age-, sex- and years of education-matched adults without MS recruited from the general Portuguese population. Both samples did not report other neurological disorders. Data were collected using self-response measures. RESULTS All potential explanatory variables differed significantly between samples, with higher scores found in MS patients. In MS clinical sample, those variables and years of education correlated with stress symptoms and predicted stress symptoms in simple linear regression models. These results allowed their selection as covariates in a multiple linear regression model. Years of education, the number of relapses, fatigue and experiential avoidance significantly predicted 51% of stress symptoms' total variance. CONCLUSIONS This study provides preliminary evidence on the importance of clinicians and researchers considering the simultaneous contribution of years of education, the number of perceived relapses, fatigue and experiential avoidance as factors that can increase vulnerability to stress in MS patients. Psychological intervention programmes that tackle these factors and associated stress symptomatology should be implemented.
Collapse
Affiliation(s)
- Teresa Carvalho
- Instituto Superior Miguel Torga, Coimbra, Portugal
- Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), University of Coimbra, Coimbra, Portugal
| | | | | | | | - Carolina da Motta
- Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), University of Coimbra, Coimbra, Portugal
- HEI-Lab: Digital Human-Environment Interaction Labs, Lusófona University, Lisbon, Portugal
| |
Collapse
|
2
|
Polick CS, Darwish H, de Olivera LP, Watson A, Vissoci JRN, Calhoun PS, Ploutz-Snyder R, Connell CM, Braley TJ, Stoddard SA. Resilience, mental health, sleep, and smoking mediate pathways between lifetime stressors and Multiple Sclerosis severity. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.06.24302405. [PMID: 38370736 PMCID: PMC10871453 DOI: 10.1101/2024.02.06.24302405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Intro Lifetime stressors (e.g., poverty, violence, discrimination) have been linked to Multiple Sclerosis (MS) features; yet mechanistic pathways and relationships with cumulative disease severity remain nebulous. Further, protective factors like resilience, that may attenuate the effects of stressors on outcomes, are seldom evaluated. Aim To deconstruct pathways between lifetime stressors and cumulative severity on MS outcomes, accounting for resilience. Methods Adults with MS (N=924) participated in an online survey through the National MS Society listserv. Structural Equation Modeling was used to examine the direct and indirect effect of lifetime stressors (count/severity) on MS severity (self-reported disability, relapse burden, fatigue, pain intensity and interference), via resilience, mental health (anxiety and depression), sleep disturbance, and smoking. Results The final analytic model had excellent fit (GFI=0.998). Lifetime stressors had a direct relationship with MS severity (β=0.27, p<.001). Resilience, mental health, sleep disturbance, and smoking significantly mediated the relationship between lifetime stressors and MS severity. The total effect of mediation was significant (β=0.45). Conclusions This work provides foundational evidence to inform conceptualization of pathways by which stress could influence MS disease burden. Resilience may attenuate effects of stressors, while poor mental health, smoking, and sleep disturbances may exacerbate their impact. Parallel with usual care, these mediators could be targets for early multimodal therapies to improve disease course.
Collapse
Affiliation(s)
- Carri S Polick
- School of Nursing, Duke University, Durham, NC, USA
- VA Healthcare System, Durham, NC, USA
| | - Hala Darwish
- Division of Multiple Sclerosis & Neuroimmunology, Department of Neurology, Michigan Medicine, Ann Arbor, MI, USA
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | | | - Ali Watson
- School of Medicine, Duke University, Durham, NC, USA
| | | | - Patrick S Calhoun
- VA Healthcare System, Durham, NC, USA
- Department of Psychiatry, Duke University, Durham, NC, USA
| | | | | | - Tiffany J Braley
- Division of Multiple Sclerosis & Neuroimmunology, Department of Neurology, Michigan Medicine, Ann Arbor, MI, USA
| | | |
Collapse
|
3
|
Conway DS, Sullivan AB, Rensel M. Health, Wellness, and the Effect of Comorbidities on the Multiple Sclerosis Disease Course: Tackling the Modifiable. Neurol Clin 2024; 42:229-253. [PMID: 37980117 DOI: 10.1016/j.ncl.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Multiple sclerosis (MS) is a disease of the central nervous system characterized by inflammatory demyelination and neurodegeneration. Numerous disease-modifying therapies for MS exist but are only partially effective, making it essential to optimize all factors that may influence the course of the disease. This includes conscientious management of both mental and physical comorbidities, as well as a comprehensive strategy for promoting wellness in patients with MS. Thoughtful engagement of those living with MS through shared decision making and involvement of a multidisciplinary team that includes primary care, relevant specialists, psychology, and rehabilitation is likely to lead to better outcomes.
Collapse
Affiliation(s)
- Devon S Conway
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Amy B Sullivan
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mary Rensel
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
4
|
Guinebretiere O, Nedelec T, Gantzer L, Lekens B, Durrleman S, Louapre C. Association Between Diseases and Symptoms Diagnosed in Primary Care and the Subsequent Specific Risk of Multiple Sclerosis. Neurology 2023; 101:e2497-e2508. [PMID: 38052493 PMCID: PMC10791050 DOI: 10.1212/wnl.0000000000207981] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/20/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Previous studies have reported a possible prodrome in multiple sclerosis (MS) defined by nonspecific symptoms including mood disorder or genitourinary symptoms and increased health care use detected several years before diagnosis. This study aimed to evaluate agnostically the associations between diseases and symptoms diagnosed in primary care and the risk of MS relative to controls and 2 other autoimmune inflammatory diseases with similar population characteristics, namely lupus and Crohn disease (CD). METHODS A case-control study was conducted using electronic health records from the Health Improvement Network database in the United Kingdom and France. We agnostically assessed the associations between 113 diseases and symptoms in the 5 years before and after diagnosis in patients with subsequent diagnosis of MS. Individuals with a diagnosis of MS were compared with individuals without MS and individuals with 2 other autoimmune diseases, CD and lupus. RESULTS The study population consisted of patients with MS (n = 20,174), patients without MS (n = 54,790), patients with CD (n = 30,477), and patients with lupus (n = 7,337). Twelve ICD-10 codes were significantly positively associated with the risk of MS compared with controls without MS. After considering ICD-10 codes suggestive of neurologic symptoms as the first diagnosis of MS, 5 ICD-10 codes remained significantly associated with MS: depression (UK: odds ratio 1.22, 95% CI 1.11-1.34), sexual dysfunction (1.47, 1.11-1.95), constipation (1.5, 1.27-1.78), cystitis (1.21, 1.05-1.39), and urinary tract infections of unspecified site (1.38, 1.18-1.61). However, none of these conditions was selectively associated with MS in comparisons with both lupus and CD. All 5 ICD-10 codes identified were still associated with MS during the 5 years after diagnosis. DISCUSSION We identified 5 health conditions associated with subsequent MS diagnosis, which may be considered not only prodromal but also early-stage symptoms. However, these health conditions overlap with prodrome of 2 other autoimmune diseases; hence, they lack specificity to MS.
Collapse
Affiliation(s)
- Octave Guinebretiere
- From the Sorbonne Université (O.G., T.N., S.D., C.L.), Paris Brain Institute-ICM, Inserm, CNRS, Inria; Cegedim R&D (L.G., B.B.L.), Boulogne-Billancourt; and Department of Neurology (C.L.), CIC Neurosciences, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, France
| | - Thomas Nedelec
- From the Sorbonne Université (O.G., T.N., S.D., C.L.), Paris Brain Institute-ICM, Inserm, CNRS, Inria; Cegedim R&D (L.G., B.B.L.), Boulogne-Billancourt; and Department of Neurology (C.L.), CIC Neurosciences, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, France
| | - Laurene Gantzer
- From the Sorbonne Université (O.G., T.N., S.D., C.L.), Paris Brain Institute-ICM, Inserm, CNRS, Inria; Cegedim R&D (L.G., B.B.L.), Boulogne-Billancourt; and Department of Neurology (C.L.), CIC Neurosciences, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, France
| | - Beranger Lekens
- From the Sorbonne Université (O.G., T.N., S.D., C.L.), Paris Brain Institute-ICM, Inserm, CNRS, Inria; Cegedim R&D (L.G., B.B.L.), Boulogne-Billancourt; and Department of Neurology (C.L.), CIC Neurosciences, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, France
| | - Stanley Durrleman
- From the Sorbonne Université (O.G., T.N., S.D., C.L.), Paris Brain Institute-ICM, Inserm, CNRS, Inria; Cegedim R&D (L.G., B.B.L.), Boulogne-Billancourt; and Department of Neurology (C.L.), CIC Neurosciences, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, France
| | - Celine Louapre
- From the Sorbonne Université (O.G., T.N., S.D., C.L.), Paris Brain Institute-ICM, Inserm, CNRS, Inria; Cegedim R&D (L.G., B.B.L.), Boulogne-Billancourt; and Department of Neurology (C.L.), CIC Neurosciences, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, France
| |
Collapse
|
5
|
Briones-Buixassa L, Montañés-Masias B, Milà-Villaroel R, Arrufat FX, Aragonès JM, Norton S, Bort-Roig J, Moss-Morris R. The bidirectional effect of stress and functionality in multiple sclerosis and the interaction role of anxiety, coping and social support. J Psychosom Res 2023; 170:111375. [PMID: 37196585 DOI: 10.1016/j.jpsychores.2023.111375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/27/2023] [Accepted: 05/10/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE The present study aims to analyse the bidirectional hypothesis between stress and multiple sclerosis with several measures of stress, impairment and functionality, considering also the interaction role of stress-related psychosocial factors such as anxiety, coping and social support. METHODS A one-year follow-up was conducted with 26 people with multiple sclerosis. Participants reported i) at baseline, anxiety (State-Trait Anxiety Inventory), and social support (Multidimensional Scale of Perceived Social Support); ii) daily, Ecological Momentary Assessment through self-reported diaries of stressful events and coping strategies; iii) monthly, the perceived stress (Perceived Stress Scale), iv) trimonthly, the self-reported functionality (Functionality Assessment in multiple sclerosis) and v) at baseline and at the end, neurologist rated impairment (Expanded Disability Status Scale). Mixed-effect regression models were conducted. RESULTS The bidirectional hypothesis was confirmed with perceived stress and self-reported functionality, which were negatively related in both directions. Coping and anxiety showed an interaction effect: active coping increased functionality only with high levels of stress, and high-trait anxiety showed lower functionality whereas low-trait anxiety showed higher functionality but only with low stress levels. CONCLUSION People with multiple sclerosis may benefit from different types of psychological therapies, from gold-standard therapies like Cognitive Behavioural Therapy to third-waves therapies like Dialectical Behaviour Therapy or mindfulness, that focus on dealing with stress and affective symptoms, adjusting to the disease, and to improving their overall quality of life. More research is needed in this field under the biopsychosocial model.
Collapse
Affiliation(s)
- Laia Briones-Buixassa
- Department of basic health sciences, Innovation in Mental Health and Social Wellbeing Research Group (ISaMBeS), Centre for Health and Social Care Research (CESS), Universitat de Vic - Universitat Central de Catalunya, C/ Sagrada Familia, 7, Vic 08500 - Spain; Department of Health Sciences, Universitat de Vic-Universitat Central de Catalunya, Vic, Catalonia, Spain.
| | - Brenda Montañés-Masias
- Department of basic health sciences, Innovation in Mental Health and Social Wellbeing Research Group (ISaMBeS), Centre for Health and Social Care Research (CESS), Universitat de Vic - Universitat Central de Catalunya, C/ Sagrada Familia, 7, Vic 08500 - Spain
| | - Raimon Milà-Villaroel
- Global Research on Wellbeing (GRoW), Blanquerna School of Health Sciences-Ramon Llull University, Barcelona, Spain
| | | | - Josep Mª Aragonès
- Neurology Department, Consorci Hospitalari de Vic, Vic, Catalonia, Spain
| | - Sam Norton
- Psychology Department, Health Psychology Section, Institute for Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Judit Bort-Roig
- Sport and Physical Activity Research Group, Centre for Health and Social Care Research, Universitat de Vic - Universitat Central de Catalunya, Vic, Catalonia, Spain
| | - Rona Moss-Morris
- Psychology Department, Health Psychology Section, Institute for Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
6
|
Pilipović I, Stojić-Vukanić Z, Leposavić G. Adrenoceptors as potential target for add-on immunomodulatory therapy in multiple sclerosis. Pharmacol Ther 2023; 243:108358. [PMID: 36804434 DOI: 10.1016/j.pharmthera.2023.108358] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 02/03/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023]
Abstract
This review summarizes recent findings related to the role of the sympathetic nervous system (SNS) in pathogenesis of multiple sclerosis (MS) and its commonly used experimental model - experimental autoimmune encephalomyelitis (EAE). They indicate that noradrenaline, the key end-point mediator of the SNS, acting through β-adrenoceptor, has a contributory role in the early stages of MS/EAE development. This stage is characterized by the SNS hyperactivity (increased release of noradrenaline) reflecting the net effect of different factors, such as the disease-associated inflammation, stress, vitamin D hypovitaminosis, Epstein-Barr virus infection and dysbiosis. Thus, the administration of propranolol, a non-selective β-adrenoceptor blocker, readily crossing the blood-brain barrier, to experimental rats before the autoimmune challenge and in the early (preclinical/prodromal) phase of the disease mitigates EAE severity. This phenomenon has been ascribed to the alleviation of neuroinflammation (due to attenuation of primarily microglial activation/proinflammatory functions) and the diminution of the magnitude of the primary CD4+ T-cell autoimmune response (the effect associated with impaired autoantigen uptake by antigen presenting cells and their migration into draining lymph nodes). The former is partly related to breaking of the catecholamine-dependent self-amplifying microglial feed-forward loop and the positive feedback loop between microglia and the SNS, leading to down-regulation of the SNS hyperactivity and its enhancing influence on microglial activation/proinflammatory functions and the magnitude of autoimmune response. The effects of propranolol are shown to be more prominent in male EAE animals, the phenomenon important as males (like men) are likely to develop clinically more severe disease. Thus, these findings could serve as a firm scientific background for formulation of a new sex-specific immune-intervention strategy for the early phases of MS (characterized by the SNS hyperactivity) exploiting anti-(neuro)inflammatory and immunomodulatory properties of propranolol and other relatively cheap and safe adrenergic drugs with similar therapeutic profile.
Collapse
Affiliation(s)
- Ivan Pilipović
- Institute of Virology, Vaccines and Sera "Torlak", Belgrade, Serbia
| | - Zorica Stojić-Vukanić
- University of Belgrade-Faculty of Pharmacy, Department of Microbiology and Immunology, Belgrade, Serbia
| | - Gordana Leposavić
- University of Belgrade-Faculty of Pharmacy, Department of Pathobiology, Belgrade, Serbia.
| |
Collapse
|
7
|
Novak AM, Lev-Ari S. Resilience, Stress, Well-Being, and Sleep Quality in Multiple Sclerosis. J Clin Med 2023; 12:jcm12020716. [PMID: 36675644 PMCID: PMC9864697 DOI: 10.3390/jcm12020716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 01/19/2023] Open
Abstract
(1) Background: Multiple Sclerosis (MS) is a chronic, progressive, immune-mediated disorder that affects the Central Nervous System and is the most common cause of non-traumatic neurological disability in young adults. The study aimed to assess the levels of stress, resilience, well-being, sleep quality, and fatigue in Israeli people with MS (PwMS), and to examine the associations between these factors and the sociodemographic and clinical characteristics. These factors had never before been studied in conjunction in PwMS, nor had they been systematically addressed in Israel, the unique geopolitical situation of which may pose unique challenges. (2) Methods: This was a survey-based, cross-sectional study conducted through an Internet platform. (3) Results: Israeli PwMS who participated in the study were experiencing relatively high levels of stress and low resilience, poor sleep quality, and severe fatigue. The analysis revealed significant associations between resilience and stress, well-being, and anxiety, as well as stress and well-being, resilience, sleep quality, fatigue, and Clinically Isolated Syndrome (CIS). (4) Conclusions: the Israeli PwMS who participated in the study were experiencing higher levels of stress, lower resilience and worse sleep quality than PwMS in other countries, as compared to results previously reported in literature. The findings of this study ought to serve as a call to action for the MS care providers in Israel and warrant further research into the possible causes of the phenomenon and strategies to address it.
Collapse
|
8
|
Conceptualization, use, and outcomes associated with compassion in the care of people with multiple sclerosis: a scoping review. J Neurol 2023; 270:1300-1322. [PMID: 36445508 PMCID: PMC9707147 DOI: 10.1007/s00415-022-11497-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Compassion is widely regarded as an important component of high-quality healthcare. However, its conceptualization, use, and associated outcomes in the care of people with multiple sclerosis (PwMS) have not been synthesized. The aim of this review is to scope the peer reviewed academic literature on the conceptualization, use, and outcomes associated with compassion in the care of PwMS. METHODS Studies were eligible for inclusion if reporting primary research data from quantitative, qualitative, or mixed-methods studies on the conceptualization, use, and outcomes associated with compassion in the care of PwMS. Relevant studies were identified through searching five electronic databases (CINAHL, Cochrane Library, EMBASE, MEDLINE, and PsycINFO) in January 2022. We followed the guidance outlined in the Joanna Briggs Institute (JBI) manual for evidence synthesis, and also referred to the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews Checklist (PRISMA-ScR). Simple descriptive methods were used to chart quantitative findings, and a descriptive approach with basic content analysis was employed to describe qualitative findings. RESULTS Fifteen studies were included (participant n = 1722): eight quantitative, six mixed-methods, one exclusively qualitative. Synthesized qualitative data revealed that PwMS conceptualize compassion as involving self-kindness, agency, and acceptance. PwMS report using self-compassion in response to unpleasant sensations and experiences. Quantitative findings suggest that compassion may mediate benefit finding, reduced distress, and improved quality of life (QoL) in PwMS, that those with the condition may become more compassionate through time, and that self-compassion specifically can be increased through training in mindfulness. In this context, greater self-compassion in PwMS correlates with less depression and fatigue, better resilience and QoL. Among studies, self-compassion was the most common outcome measure for PwMS. CONCLUSIONS A nascent literature exists on the conceptualization, use, and outcomes associated with compassion in the care of PwMS. Further research is required to better understand what compassion means to PwMS and those caring for them. However, self-compassion can be cultivated among PwMS and may be helpful for managing unpleasant somatic symptoms and in benefit finding. Impact on other health outcomes is less clear. The use of compassion by health care providers in the care of PwMS is unstudied.
Collapse
|
9
|
Faraji J, Gustafson C, Bettenson D, Negoro H, Yong VW, Metz GAS. Bladder dysfunction in experimental autoimmune encephalomyelitis reflects clinical severity: A pilot study. J Neuroimmunol 2022; 372:577973. [PMID: 36209613 DOI: 10.1016/j.jneuroim.2022.577973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/19/2022] [Accepted: 09/26/2022] [Indexed: 12/31/2022]
Abstract
Multiple sclerosis (MS) is commonly associated with bladder dysfunction resulting in a progressive loss of voluntary control for urination over time. Here, we used the voided stain on paper (VSOP) method to investigate bladder function in the experimental autoimmune encephalomyelitis (EAE) mouse model of MS. Using the VSOP test, we show that bladder dysfunction reflects pro-inflammatory processes of EAE and severity of clinical EAE symptoms, as characterized by increased urine voided volume per micturition (UVVM) on post-induction day 7 and decreased UVVM on post-induction day 14. The UVVM was closely related to a clinical disease index of EAE symptoms and plasma granulocyte-macrophage colony-stimulating factor (GM-CSF) cytokine levels. UVVM was also sensitive to early life stress caused by animal transportation, which diminished UVVM at the peak of symptoms on post-induction day 14 in EAE mice. The results indicate that symptoms and progression of EAE can be reliably measured by VSOP as a non-motor function assessment.
Collapse
Affiliation(s)
- Jamshid Faraji
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, Alberta T1K 3M4, Canada.
| | - Connor Gustafson
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, Alberta T1K 3M4, Canada
| | - Dennis Bettenson
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, Alberta T1K 3M4, Canada
| | - Hiromitsu Negoro
- Department of Urology, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - V Wee Yong
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta T2N 4N1, Canada
| | - Gerlinde A S Metz
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, Alberta T1K 3M4, Canada; Southern Alberta Genome Sciences Centre, University of Lethbridge, Lethbridge, Alberta T1K 3M4, Canada.
| |
Collapse
|
10
|
Polick CS, Polick SR, Stoddard SA. Relationships between childhood trauma and multiple sclerosis: A systematic review. J Psychosom Res 2022; 160:110981. [PMID: 35779440 DOI: 10.1016/j.jpsychores.2022.110981] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Adverse Childhood Experiences (ACEs), such as physical, emotional, and sexual abuse trigger inflammatory changes and have been associated with many causes of morbidity and mortality, including autoimmune diseases. Although Multiple Sclerosis (MS) is a debilitating neurological autoimmune disease, literature linking ACEs and MS is understudied. The aim of this review was to examine the 1) state of the literature, and 2) relationships between childhood adversity and the prevalence and physical clinical features of MS (e.g., age at onset, relapses, pain, fatigue, disability). METHODS A comprehensive search was preformed through five databases and by hand using the ancestry and descendancy approach for connections to papers published through January 20th, 2022. Studies were screened by independent reviewers using Rayyan.ai, and critically appraised for both quality and reporting transparency. RESULTS Twelve studies examined relationships between any ACE(s) and the prevalence or physical clinical features of MS. There was considerable variance in the measurement of stressors, confounders, and categorization of MS; however most studies (n = 10) demonstrated an association between ACEs and MS (alone or grouped with other similar diagnoses), or physical clinical features. CONCLUSION Although there are few studies in this area, it is of quickly growing interest. These results should be cautiously interpreted, yet highlight the need for continued work to disentangle and discern true associations.
Collapse
Affiliation(s)
- Carri S Polick
- University of Michigan, School of Nursing, Ann Arbor, MI, United States of America.
| | - Scott R Polick
- Department of Psychiatry, St. Joseph Mercy Health System, Ann Arbor, MI, United States of America.
| | - Sarah A Stoddard
- University of Michigan, School of Nursing, Ann Arbor, MI, United States of America.
| |
Collapse
|
11
|
Hosseini Z, Homayuni A, Ghanbarnejad A. Determinants of stress coping behaviors in patients with Multiple Sclerosis (MS-DSCB): development and psychometrics of a PRECEDE model-based questionnaire. BMC Psychiatry 2022; 22:578. [PMID: 36042451 PMCID: PMC9426368 DOI: 10.1186/s12888-022-04217-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Stress management delays the onset or exacerbation of symptoms of multiple sclerosis. The present study aimed to develop and psychometrically evaluate a questionnaire to measure the determinants of stress coping behaviors in patients with multiple sclerosis. METHODS This was a methodological study that was conducted in two stages: qualitative and quantitative phases. Participants in this study were patients with multiple sclerosis who referred to the MS Association and Charity Foundations for Special Diseases in Isfahan in 2021. Preliminary item pool was developed by qualitative part of the study. The validity of the questionnaire was determined with item impact, content validity ratio (CVR), content validity index (CVI), face validity, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). RESULTS In the first stage, an item pool containing 97 items were generated and after removing duplicate items and merging some of them, a questionnaire containing 51 items was developed. Ten items were removed based on the results of face validity and content validity. The EFA revealed 11 factors containing 41 items that explained 64% of the total variance of test. In CFA, 9 other items were deleted, and the questionnaire was reduced to 32 phrases in general. The results of the CFA determined the 9-factor structure of the questionnaire including awareness, attitude, self-efficacy, access to resources, skills of using resources, social support, important others, behavioral consequences and social comparison. The Cronbach's alpha coefficient of the questionnaire was 0.726. CONCLUSION The results showed that the designed questionnaire is a valid and reliable tool for assessing the determinants of stress coping behaviors in patients with multiple sclerosis. Identifying these factors and designing interventions based on them, in order to control or reduce stress in these patients, can help to improve the quality of life in these patients.
Collapse
Affiliation(s)
- Zahra Hosseini
- grid.412237.10000 0004 0385 452XHealth Education and Health Promotion, Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Atefeh Homayuni
- Student Research Committee, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
| | - Amin Ghanbarnejad
- grid.412237.10000 0004 0385 452XDepartment of Public Health, School of Health, Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| |
Collapse
|
12
|
Allostatic load index in patients with multiple sclerosis: A case-control study. Psychoneuroendocrinology 2022; 142:105788. [PMID: 35525125 DOI: 10.1016/j.psyneuen.2022.105788] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/22/2022]
Abstract
Elevated allostatic load (AL) index is a cumulative measure of biological dysregulations associated with stress exposure. It has been reported that stress plays an important role in the pathophysiology of multiple sclerosis (MS). However, the AL index has not been investigated in this population so far. Therefore, we aimed to investigate the AL index in patients with MS compared to healthy controls. A total of 90 patients with relapsing-remitting MS (76.7% females) and 47 healthy controls (76.6% females) were included in the study. The AL index was computed based on percentile distributions of 18 biomarkers. The AL index was significantly higher in patients with MS compared to healthy controls (2.74 ± 0.99 vs. 1.96 ± 0.71, p < 0.001), even after adjustment for age and education. With respect to specific AL biomarkers, individuals with MS had significantly lower resting heart rate, the levels of high-density lipoproteins and dehydroepiandrosterone sulfate as well as significantly higher level of hsCRP and albumin compared to healthy controls. There were no significant correlations of the AL index with depressive and anxiety symptoms, perceived stress, type D personality traits, insomnia, the odds of using specific coping strategies as well as MS-related clinical characteristics. These findings indicate that the AL index is increased in patients with MS. However, the exact mechanisms underlying this observation remain unknown and require additional studies.
Collapse
|
13
|
Jiang J, Zhang C, Abduljabbar S, Osier N. The Relationship Between Stress and Disease Onset and Relapse in Multiple Sclerosis: A Systematic Review. Mult Scler Relat Disord 2022; 67:104142. [DOI: 10.1016/j.msard.2022.104142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/26/2022] [Accepted: 08/21/2022] [Indexed: 11/30/2022]
|
14
|
Abstract
Studies conducted in healthy subjects have clearly shown that different hypnotic susceptibility, which is measured by scales, is associated with different functional equivalence between imagery and perception/action (FE), cortical excitability, and information processing. Of note, physiological differences among individuals with high (highs), medium (mediums), and low hypnotizability scores (lows) have been observed in the ordinary state of consciousness, thus independently from the induction of the hypnotic state, and in the absence of specific suggestions. The potential role of hypnotic assessment and its relevance to neurological diseases have not been fully explored. While current knowledge and therapies allow a better survival rate, there is a constant need to optimize rehabilitation treatments and quality of life. The aim of this paper is to provide an overview of hypnotizability-related features and, specifically, to discuss the hypothesis that the stronger FE, the different mode of information processing, and the greater proneness to control pain and the activity of the immune system observed in individuals with medium-to-high hypnotizability scores have potential applications to neurology. Current evidence of the outcome of treatments based on hypnotic induction and suggestions administration is not consistent, mainly owing to the small sample size in clinical trials and inadequate control groups. We propose that hypnotic assessment may be feasible in clinical routine and give additional cues into the treatment and rehabilitation of neurological diseases.
Collapse
|
15
|
Özer D, Emine Ata E, DİkeÇ G, Demİr S. The relationship between stress, anxiety, and depression levels and pseudobulbar affect in patients with Multiple Sclerosis. Contemp Nurse 2022; 58:317-329. [PMID: 35880717 DOI: 10.1080/10376178.2022.2107037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Pseudobulbar affect (PBA) has recently been added to the list of mental disorders commonly observed in patients with Multiple Sclerosis (MS). The emotional changes experienced by MS patients may be associated with other mental problems and adversely affect disease prognosis. However, there are limited studies in the international and national literature on this subject. AIM This study aimed to evaluate the relationship between PBA and stress, anxiety, and depression levels in patients with MS. DESIGN This is a descriptive, relational, and cross-sectional study. METHODS A total of 442 MS patients followed in the neurology outpatient clinic of a hospital and registered with the MS Society in Turkey participated in this study. Data were collected using a personal information form, the Turkish version of the Center for Neurologic Study-Lability Scale (CNS-LS), and the Depression Anxiety Stress Scale (DASS). RESULTS In this study, 63.3% of the patients had PBA, 21% had extremely severe depression, 41.6% had extremely severe anxiety, and 24.9% had severe stress. Correlation analysis revealed weak positive correlations between CNS-LS total score and DASS subscale and total scores. Depression, anxiety, and stress levels accounted for 22.5% of the variation in CNS-LS total score. CONCLUSION The results of this study indicate that a majority of MS patients in Turkey experience PBA, depression, anxiety, and stress, and that PBA is positively associated with depression, anxiety, and stress. IMPACT STATEMENT This study, indicates that should be increased consultation-liaison psychiatry services in Turkey, and MS patients should benefit from comprehensive psychiatric services.
Collapse
Affiliation(s)
- Duygu Özer
- MsN, PhD Candidate, University of Health Sciences, Sultan II. Abdulhamid Han Training and Research Hospital, Department of Psychiatry, Istanbul, Turkey
| | - Elvan Emine Ata
- Assis. Prof., University of Health Sciences, Hamidiye Faculty of Nursing, Department of Psychiatric Nursing, Istanbul, Turkey. E-mail:
| | - Gül DİkeÇ
- Assoc. Prof., Fenerbahce University, Faculty of Health Sciences, Department of Nursing, Istanbul, Turkey. E-mail:
| | - Serkan Demİr
- Assoc. Prof., MD, Department of Neurology, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, Istanbul, Turkey. E-mail:
| |
Collapse
|
16
|
Chen GX, Douwes J, den Berg LH, Glass B, McLean D, ’t Mannetje AM. Sports and trauma as risk factors for Motor Neurone Disease: New Zealand case-control study. Acta Neurol Scand 2022; 145:770-785. [PMID: 35355246 PMCID: PMC9321578 DOI: 10.1111/ane.13615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 11/26/2022]
Abstract
Objectives To assess whether sports, physical trauma and emotional trauma are associated with motor neurone disease (MND) in a New Zealand case–control study (2013–2016). Methods In total, 321 MND cases and 605 population controls were interviewed collecting information on lifetime histories of playing sports, physical trauma (head injury with concussion, spine injury) and emotional trauma (14 categories). ORs were estimated using logistic regression adjusting for age, sex, ethnicity, socioeconomic status, education, smoking status, alcohol consumption and mutually adjusting for all other exposures. Results Head injury with concussion ≥3 years before diagnosis was associated with MND (OR 1.51, 95% CI: 1.09–2.09), with strongest associations for two (OR 4.01, 95% CI: 1.82–8.86), and three or more (OR 2.34, 95% CI: 1.00–5.45) head injuries. Spine injury was not associated with MND (OR 0.81, 95% CI: 0.48–1.36). Compared to never playing sports, engaging in sports throughout childhood and adulthood increased MND risk (OR 1.81, 95% CI: 1.01–3.25), as was more than 12 years playing football/soccer (OR 2.35, 95% CI: 1.19–4.65). Reporting emotionally traumatic events in more than three categories was associated with MND (OR 1.88, 95% CI: 1.17–3.03), with physical childhood abuse the only specific emotional trauma associated with MND (OR 1.82, 95% CI: 1.14–2.90), particularly for those reporting longer abuse duration (OR(5–8 years) 2.26, 95% CI: 1.14–4.49; OR(>8 years) 3.01, 95% CI: 1.18–7.70). For females, having witnessed another person being killed, seriously injured or assaulted also increased MND risk (OR 2.68, 95% CI: 1.06–6.76). Conclusions This study adds to the evidence that repeated head injury with concussion, playing sports in general, and playing football (soccer) in particular, are associated with an increased risk of MND. Emotional trauma, that is physical abuse in childhood, may also play a role.
Collapse
Affiliation(s)
- Grace Xia Chen
- Research Centre for Hauora and Health Massey University Wellington New Zealand
| | - Jeroen Douwes
- Research Centre for Hauora and Health Massey University Wellington New Zealand
| | - Leonard H. den Berg
- Brain Centre Rudolf Magnus, Department of Neurology University Medical Centre Utrecht The Netherlands
| | - Bill Glass
- Research Centre for Hauora and Health Massey University Wellington New Zealand
| | - David McLean
- Research Centre for Hauora and Health Massey University Wellington New Zealand
| | | |
Collapse
|
17
|
Elkhalii-Wilhelm S, Sippel A, Riemann-Lorenz K, Kofahl C, Scheiderbauer J, Arnade S, Kleiter I, Schmidt S, Heesen C. Experiences of persons with Multiple Sclerosis with lifestyle adjustment–A qualitative interview study. PLoS One 2022; 17:e0268988. [PMID: 35622783 PMCID: PMC9140290 DOI: 10.1371/journal.pone.0268988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/12/2022] [Indexed: 12/04/2022] Open
Abstract
Background Persons with Multiple Sclerosis (pwMS) follow individual strategies to cope with this highly heterogeneous disease. As surveys show, lifestyle habits play an important role in pwMS. However, little is known about individual experiences of pwMS with different lifestyle adjustment strategies. Objective This study aims to describe and understand individual experiences of pwMS with lifestyle adjustments. Methods Semi-structured interviews were conducted with 50 pwMS in Germany. Criteria for inclusion were age ≥ 18 years and a diagnosis of relapsing-remitting Multiple Sclerosis. Data were analyzed inductively and deductively according to a six-step thematic analysis. Results The three main themes for experience-based lifestyle adjustments were: 1) nutrition and supplements, 2) exercise and physical activity, and 3) stress management. Influencing factors on the decision-making process such as active disease management, information and advice, desire for mental health and social support, and the wish for self-determination were identified. Impacts of starting or maintaining lifestyle habits included, for example, MS-specific, general, and mental health benefits, the development of coping strategies, social support, and barriers that led to a termination of lifestyle adjustments. Conclusion This study provides a rich and nuanced amount of experiences of pwMS with lifestyle adjustments and leads to three important conclusions: 1) Further research is warranted to better describe the perceived effects of lifestyle habits on MS symptoms and progression, in particular with regard to nutrition and stress reduction; 2) patient education in MS should include the available evidence on lifestyle management and 3) patients need to be actively supported in changing their lifestyle behavior.
Collapse
Affiliation(s)
- Saskia Elkhalii-Wilhelm
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- * E-mail:
| | - Anna Sippel
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Karin Riemann-Lorenz
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christopher Kofahl
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - Sigrid Arnade
- LEBENSNERV–Stiftung zur Förderung der Psychosomatischen MS-Forschung, Berlin, Germany
| | - Ingo Kleiter
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke GmbH, Berg, Germany
| | - Stephan Schmidt
- Neurologische Gemeinschaftspraxis, Gesundheitszentrum St. Johannes, Bonn, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| |
Collapse
|
18
|
Campbell KA, Ford-Gilboe M, Stanley M, MacKinnon K. Intimate partner violence and women living with episodic disabilities: a scoping review protocol. Syst Rev 2022; 11:97. [PMID: 35585642 PMCID: PMC9115998 DOI: 10.1186/s13643-022-01972-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 05/02/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Violence towards women with disabilities is most commonly perpetrated by current or former intimate partners and more than half of disabled women experience intimate partner violence in their lifetime. Disabilities differ by presence, type, and complexity, yet are commonly researched collectively. A more nuanced understanding of the relationship between intimate partner violence and episodic disability is required to better support women living with these concurrent challenges. The objective of this scoping review is to investigate and synthesize the literature reporting on intimate partner violence for women living with an episodic disability to identify key concepts and knowledge gaps on this topic. Ultimately, this review aims to improve health services for this stigmatized group of women with episodic disabilities. METHODS This scoping review will consider all studies that focus on women (18 years of age or older) who have experienced intimate partner violence and have an episodic disability. Episodic disabilities will include multiple sclerosis, chronic fatigue syndrome, fibromyalgia, lupus, or rheumatoid arthritis. The broad review question is what is known about intimate partner violence within the context of women living with an episodic disability? Databases to be searched include MEDLINE (OVID), CINAHL, Embase, PsychInfo, and Scopus with no limits on language or time frame. Joanna Briggs Institute methodology will guide this scoping review to address the review questions outlined in the protocol. For papers that meet the inclusion criteria, data will be extracted, and findings will be presented in tables and narrative form. A PRISMA table will be included to enhance the transparency of the process. A descriptive qualitative approach to analysis will be conducted following Braun and Clarke's reflexive thematic analysis. The findings of the scoping review will be presented through a thematic narrative. DISCUSSION Findings from this review will be used to identify important priorities for future research based on knowledge gaps and inform both health care practices and health and social interventions for women living with intimate partner violence and episodic disabilities.
Collapse
Affiliation(s)
- Karen A. Campbell
- Arthur Labatt Family School of Nursing, Faculty of Health Science, The University of Western Ontario, 1151 Richmond St, London, Ontario N6A 3K7 Canada
| | - Marilyn Ford-Gilboe
- Arthur Labatt Family School of Nursing, Faculty of Health Science, The University of Western Ontario, 1151 Richmond St, London, Ontario N6A 3K7 Canada
| | - Meagan Stanley
- Allyn & Betty Taylor Library, The University of Western Ontario, 1151 Richmond St, London, Ontario N6A 3K7 Canada
| | - Karen MacKinnon
- School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria, British Columbia V8P 2Y2 Canada
| |
Collapse
|
19
|
Sparaco M, Miele G, Lavorgna L, Abbadessa G, Bonavita S. Association between relapses, stress, and depression in people with multiple sclerosis during the COVID-19 pandemic. Neurol Sci 2022; 43:2935-2942. [PMID: 35092543 PMCID: PMC8799958 DOI: 10.1007/s10072-022-05917-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 01/20/2022] [Indexed: 11/30/2022]
Abstract
Abstract
Background
Stress is a potential trigger for clinical and radiological activity in Multiple Sclerosis (MS). COVID-19 pandemic has been a relevant source of mental distress in people with MS (pwMS) and deeply impacted on disease management.
Objective
To investigate the association between stress, anxiety, depression, and risk of relapse during the COVID-19 pandemic.
Methods
From an electronic database used for clinical practice, we extracted data of relapsing–remitting (RR) or relapsing-progressive (RP) MS patients and calculated the annualized relapse rate (ARR) during 2019 and 2020. From 01/12/2020 to 30/12/2020, enrolled patients were invited to fill in a Google Forms survey to investigate depression, anxiety, stress, and Post-Traumatic Stress Disorder (PTSD).
Results
We selected 216 patients with RR or RP-MS to calculate ARR: compared to 2019, in 2020 there was a significant increase in ARR (p = 0.0142).
Over 216 selected pwMS, 154 completed the survey. Matching the survey responses and incidence of relapses in 2020, there was a significant association between relapses and stress (p = 0.030) and relapses and depression (p = 0.011), but not between relapses and anxiety (p = 0.130) or PTSD (p = 0.279).
Conclusions
Our results support the hypothesis that pandemic-related stress is associated to clinical exacerbations, both as a possible consequence of the COVID-19 impact on MS care.
Collapse
Affiliation(s)
- Maddalena Sparaco
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy
| | - Giuseppina Miele
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy
| | - Luigi Lavorgna
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy
| | - Gianmarco Abbadessa
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy.
| |
Collapse
|
20
|
Lee B, Chan F. The Development and Psychometric Validation of the Brief Disability-Related Stress Scale in Individuals With Multiple Sclerosis. REHABILITATION COUNSELING BULLETIN 2022. [DOI: 10.1177/00343552221087173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Disability-related stress is the unique stressful experiences and challenges people with disabilities encounter. The goal of the study was to develop and validate the Brief Disability-Related Stress Scale ( BDRSS) in a sample of people with multiple sclerosis (MS). Findings demonstrated that the BDRSS is unidimensional and has good psychometric properties (internal consistency reliability coefficient [Cronbach’s α = .86]). The BDRSS was also found to correlate with the Perceived Stress Scale–10 ( PSS-10; r = .69). Results of this study suggested the potential clinical utility of incorporating the BDRSS in rehabilitation, mental health, and neuropsychology settings to assess stressors experienced by people with MS.
Collapse
Affiliation(s)
| | - Fong Chan
- University of Wisconsin-Madison, USA
| |
Collapse
|
21
|
Kahraman T, Rasova K, Jonsdottir J, Medina CS, Kos D, Coote S, Tacchino A, Smedal T, Arntzen EC, Quinn G, Learmonth Y, Pedulla L, Moumdjian L, Kalron A. The impact of the COVID-19 pandemic on physical therapy practice for people with multiple sclerosis: A multicenter survey study of the RIMS network. Mult Scler Relat Disord 2022; 62:103799. [PMID: 35428030 PMCID: PMC8994702 DOI: 10.1016/j.msard.2022.103799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/24/2022] [Accepted: 04/08/2022] [Indexed: 10/24/2022]
|
22
|
Shahbaz A, Allahverdi N, Parizad N. “It's like the snakes and ladders game.”; lived experience of patients with multiple sclerosis regarding their return to work: A qualitative study. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03019-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
23
|
Longley WA, Tate RL, Brown RF. The psychological benefits of neuropsychological assessment feedback as a psycho-educational therapeutic intervention: A randomized-controlled trial with cross-over in multiple sclerosis. Neuropsychol Rehabil 2022; 33:764-793. [PMID: 35332853 DOI: 10.1080/09602011.2022.2047734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ABSTRACTEvidence supporting the direct therapeutic benefits of neuropsychological assessment (NPA) feedback relies mostly upon post-feedback consumer surveys. This randomized-controlled trial with cross-over investigated the benefits of NPA feedback in multiple sclerosis (MS). Seventy-one participants were randomly allocated to NPA with feedback or a "delayed-treatment" control group. The primary hypotheses were that NPA feedback would lead to improved knowledge of cognitive functioning and improved coping. Outcome instruments were administered by a research assistant blinded to group allocation. At 1-week post-NPA feedback there were no significant group-by-time interaction effects, indicating no improvement. But nor was there any significant deterioration in psychological wellbeing, despite most participants receiving "bad news" confirming cognitive impairment. At 1-month follow-up, within-subjects' analyses not only found no evidence of any delayed deterioration, but showed clinically significant improvement (small-medium effects) in perceived everyday cognitive functioning, MS self-efficacy, stress and depression. Despite lack of improvement in the RCT component at 1-week post-NPA feedback, the absence of deterioration at this time, in addition to significant improvements in perceived cognitive functioning, self-efficacy and mood at follow-up, together with high satisfaction ratings, all support NPA feedback as a safe psycho-educational intervention that is followed by improved psychological wellbeing over time.Trial registration: Uniform Trial Number identifier: U1111-1127-1585.Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12612000161820.
Collapse
Affiliation(s)
- Wendy A Longley
- John Walsh Centre for Rehabilitation Research, The Kolling Institute of Medical Research, Northern Sydney Medical School, University of Sydney, Sydney, Australia
| | - Robyn L Tate
- John Walsh Centre for Rehabilitation Research, The Kolling Institute of Medical Research, Northern Sydney Medical School, University of Sydney, Sydney, Australia
| | - Rhonda F Brown
- Research School of Psychology, Australian National University, Canberra, Australia
| |
Collapse
|
24
|
Tremlett H, Munger KL, Makhani N. The Multiple Sclerosis Prodrome: Evidence to Action. Front Neurol 2022; 12:761408. [PMID: 35173664 PMCID: PMC8841819 DOI: 10.3389/fneur.2021.761408] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/14/2021] [Indexed: 01/10/2023] Open
Abstract
A growing body of work points toward the existence of a clinically symptomatic prodromal phase in multiple sclerosis (MS) that might span 5–10 years or more. A prodrome is an early set of signs or symptoms predating the onset of classical disease, which in turn predates a definitive diagnosis. Evidence for a prodromal phase in MS could have major implications for prevention, earlier recognition and treatment, as well as an improved disease course or prognosis. This Perspective provides a succinct overview of the recent advances in our understanding of the MS prodrome and current key challenges. Many of the MS prodromal features characterized thus far are non-specific and are common in the general population; no single feature alone is sufficient to identify an individual with prodromal MS. Biomarkers may increase specificity and accuracy for detecting individuals in the MS prodromal phase, but are yet to be discovered or formally validated. Progress made in the elucidation of prodromal phases in other neurological and immune-mediated diseases suggests that these barriers can be overcome. Therefore, while knowledge of a prodromal phase in MS remains nascent, how best to move from the rapidly growing evidence to research-related action is critical. Immediate implications include refining the concept of the MS continuum to include a prodromal phase. This will help inform the true “at risk” period when considering exposures that might cause MS. Major long-term implications include the earlier recognition of MS, improved prognosis, through earlier disease management, and the future possibility of MS disease prevention.
Collapse
Affiliation(s)
- Helen Tremlett
- Faculty of Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
- *Correspondence: Helen Tremlett
| | | | - Naila Makhani
- Departments of Pediatrics and Neurology, Yale School of Medicine, New Haven, CT, United States
| |
Collapse
|
25
|
Palukuru S, Patil SS, Nagarathna R, Singh A, Nibedita KS. Content Validity of an Integrated Yoga Module for Practice During Remission in Relapsing-Remitting Multiple Sclerosis Patients. Ann Neurosci 2021; 28:29-38. [PMID: 34733052 PMCID: PMC8558981 DOI: 10.1177/09727531211023754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/25/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Some investigations point to the beneficial effects of yoga in alleviating
the motor and cognitive dysfunctions in multiple sclerosis (MS) patients by
using varying combinations of physical, breathing, and meditative practices
of yoga. There is a need for a validated yoga module with a holistic
approach that can be used as a standardized protocol by researchers and
therapists. Purpose: To develop and validate an integrated yoga module for practice in
relapsing–remitting MS patients to improve their quality of life. Methods: We did a thorough review of the literature for the development of the yoga
module. We formed an expert group with 24 experts and a neurologist and used
two rounds of interactive Delphi method to combine their opinion to obtain
content validity of the module through online structured questionnaire
prepared for the purpose on a Google Form. We incorporated all suggestions
obtained by the experts. The final module (60 min per session, twice a day,
five days per week) included warm-up exercises, customized asanas,
relaxation techniques, and OM meditation. Advice on yogic diet and
discussion using yogic concepts for stress management also form a part of
the holistic approach to yoga lifestyle modification. Results: Analysis divulged that 30 out of 39 practices exhibited a content validity
ratio value greater than or equal to 0.42. Conclusion: The study has shown good content validity of the integrated yoga module.
Future clinical studies are being planned to rule the feasibility and
reliability of this module.
Collapse
Affiliation(s)
- Sreedhar Palukuru
- Department of Yoga and Life Sciences, S-VYASA Yoga University, Bengaluru, Karnataka, India
| | - Suchitra S Patil
- Department of Yoga and Life Sciences, S-VYASA Yoga University, Bengaluru, Karnataka, India
| | - R Nagarathna
- Department of Yoga and Life Sciences, S-VYASA Yoga University, Bengaluru, Karnataka, India
| | - Amit Singh
- Department of Yoga and Life Sciences, S-VYASA Yoga University, Bengaluru, Karnataka, India
| | - K S Nibedita
- Department of Yoga and Life Sciences, S-VYASA Yoga University, Bengaluru, Karnataka, India
| |
Collapse
|
26
|
Alirezaei M, Eskandarieh S, Sahraian MA, Naser Moghadasi A. Depression, anxiety, and fear of COVID-19 in patients with multiple sclerosis in pandemic era: a cross-sectional study. Neurol Sci 2021; 43:59-66. [PMID: 34554334 PMCID: PMC8458786 DOI: 10.1007/s10072-021-05612-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/10/2021] [Indexed: 12/03/2022]
Abstract
Background Depression and anxiety are the two important factors determining quality of life of patients with multiple sclerosis (PWMS). In COVID-19 pandemic era, several factors can provoke mental issues of people and patients. In this cross-sectional study, we aim to estimate the new prevalence of anxious and depressive symptoms and their relating factors in PWMS. Methods In this cross-sectional study, we include PWMS who are recruited in the MS clinic of Sina Hospital, Tehran, and are joined in our channel of Telegram media. A self-designed online questionnaire consisted of 4 parts handed out between patients: demographic and clinical data, Beck depression inventory, Beck anxiety inventory, and Fear of COVID-19 Scale. Univariate and multiple logistic regression analyses were performed to find the relating factors of expression of depressive and anxious symptoms in PWMS. Results Of a total of 282 participants with the mean age of 35.66 (30.75–40) years, had been suffering from multiple sclerosis for 7.36 (3–10) years, 81.7% were women and 69.1% classified as relapsing–remitting MS. Mean score of BDI was 17.13 ± 11.51 which is classified as minimal-moderate depressive symptoms. 48.6% of patients did not express depressive symptoms (BDI-II ≤ 14) and the others reported some degrees of depression. In the univariate analysis employment (p = 0.015), marital status (p = 0.022), level of education (p = 0.004), number of hospitalization due to MS attacks (p = 0.048), and fear of COVID-19 (p ≤ 0.0001) associated significantly with presence of depressive symptoms. After entering these factors in a binary logistic regression model, level of education (p = 0.019), marital status (p = 0.044), number of hospital admissions due to MS relapses (β = 1.10, p = 0.02), and fear of COVID-19 (β = 1.07, p ≤ 0001) remained significant as relating factors. Mean score of the anxiety calculated 14.54 ± 9.75 and just 3.2% of patients had severe anxiety. Employment (p = 0.045), EDSS score (p = 0.004), and fear of COVID-19 (p ≤ 0.0001) reported relating to anxious symptoms significantly in the univariate analysis. After entering in the logistic regression analysis, EDSS (β = 1.30, p = 0.001) and fear of COVID-19 (β = 1.13, p ≤ 0.0001) remained as significant relating factors of anxious symptoms. Conclusion The overall prevalence of depressive symptoms in PWMS in our MS clinic is 51.4% which is obviously higher than other world’s centers which could be due to fear of COVID-19. In addition to fear of COVID-19, presence of depressive symptoms in PWMS is related significantly with level of education, number of hospital admissions due to MS relapses, and marital status. Other side, the patients classified as suffering from anxious symptoms had more severe problems on fear of COVID-19. But it is recommended for future studies to compare patients score in the COVID-19 era with their score before this pandemic.
Collapse
Affiliation(s)
- Mohammad Alirezaei
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sharareh Eskandarieh
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
27
|
Wicks CR, Sloan R, DiMauro S, Thompson EL, Billington S, Webb M, Pepper G. Patients' experiences of self-identification, seeking support, and anticipation of potential relapse in multiple sclerosis. Mult Scler Relat Disord 2021; 56:103259. [PMID: 34628265 DOI: 10.1016/j.msard.2021.103259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/17/2021] [Accepted: 09/06/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) relapses are associated with increased disability, reduced quality of life and negative psychosocial impacts. However, they often go unrecognised; people with MS (MSers) may face barriers to self-identification of relapses or seeking support for them. The charity Shift.ms sought to better understand 1) MSers' challenges in self-identifying potential relapses, 2) where MSers' seek support for potential relapses, and 3) the impact of the anticipation of relapses on MSers' wellbeing and daily living. METHODS Shift.ms developed a patient perspective 8-question pilot survey (included likert-style, multiple-choice, and optional free-text responses) and shared it with Shift.ms' international online community (n = 20,052). Descriptive quantitative analysis, and content analysis and thematic analysis of qualitative free-text responses were used. RESULTS 1,737 MSers responded. Just under one third (29.9%) of MSers reported that it takes them 24 h or less to self-identify a potential relapse, while more than half (54.5%) reported that identification occurs within 48 h; 55% MSers felt that the "at least 24 h" clinical criterion of relapse classification was appropriate. Challenges to relapse self-identification included confounding background symptoms or infection, variability of relapse symptoms, and individualistic nature of MS. Fatigue was reported to be the most common symptom of relapse (75%), however fatigue was also the symptom most commonly mistaken for relapse (40%). Barriers to relapse self-identification were a shorter duration since MS diagnosis and a perceived lack of consensus around relapse classification. Respondents reported they most often seek relapse support/advice from healthcare professionals (HCPs) (37.1%), family/friends (32.1%), or not at all (16.9%). Rather than temporal criteria (i.e. the 24 h criterion), participants felt that severity of symptoms could play a more critical role in whether to seek support for a potential relapse. Barriers to seeking support/advice included variability in HCP advice and feelings of invalidation. Anticipation of relapses negatively impacted MSers wellbeing; led to reduced participation in activities, and the development of adjustment/coping strategies. Relapse triggers included stress, reduced self-care, infection/illness; 78.5% reported stress or anxiety had triggered relapse. CONCLUSIONS These findings highlight difficulties MSers face in self-identifying relapses, barriers to accessing support, and impact of anticipation of relapses. They also highlight opportunities for improved MSer and HCP communication, dialogue and two-way education to help optimise patient access to relapse support and intervention.
Collapse
Affiliation(s)
| | - Rob Sloan
- Shift.ms, Platform, New Station Street, Leeds, LS1 4JB, UK
| | - Sophie DiMauro
- Shift.ms, Platform, New Station Street, Leeds, LS1 4JB, UK
| | | | - Sam Billington
- Shift.ms, Platform, New Station Street, Leeds, LS1 4JB, UK
| | - Mark Webb
- Shift.ms, Platform, New Station Street, Leeds, LS1 4JB, UK
| | - George Pepper
- Shift.ms, Platform, New Station Street, Leeds, LS1 4JB, UK.
| |
Collapse
|
28
|
Kotas R, Nowakowska-Kotas M, Budrewicz S, Pokryszko-Dragan A. The Level of Stress and Coping Strategies in Patients with Multiple Sclerosis and Their Relationships with the Disease Course. J Clin Med 2021; 10:jcm10173916. [PMID: 34501362 PMCID: PMC8432053 DOI: 10.3390/jcm10173916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/18/2021] [Accepted: 08/26/2021] [Indexed: 01/04/2023] Open
Abstract
Objectives: Stress is supposed to be linked with a background of multiple sclerosis (MS) and the disease course. Design: The study aimed to assess the level of stress and coping strategies in MS patients within a year of follow-up and to investigate the relationships between these aspects and factors related—or not—to MS. Methods: In 65 patients with MS, the Perceived Stress Scale (PSS-10), Type D Scale (DS14) and Coping Orientations to Problems Experienced (COPE) were performed at baseline and after a year. Baseline PSS-10, DS-14 and COPE scores were analyzed with regard to demographics, MS duration, treatment, indices of disability and self-reported stressful events (SEs). Final PSS-10 and COPE results were analyzed with reference to MS activity and SE within a year of follow-up. Results: Initially, 67% of patients reported a moderate or high level of stress and 31% met Type-D personality criteria. Diverse coping strategies were preferred, most of which were problem-focused. The negative affectivity DS-14 subscore (NEG) was correlated with disability level. Non-health-related SEs were associated with higher PSS-10 and NEG scores. After a year, the mean PSS-10 score decreased, while COPE results did not change significantly. Non-health-related SEs were associated with a higher PSS-10 score and less frequent use of acceptance and humor strategies. Those with an active vs. stable MS course during the follow-up did not differ in terms of PSS-10 and COPE results. Conclusions: MS patients experienced an increased level of stress. No significant relationships were found between stress or coping and MS course within a year. Non-health-related factors affected measures of stress more than MS-related factors.
Collapse
Affiliation(s)
- Roman Kotas
- Department of Psychiatry, Regional Specialist Hospital, ul. Iwaszkiewicza 5, 59-220 Legnica, Poland;
| | - Marta Nowakowska-Kotas
- Department of Neurology, Wroclaw Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; (S.B.); (A.P.-D.)
- Correspondence: ; Tel.: +48-717343100; Fax: +48-717343109
| | - Sławomir Budrewicz
- Department of Neurology, Wroclaw Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; (S.B.); (A.P.-D.)
| | - Anna Pokryszko-Dragan
- Department of Neurology, Wroclaw Medical University, ul. Borowska 213, 50-556 Wrocław, Poland; (S.B.); (A.P.-D.)
| |
Collapse
|
29
|
Abbaszadeh S, Tabary M, Aryannejad A, Abolhasani R, Araghi F, Khaheshi I, Azimi A. Air pollution and multiple sclerosis: a comprehensive review. Neurol Sci 2021. [PMID: 34341860 DOI: 10.1007/s10072-021-05508-4.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Multiple sclerosis (MS) is an inflammatory, autoimmune demyelinating disorder of the central nervous system (CNS), leading to progressive functional impairments, and many intrinsic and acquired factors are believed to be associated with its development and relapse. In terms of environmental factors, air pollution has gained much attention during recent decades, as chronic exposure to ambient air pollution seems to increase the level of some pro-inflammatory markers in the human brain, which can lead to neuroinflammation, neurodegeneration, and blood-brain barrier (BBB) breakdown. These events may also be associated with the risk of MS development and relapse. In this review, we aimed to summarize recent findings around the impact of air pollutants, including particulate matter (PM10, PM2.5, and ultra-fine particles), gaseous pollutants (carbon monoxide [CO], nitrogen oxides [NOx], sulfur dioxide [SO2], and ozone [O3]), and heavy metals, on MS development and relapse.
Collapse
Affiliation(s)
- Sahand Abbaszadeh
- Students Research Committee, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Mohammadreza Tabary
- Experimental Medicine Research Center, Tehran University of Medical Sciences, 13145-784, Tehran, Iran.
| | - Armin Aryannejad
- Experimental Medicine Research Center, Tehran University of Medical Sciences, 13145-784, Tehran, Iran
| | | | - Farnaz Araghi
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Isa Khaheshi
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirreza Azimi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
30
|
Abbaszadeh S, Tabary M, Aryannejad A, Abolhasani R, Araghi F, Khaheshi I, Azimi A. Air pollution and multiple sclerosis: a comprehensive review. Neurol Sci 2021; 42:4063-4072. [PMID: 34341860 DOI: 10.1007/s10072-021-05508-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/22/2021] [Indexed: 01/27/2023]
Abstract
Multiple sclerosis (MS) is an inflammatory, autoimmune demyelinating disorder of the central nervous system (CNS), leading to progressive functional impairments, and many intrinsic and acquired factors are believed to be associated with its development and relapse. In terms of environmental factors, air pollution has gained much attention during recent decades, as chronic exposure to ambient air pollution seems to increase the level of some pro-inflammatory markers in the human brain, which can lead to neuroinflammation, neurodegeneration, and blood-brain barrier (BBB) breakdown. These events may also be associated with the risk of MS development and relapse. In this review, we aimed to summarize recent findings around the impact of air pollutants, including particulate matter (PM10, PM2.5, and ultra-fine particles), gaseous pollutants (carbon monoxide [CO], nitrogen oxides [NOx], sulfur dioxide [SO2], and ozone [O3]), and heavy metals, on MS development and relapse.
Collapse
Affiliation(s)
- Sahand Abbaszadeh
- Students Research Committee, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Mohammadreza Tabary
- Experimental Medicine Research Center, Tehran University of Medical Sciences, 13145-784, Tehran, Iran.
| | - Armin Aryannejad
- Experimental Medicine Research Center, Tehran University of Medical Sciences, 13145-784, Tehran, Iran
| | | | - Farnaz Araghi
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Isa Khaheshi
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirreza Azimi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
31
|
Abbadessa G, Lavorgna L, Trojsi F, Coppola C, Bonavita S. Understanding and managing the impact of the Covid-19 pandemic and lockdown on patients with multiple sclerosis. Expert Rev Neurother 2021; 21:731-743. [PMID: 34278928 DOI: 10.1080/14737175.2021.1957673] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Covid-19 has been sweeping over the world for more than a year. People with Multiple Sclerosis (MS) might be particularly vulnerable either for the disease iteself or for the ongoing immune treatment. The aim of this review is to understand the impact of the Covid-19 pandemic and lockdown on patients with MS and to provide evidence-based advice to ensure them a high standard of care even during the pandemic. AREAS COVERED Literature search was conducted in the Scopus, Web of Science, Pubmed electronic databases, and articles reference lists to investigate the effect of Covid-19 on MS patients' treatment, access to health-care services and mental-health.The search terms 'multiple sclerosis' AND 'Covid-19' were combined with each of the following term 'disease modifying treatment,' 'steroids,' 'vaccination,' 'mental health,' 'stress,' 'quality of life,' 'management,' 'impact,' 'recommendations,'. EXPERT OPINION To ensure MS control during the pandemic, minimizing the risk of Covid-19 contagion, face-to-face visits may be implemented with televisits. Management of relapses and DMTs schedule should be adapted based on the specific benefit/risk ratio for each patient, considering disease activity, disability, comorbidities. Vaccination should be strongly recommended. Telerehabilitation and online psychological support programs should be encouraged to preserve motor performances and mental health.
Collapse
Affiliation(s)
- Gianmarco Abbadessa
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luigi Lavorgna
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesca Trojsi
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Cinzia Coppola
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.,Neurological Institute for Diagnosis and Care "Hermitage Capodimonte", Naples, Italy
| |
Collapse
|
32
|
Giordano A, Cetta I, Orrico M, Montini F, Sangalli F, Colombo B, Filippi M, Martinelli V. Stress related to COVID-19 pandemic as a trigger for disease activity in multiple sclerosis: a case report. Neurol Sci 2021; 42:3969-3971. [PMID: 34297265 PMCID: PMC8299174 DOI: 10.1007/s10072-021-05442-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/24/2021] [Indexed: 12/30/2022]
Affiliation(s)
- Antonino Giordano
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 48, 20132, Milan, Italy
| | - Ilaria Cetta
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 48, 20132, Milan, Italy.,Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mario Orrico
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 48, 20132, Milan, Italy
| | - Federico Montini
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 48, 20132, Milan, Italy
| | | | - Bruno Colombo
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 48, 20132, Milan, Italy.,Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | | |
Collapse
|
33
|
Lee B, Tansey TN, Chan F, Bishop M, Hoyt WT, Hancock LM. Exploration of the Effects of Protective Person–Environment Factors Between Functional Impairments and Stress in Individuals With Multiple Sclerosis: Mediation and Moderation Analyses. REHABILITATION COUNSELING BULLETIN 2021. [DOI: 10.1177/00343552211025534] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Functional impairments can lead to stress in individuals with multiple sclerosis (MS). The study examined protective person and environment factors (i.e., positive cognitive stress appraisal, core self-evaluations [CSE], resilience, hope, spirituality, social support, and environmental supports) as both mediators and moderators of this association to guide understanding of the experience of stress in this population. The sample consisted of 373 participants with MS. In simple mediation analyses, positive cognitive stress appraisal, CSE, resilience, hope, social support, and environmental supports served as a partial mediator between functional impairments and stress. In a parallel mediation analysis, significant unique indirect effects were observed for two of the seven hypothesized mediator variables (CSE and environmental supports). Separate moderator tests provided support for the CSE variable as a protective factor. The positive association between functional impairments and stress was weaker for persons reporting high CSE compared with those reporting low CSE. The findings provide implications for rehabilitation counseling practices by promoting CSE and environmental supports in improving rehabilitation and psychosocial outcomes for individuals with MS.
Collapse
Affiliation(s)
| | | | - Fong Chan
- University of Wisconsin–Madison, USA
| | | | | | - Laura M. Hancock
- University of Wisconsin School of Medicine and Public Health, Madison, USA
- William S. Middleton VA Medical Center, USA
| |
Collapse
|
34
|
Polick CS, Polick SR, Stoddard SA, Braley TJ, Slavich GM. The importance of assessing life stress exposure in multiple sclerosis: A case report. Mult Scler Relat Disord 2021; 54:103145. [PMID: 34274735 DOI: 10.1016/j.msard.2021.103145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/26/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
This case report describes associations between childhood adversity, adult stress exposure, and Multiple Sclerosis (MS) to highlight the intersection between mental health and neurological illness in persons with MS (PwMS). We focus on a high-adversity, high-resource patient who self-referred to mental health services for depression and suicidal ideation, without ever being screened for past or current stress exposure. MS and common comorbid symptoms (e.g., fatigue, depression, suicidality) may be affected by adversity and compounded by pandemic-related stressors, including socio-political and economic sequelae. This case illustrates the potential benefit of screening for lifetime stressors as a mechanism to improve case conceptualizations, enable referrals to mental health specialists to promote coping and resiliency, reduce future MS morbidity, and illuminate stress as an important research focus that deserves further exploration in PwMS.
Collapse
Affiliation(s)
- Carri S Polick
- School of Nursing, University of Michigan, 400 North Ingalls Street, Ann Arbor, MI 48109, USA.
| | - Scott R Polick
- Department of Psychiatry, St. Joseph Mercy Hospital, Ann Arbor, MI, USA
| | - Sarah A Stoddard
- Department of Systems, Populations and Leadership, School of Nursing, University of Michigan Ann Arbor, MI, USA
| | - Tiffany J Braley
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - George M Slavich
- Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| |
Collapse
|
35
|
Manacorda T, Bandiera P, Terzuoli F, Ponzio M, Brichetto G, Zaratin P, Bezzini D, Battaglia MA. Impact of the COVID-19 pandemic on persons with multiple sclerosis: Early findings from a survey on disruptions in care and self-reported outcomes. J Health Serv Res Policy 2021; 26:189-197. [PMID: 33337256 PMCID: PMC8182334 DOI: 10.1177/1355819620975069] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To describe the disruptions in care experienced by persons with Multiple Sclerosis in Italy due to the COVID-19 pandemic and the self-reported impact on their health and wellbeing. METHODS A cross-sectional online survey was completed by 2722 persons with Multiple Sclerosis, after Italy instituted a national lockdown in response to the pandemic. RESULTS Persons with Multiple Sclerosis reported that the pandemic caused broad disruptions to usual health and social care services, which impacted on their health and wellbeing. Disruptions in care were consistently associated with negative self-reported impacts on the expected progression of the disease, on out-of-pocket expenditure and on carer's stress. Psychological consequences were associated with interruption to usual psychological support, and concerns about the safety of care delivered in person. CONCLUSIONS The quality of life of persons with Multiple Sclerosis depends greatly on prompt access to a broad range of health and care services. Negative psychological impacts reported by persons with Multiple Sclerosis with less severe disabilities show that accessible integrated services are crucial for maintenance of their wellbeing. Most persons with Multiple Sclerosis with more severe disability experienced negative impacts on perceived health. Their carers compensating for lack of social input resulted in care overburden. As continuity of care is crucial for persons with Multiple Sclerosis, as well as for persons with chronic conditions in general, strategies must be in place to ensure it is included in future pandemic response plans.
Collapse
Affiliation(s)
- Tommaso Manacorda
- Research Fellow, Department of Health Services Research and
Policy, London School of Hygiene and Tropical Medicine, UK
- Expert Advisor, Italian Multiple Sclerosis Foundation,
Italy
| | - Paolo Bandiera
- Director, Advocacy and Legal Department, Italian Multiple
Sclerosis Society, Italy
| | - Federica Terzuoli
- Project Manager, Advocacy and Legal Department, Italian Multiple
Sclerosis Society, Italy
| | - Michela Ponzio
- Researcher, Scientific Research Area, Italian Multiple Sclerosis
Foundation, Italy
| | - Giampaolo Brichetto
- Researcher, Scientific Research Area, Italian Multiple Sclerosis
Foundation, Italy
- Clinical Director, AISM Rehabilitation Centre, Italian Multiple
Sclerosis Society, Italy
| | - Paola Zaratin
- Research Director, Scientific Research Area, Italian Multiple
Sclerosis Foundation, Italy
| | - Daiana Bezzini
- Researcher, Department of Life Sciences, University of Siena,
Italy
| | - Mario A Battaglia
- President, Italian Multiple Sclerosis Foundation and Professor,
Department of Life Sciences, University of Siena, Italy
| |
Collapse
|
36
|
Mindfulness-Based Interventions for the Improvement of Well-Being in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis. Psychosom Med 2021; 82:600-613. [PMID: 32541543 DOI: 10.1097/psy.0000000000000819] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The study aims to meta-analytically review studies about the effects of mindfulness-based interventions (MBIs) on well-being of people with multiple sclerosis (MS). METHODS Seven electronic databases were searched from June 2018 to September 2018. A systematic review and a meta-analysis were conducted. RESULTS Twenty-one studies were included in qualitative synthesis, and 10 studies were included in meta-analysis. MBIs are effective with an overall moderate effect size (Hedges' g = 0.70) in improving well-being in people with MS, with lasting effects at the follow-up (g = 0.55). In particular, MBIs demonstrated to highly reduce stress (g = 1.07) and to improve depression and anxiety symptoms with a moderate to large effect at postintervention (g = 0.77 and g = 0.63, respectively). CONCLUSIONS MBIs represent a valid and effective mind-body intervention to improve the well-being of patients with MS. Further studies should investigate which components of MBIs could be more beneficial for patients with progressive MS. PROSPERO REGISTRATION CRD42018099704.
Collapse
|
37
|
Kołtuniuk A, Kazimierska-Zając M, Cisek K, Chojdak-Łukasiewicz J. The Role of Stress Perception and Coping with Stress and the Quality of Life Among Multiple Sclerosis Patients. Psychol Res Behav Manag 2021; 14:805-815. [PMID: 34177278 PMCID: PMC8219305 DOI: 10.2147/prbm.s310664] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/17/2021] [Indexed: 12/20/2022] Open
Abstract
Purpose Multiple sclerosis (MS) is one of the most common neurological disorders and a cause of disability in young adults. Adequate stress management in MS patients may merit the benefits of both physical and psychological well-being. This study aimed to evaluate the quality of life in MS patients and its correlation with stress levels and coping strategies. Methods This descriptive and correlational study was conducted among 109 patients diagnosed with relapsing-remitting MS (RRMS). The study was based on a questionnaire designed by the authors and the following standardized questionnaires: the Perceived Stress Scale (PSS-10), the Inventory for Measuring Coping with Stress (Mini-COPE), and the Multiple Sclerosis International Quality of Life Questionnaire (MusiQoL). Results Data analysis showed that 47.71% of the patients experienced a high level of stress, and the most often used strategies under challenging situations included seeking emotional support (2.11) and active coping (1.96). Also, it showed that when the level of stress is higher, the QOL in all domains is lower. Coping strategies such as sense of humor, turning to religion, self-distraction, denial, venting, substance use, behavioral disengagement, and self-blame are negatively correlated with the quality of life of MS. Conclusion Quality of life in MS patients is negatively affected by a higher level of perceived stress. The use of coping strategies such as active coping, positive reframing, acceptance, and seeking emotional and instrumental support is positively correlated with the quality of life of MS patients.
Collapse
Affiliation(s)
- Aleksandra Kołtuniuk
- Department of Nervous System Diseases, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Magdalena Kazimierska-Zając
- Department of Nervous System Diseases, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Kinga Cisek
- Department of Nervous System Diseases, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | | |
Collapse
|
38
|
Lakin L, Davis BE, Binns CC, Currie KM, Rensel MR. Comprehensive Approach to Management of Multiple Sclerosis: Addressing Invisible Symptoms-A Narrative Review. Neurol Ther 2021; 10:75-98. [PMID: 33877583 PMCID: PMC8057008 DOI: 10.1007/s40120-021-00239-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/03/2021] [Indexed: 02/06/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic autoimmune inflammatory disease of the central nervous system, leading to neurodegeneration and manifesting as a variety of symptoms. These can include "invisible" symptoms, not externally evident to others, such as fatigue, mood disorders, cognitive impairments, pain, bladder/bowel dysfunction, sexual dysfunction, and vision changes. Invisible symptoms are highly prevalent in people living with MS, with multifactorial etiology and potential to impact the disease course. Patient experiences of these symptoms include both physical and psychosocial elements, which when unaddressed negatively influence many aspects of quality of life and perception of health. Despite the high impact on patient lives, gaps persist in awareness and management of these hidden symptoms. The healthcare provider and patient author experiences brought together here serve to raise the profile of invisible symptoms and review strategies for a team-based approach to comprehensive MS care. We summarize the current literature regarding the prevalence and etiology of invisible symptoms to convey the high likelihood that a person living with MS will contend with one or more of these concerns. We then explore how open communication between people living with MS and their care team, stigma mitigation, and shared decision-making are key to comprehensive management of invisible symptoms. We recommend validated screening tools and technological advancements that may be incorporated into MS care to regularly monitor these symptoms, offering insight into how healthcare providers can both educate and listen to patients, with the goal of improved patient quality of life. By pairing clinical knowledge with an understanding and consideration of the patient perspective, providers will be equipped to foster a patient-centered dialogue that encourages shared decision-making. Invisible symptoms of MS.
Collapse
Affiliation(s)
- Lynsey Lakin
- The Neurology Group, 9120 Haven Ave, Rancho Cucamonga, CA, USA
- Comprehensive MS Center, The University of California Riverside, 3390 University Ave, Suite 100, Riverside, CA, USA
| | - Bryan E Davis
- Comprehensive MS Center, The University of California Riverside, 3390 University Ave, Suite 100, Riverside, CA, USA
| | - Cherie C Binns
- Accelerated Cure Project/iConquerMS, 187 Robinson Street, Wakefield, RI, USA
| | - Keisha M Currie
- Currie Consultancy Agency LLC., 11 M. R. Watson Court, Eastover, SC, USA
| | - Mary R Rensel
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA.
| |
Collapse
|
39
|
Coping with stress during the first wave of the COVID-19 pandemic by Turkish people with Multiple Sclerosis: The relationship between perceived stress and quality of life. Mult Scler Relat Disord 2021; 53:103039. [PMID: 34087686 PMCID: PMC8451203 DOI: 10.1016/j.msard.2021.103039] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/09/2021] [Accepted: 05/16/2021] [Indexed: 12/26/2022]
Abstract
Background Multiple sclerosis (MS) is a chronic inflammatory disease and acute exacerbations are also a part of the clinical course. The presence of the disease and relapses cause stress in people with MS (pwMS). For this reason, stress coping strategies of the patients are important in reducing perceived stress. Our aim in this study is to evaluate which strategies pwMS use during the COVID-19 pandemic, the effect of the strategies on perceived stress, their relationship with relapses and their role on quality of life (QoL). Methods An online form including Perceived Stress Scale (PSS; 10 items), Coping with Experienced Problems Scale (Brief-COPE; 28 items) and SF-12 were sent to 340 pwMS under our follow-up. Results During the COVID-19 pandemic, we found that the patients used the strategies of turn to religion, planning and acceptance at a high rate. PSS score was high in 23 (11.2%) of the patients. The patients with low perceived stress used the acceptance strategy more (P=0.008). We found a negative correlation between physical component summary (PCS) of SF-12 and denial (r=-0.2, p<0.001) and distraction (r =-0.1, p=0.04). A negative correlation was found between mental component summary (MCS) of SF-12 and behavioral disconnection (r=-0.2, p=0.006). There was a positive correlation between MCS and humor (r=0.1, p=0.04), use of instrumental support (r=0.2, p=0.009), planning (r=0.1, p=0.04), and positive reframing (r=0.2, p=0.002). Conclusion PwMS have been successful in coping with stress in the first half of the pandemic with the combination of emotional and problem-focused strategies. Acceptance strategy was highly adopted by patients with low PSS, and the tendency to use the active coping strategy together with the acceptance strategy was high in patients without relapses. Adoption to emotional strategies may have prevented the severe deterioration in QoL in this study group in the early period of Covid-19 pandemic.
Collapse
|
40
|
Sbragia E, Colombo E, Pollio C, Cellerino M, Lapucci C, Inglese M, Mancardi G, Boffa G. Embracing resilience in multiple sclerosis: a new perspective from COVID-19 pandemic. PSYCHOL HEALTH MED 2021; 27:352-360. [PMID: 33899615 DOI: 10.1080/13548506.2021.1916964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Coronavirus disease 2019 (COVID-19) resulted in several psychological consequences. Past epidemiological experiences already showed the deep albeit heterogeneous psychological repercussions of pandemics. Nevertheless, little is known about COVID-19 outbreak and the possible strategies for boosting resilience in patients with chronic diseases such as Multiple Sclerosis (MS). Therefore, we designed a study aiming to assess the changes in mental distress during COVID-19 outbreak in patients with MS and to identifyfactors contributing to resilience's development.We enrolled 106 patients (69 relapsing-remitting, 20 secondary-progressive, and 17 primary-progressive) whose neuropsychological assessment before the COVID-19 pandemic (1 January 2019-1 March 2020) was available. It consisted of Brief International Cognitive Assessment for MS (BICAMS), Hospital Anxiety and Depression Scale (HADS) and patient-reported MS Neuropsychological Screening Questionnaire (MSNQ-P). All patients were re-tested during Italian lockdown through an online survey, comprehensive of sociodemographic information, HADS self-rating Scale, MSNQ-P Questionnaire and finally Connor-Davidson Resilience self-rating Scale (CD-RISC 25), in order to evaluate resilience.No significant changes in HADS and MSNQ-P scores were detected during COVID-19 pandemic in our population. Though, pre-existing lower HADS and MSNQ-P scores but not demographic, disease- and treatment-related elements were found significantly (p < 0.0001) and independently associated with a better resilience attitude.
Collapse
Affiliation(s)
- Elvira Sbragia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, Genoa, Italy
| | - Eleonora Colombo
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, Genoa, Italy
| | - Chiara Pollio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, Genoa, Italy
| | - Maria Cellerino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, Genoa, Italy
| | - Caterina Lapucci
- Laboratory of Experimental Neurosciences, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, Genoa, Italy.,Department of Neurology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Gianluigi Mancardi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, Genoa, Italy.,Scientific Clinical Institutes Maugeri IRCCS, Genova, Italy
| | - Giacomo Boffa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, Genoa, Italy
| |
Collapse
|
41
|
Korkmaz C, Üsküdar Cansu D, Kabay SC. Familial coexistence of demyelinating diseases and familial Mediterranean fever. Rheumatol Int 2021; 42:167-173. [PMID: 33715072 DOI: 10.1007/s00296-021-04821-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/20/2021] [Indexed: 11/26/2022]
Abstract
Familial Mediterranean fever (FMF) is a monogenic autoinflammatory disease characterized by fever and serositis attacks caused by mutations in the MEditerranean FeVer (MEFV) gene encoding the pyrin gene. Gain of the function mutations of the pyrin gene lead to stimulation of pro-inflammatory cytokines. Persistent pro-inflammatory situation in the course of FMF may play a role in the development of some other inflammatory diseases such as Behcet's disease, psoriasis, and vasculitis. Multiple sclerosis (MS), as a demyelinating disorder, is also more commonly seen in FMF patients compared to the general population. There are scarcely any research reporting that these two diseases coexist in more than one person in the same family. We have discovered cases of FMF and demyelinating disorders in five members of two different families. Besides the two families we are reporting, there are only four other families reported so far. Having combined the data of all these six families, we present a case-based review in this study. We aimed to draw attention of physicians to familial co-occurence of FMF and demyelinating disorders and also to discuss possible mechanisms of the coexistence of these two diseases in light of the literature.
Collapse
Affiliation(s)
- Cengiz Korkmaz
- Division of Rheumatology, Department of Internal Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey.
| | - Döndü Üsküdar Cansu
- Division of Rheumatology, Department of Internal Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Sibel Canbaz Kabay
- Department of Neurology, Kütahya Health Science University, Kütahya, Turkey
| |
Collapse
|
42
|
Melnikov M, Sviridova A, Rogovskii V, Oleskin A, Boziki M, Bakirtzis C, Kesidou E, Grigoriadis N, Boykо A. Serotoninergic system targeting in multiple sclerosis: the prospective for pathogenetic therapy. Mult Scler Relat Disord 2021; 51:102888. [PMID: 33756440 DOI: 10.1016/j.msard.2021.102888] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 02/07/2023]
Abstract
Serotonin (5-hydroxytryptamine) (5-HT) is a neurotransmitter, which mediates neuropsychological functions of the central nervous system (CNS). Recent studies have shown the modulatory effect of 5-HT on gut microbiota functions, which play an essential role in developing CNS inflammatory diseases. Finally, 5-HT is a direct mediator of neuroimmune interaction. The article reviews the literature data on the role of 5-HT in the regulation of neuroinflammation in multiple sclerosis (MS). The influence of 5-HT and selective serotonin reuptake inhibitors (SSRIs) on experimental autoimmune encephalomyelitis (EAE) and MS pathogenesis, as well as the therapeutic potential of serotoninergic drugs as a pathogenetic therapy of MS, are discussed.
Collapse
Affiliation(s)
- Mikhail Melnikov
- Department of Neuroimmunology, Federal Center of Brain research and Neurotechnology of the Federal Medical-Biological Agency of Russia; Department of Neurology, Neurosurgery and Medical Genetics and Department of Molecular Pharmacology and Radiobiology, Pirogov Russian National Research Medical University, Moscow, Russia; Laboratory of Clinical Immunology, National Research Center Institute of Immunology of the Federal Medical-Biological Agency of Russia, Moscow, Russia.
| | - Anastasiya Sviridova
- Department of Neuroimmunology, Federal Center of Brain research and Neurotechnology of the Federal Medical-Biological Agency of Russia; Department of Neurology, Neurosurgery and Medical Genetics and Department of Molecular Pharmacology and Radiobiology, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Vladimir Rogovskii
- Department of Neuroimmunology, Federal Center of Brain research and Neurotechnology of the Federal Medical-Biological Agency of Russia; Department of Neurology, Neurosurgery and Medical Genetics and Department of Molecular Pharmacology and Radiobiology, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Alexander Oleskin
- General Ecology and Hydrobiology Department, School of Biology, Moscow State University, Moscow, Russia
| | - Marina Boziki
- 2nd Neurological University Department, Aristotle University of Thessaloniki, AHEPA General Hospital, Thessaloniki, Greece
| | - Christos Bakirtzis
- 2nd Neurological University Department, Aristotle University of Thessaloniki, AHEPA General Hospital, Thessaloniki, Greece
| | - Evangelia Kesidou
- 2nd Neurological University Department, Aristotle University of Thessaloniki, AHEPA General Hospital, Thessaloniki, Greece
| | - Nikolaos Grigoriadis
- 2nd Neurological University Department, Aristotle University of Thessaloniki, AHEPA General Hospital, Thessaloniki, Greece
| | - Alexey Boykо
- Department of Neuroimmunology, Federal Center of Brain research and Neurotechnology of the Federal Medical-Biological Agency of Russia; Department of Neurology, Neurosurgery and Medical Genetics and Department of Molecular Pharmacology and Radiobiology, Pirogov Russian National Research Medical University, Moscow, Russia
| |
Collapse
|
43
|
Krause N, Riemann-Lorenz K, Steffen T, Rahn AC, Pöttgen J, Stellmann JP, Köpke S, Friede T, Icks A, Vomhof M, Temmes H, van de Loo M, Gold SM, Heesen C. Study protocol for a randomised controlled trial of a web-based behavioural lifestyle programme for emPOWERment in early Multiple Sclerosis (POWER@MS1). BMJ Open 2021; 11:e041720. [PMID: 33593774 PMCID: PMC7888332 DOI: 10.1136/bmjopen-2020-041720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Multiple sclerosis (MS) is an inflammatory and degenerative disease of the central nervous system that mainly affects young adults. Uncertainty is a major psychological burden of the disease from diagnosis to prognosis, enhanced by the pressure to make early decisions on a diverse set of immunotherapies. Watchful waiting for 1-2 years while adapting goals and lifestyle habits to life with a chronic disease represents another reasonable option for persons with MS (PwMS). A behaviour change programme based on evidence-based patient information (EBPI) is not available in standard care. This randomised controlled trial (RCT) with an embedded process evaluation investigates the efficacy and cost-effectiveness of a web-based behavioural lifestyle programme to change lifestyle behaviour and reduce inflammatory disease activity in PwMS. METHODS AND ANALYSIS A web-based behavioural intervention will be evaluated in an RCT aiming to recruit 328 persons with clinically isolated syndrome, suspected MS or confirmed MS for less than 1 year, who have not yet started immunotherapy. Moreover, a mixed-methods process evaluation and a health economic evaluation will be carried out. Participants will be recruited in at least 16 MS centres across Germany and randomised to an intervention group with 12 months of access to EBPI about lifestyle factors in MS, combined with a complex behaviour change programme or to a control group (optimised standard care). The combined primary endpoint is the incidence of new T2 lesions on MRI or confirmed relapses. ETHICS AND DISSEMINATION The study has been approved by the Ethics Committee of the Hamburg Chamber of Physicians (PV6015). Trial results will be communicated at scientific conferences and meetings and presented on relevant patient websites and in patient education seminars. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03968172); Pre-results.
Collapse
Affiliation(s)
- Nicole Krause
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karin Riemann-Lorenz
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tanja Steffen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Christin Rahn
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Jana Pöttgen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan-Patrick Stellmann
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- APHM, Timone Hospital, CEMEREM, Marseille, France
| | - Sascha Köpke
- University of Cologne, Faculty of Medicine and University Hospital Cologe, Institute of Nursing Science, Cologne, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Centre Göttingen, Göttingen, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Markus Vomhof
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Herbert Temmes
- German Multiple Sclerosis Society, Federal Association, Hannover, Germany
| | - Markus van de Loo
- German Multiple Sclerosis Society, Federal Association, Hannover, Germany
| | - Stefan M Gold
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychiatry and Medical Department, Section Psychosomatic Medicine, Charité-University Medicine Berlin, Berlin, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
44
|
Ramezani N, Ashtari F, Bastami EA, Ghaderi K, Hosseini SM, Naeini MK, Rajabi F, Adibi I. Fear and anxiety in patients with multiple sclerosis during COVID-19 pandemic; report of an Iranian population. Mult Scler Relat Disord 2021; 50:102798. [PMID: 33571791 PMCID: PMC7982777 DOI: 10.1016/j.msard.2021.102798] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/21/2021] [Accepted: 01/26/2021] [Indexed: 02/06/2023]
Abstract
Background There are reports that stress-related disorders are increasing during coronavirus disease 2019 (COVID-19) pandemic. Patients with Multiple Sclerosis (MS) are at higher risk of developing psychiatric disorders, which result in worsening of their disability. There are concerns about the mental health of MS patients during this pandemic. Objective We aimed to evaluate the prevalence of anxiety, depression, and levels of fear about Corona in MS patients during the COVID-19 pandemic. Materials and methods This was a cross-sectional study on MS patients who were admitted to the MS clinics affiliated with Isfahan University of medical sciences from May to June 2020. Anxiety and depression were evaluated according to the Hospital Anxiety and Depression Scale (HADS). The Corona Fear Questionnaire developed by Ahorsu et al. was applied to evaluate the state of fear about COVID-19. Chi-square tests were used to compare depression and anxiety between different groups, Kruskal-Wallis was used for fear scores, Spearman correlation coefficient was also reported for correlations. Results 410 MS patients with a mean age of 38.6 years (±10.35) were enrolled in the study. Among those patients who answered the HADS questionnaire completely (n=399, n=388, for anxiety and depression subscales respectively) the prevalence of anxiety and depression were 31.2% (n=128) and 39.3% (n=161), respectively. There was no significant relationship between anxiety and depression with any of the following variables: sex, marital status, history of drug abuse, smoking, duration of taking psychiatric medication, being tested for COVID-19, being quarantined. Regarding fear about COVID-19, patients with depression or anxiety showed higher scores on the fear questionnaire (p-value=0.03, p-value=0.008 respectively). Conclusions The prevalence of anxiety and depression in MS patients was higher than previously reported. Fear about COVID-19 was correlated with anxiety and depression. Multicenter studies are required to develop specific recommendations for screening mental health problems in MS patients during COVID pandemic.
Collapse
Affiliation(s)
- Neda Ramezani
- Isfahan Neurosciences Research Center, Isfahan University of medical sciences, Isfahan, Iran
| | - Fereshteh Ashtari
- Isfahan Neurosciences Research Center, Isfahan University of medical sciences, Isfahan, Iran; Department of neurology, School of medicine, Isfahan University of medical sciences, Isfahan, Iran.
| | - Elahe Abdi Bastami
- Isfahan Neurosciences Research Center, Isfahan University of medical sciences, Isfahan, Iran
| | - Kimia Ghaderi
- Isfahan Neurosciences Research Center, Isfahan University of medical sciences, Isfahan, Iran
| | - Sayed Mohsen Hosseini
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Kazemi Naeini
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Rajabi
- Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Iman Adibi
- Isfahan Neurosciences Research Center, Isfahan University of medical sciences, Isfahan, Iran; Department of neurology, School of medicine, Isfahan University of medical sciences, Isfahan, Iran
| |
Collapse
|
45
|
Bonavita S, Sparaco M, Russo A, Borriello G, Lavorgna L. Perceived stress and social support in a large population of people with multiple sclerosis recruited online through the COVID-19 pandemic. Eur J Neurol 2021; 28:3396-3402. [PMID: 33368849 DOI: 10.1111/ene.14697] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 10/31/2020] [Accepted: 12/15/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE The COVID-19 emergency may cause post-traumatic stress disorder (PTSD), and with regard to people with MS (pwMS) chronic exposure to a wide range of challenging life events has been shown to be correlated with worsening of neurological symptoms, increased lesion burden on brain magnetic resonance imaging and relapses. The aim was to investigate perceived stress, depression, perceived social support, habits and behaviour changes in pwMS through COVID-19 in comparison to a control group. METHODS A web-based survey was posted on SMsocialnetwork.com to investigate perceived stress (using the Perceived Stress Scale), depression (with Patient Health Questionnaire 2) and perceived social support (using Social Provision Scale 10 item) in pwMS and a control group through the COVID-19 pandemic. A secondary group of people with migraine was investigated. RESULTS In all, 1286 answers from 612 pwMS and 674 control people were included in the final analysis. The answers from 318 people with migraine were included for a secondary analysis. A higher proportion of pwMS were depressed (43.1% vs. 23.1%; p < 0.001), had a high level of perceived stress (58% vs. 39.8%; p < 0.001) and felt significantly less social support (median 33 vs. 35; Q1-Q3 28-36 vs. 32-37; p < 0.001) compared to the control group. A higher percentage of people with migraine were depressed (50% vs. 43%, p = 0.04) compared to pwMS. CONCLUSIONS Considering the negative impact that prolonged stress may have on clinical and radiological disease activity of pwMS, and bearing in mind that a beneficial effect has been demonstrated and achieved with stress management, it is suggested to promote stress control in these patients during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy.,Neurological Institute for Diagnosis and Care 'Hermitage Capodimonte', Naples, Italy
| | - Maddalena Sparaco
- Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Antonio Russo
- Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | | | - Luigi Lavorgna
- Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| |
Collapse
|
46
|
Disability and its association with psychological factors in multiple sclerosis patients. Mult Scler Relat Disord 2021; 49:102733. [PMID: 33571947 DOI: 10.1016/j.msard.2020.102733] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/21/2020] [Accepted: 12/30/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Multiple Sclerosis (MS) is a neurological, and immune-mediated demyelinating disease. Psychological factors in MS disease and psychosocial interventions based on these factors have a major role in the adjustment of MS patients toward their disease. The aim of the study was to compare the psychological components of happiness, psychological well-being, love of life, meaning in life, and somatic health between MS patients with low Expanded Disability Status Scale (EDSS) scores and MS patients with higher EDSS scores. METHOD A sample of 128 patients with MS was recruited. Patients were administered the EDSS, the Self-Rating Scale of Happiness (SRH), the World Health Organization-five Well-Being Index (WHO-5), the Love of Life Scale (LLS), the Meaning in Life Questionnaire (MLQ) and the Patient Health Questionnaire-15 (PHQ-15). Patients with EDSS>3 (cases) and EDSS≤3 (controls) were compared. RESULTS The cases had lower scores for happiness, love of life, psychological well-being, meaning in life, the present of meaning in life subscale, and somatic health, compared with the controls. The differences between cases and controls remained statistically significant after controlling for age and sex. CONCLUSION Positive health promotion and education intervention programs to reduce disability and increase MS patients' well-being should be one of the priorities in the Iran healthcare system for MS patients. Therapists should take these components into account when working with MS patients with moderate and severe disability.
Collapse
|
47
|
The International Classification of Functioning, Disability, and Health (ICF) as a community participation model for people with multiple sclerosis: A hierarchical regression analysis. THE AUSTRALIAN JOURNAL OF REHABILITATION COUNSELLING 2020. [DOI: 10.1017/jrc.2020.15] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AbstractMultiple sclerosis (MS) is a central nervous system disorder that impacts more than 400,000 people in the U.S. The disease results in multiple functional impairments that are diverse and varied across individuals. Additonally, MS has a profound impact on community participation which, like other rehabilitation outcomes, cannot be explained on the basis of functional limitations alone. The purpose of this study was to develop and evaluate a model of community participation for people living with MS using the World Health Organization (WHO) International Classification of Functioning, Disability, and Health (ICF) framework. The model focused on the roles that personal factors have as predictors of community participation, while also serving as mediators and moderators for the relationship between activity limitation and participation. Results from the hierarchical regression analysis indicated that demographic characteristics (i.e. MS type), personal factors (i.e. core self-evaluations (CSE), MS self-management, resilience, and social skills), and activity limitations accounted for 64% of the variance in participation. Further, mediation analysis indicated that CSE mediated the relationship between activity limitation and community participation. Finally, moderation analysis indicated an interaction effect between educational attainment and MS self-management. Implications for future research in rehabilitation and clinical application are discussed.
Collapse
|
48
|
Anagnostouli M, Markoglou N, Chrousos G. Psycho-neuro-endocrino-immunologic issues in multiple sclerosis: a critical review of clinical and therapeutic implications. Hormones (Athens) 2020; 19:485-496. [PMID: 32488815 DOI: 10.1007/s42000-020-00197-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/06/2020] [Indexed: 12/16/2022]
Abstract
Multiple sclerosis (MS) is a multifactorial, chronic, immune-mediated, and neurodegenerative disease, having a well-known hypothalamic-pituitary-adrenal (HPA) axis dysfunction. Several hormones have a great impact in the immune dysregulation, psychology, and cognitive status of patients with MS, as also in the fertility and response to treatment. In this comprehensive review, as an introduction, we mention basic data concerning MS: epidemiology, genetics, immunogenetics, epigenetics, pathophysiology, and neuroimmunology. Hormonal components of the disease cascade, mainly glucocorticoids (stress-related hormone), estrogens, prolactin and dehydroepiandrosterone (sex-related hormones), melatonin, and vitamin D, are discussed, aiming at focusing on core data regarding the impact of these hormones in MS pathophysiology, severity of the disease, correlation with comorbid mental disorders, and fertility. A great focus is given in the pre- and post-pregnancy period of MS patients, in the context of the disease-modifying treatments (DMTs) and HPA status, having in mind that there are only very limited knowledge and few papers on this specific life period of these women, having MS. All this data are presented in the main text and also in the workable tables, for the first time, suggesting targeted topics that need to be addressed in the near future.
Collapse
Affiliation(s)
- Maria Anagnostouli
- Demyelinating Diseases Clinic, 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Aeginition Hospital, Vasilissis Sofias 72-74, 115 28, Athens, Greece.
- Immunogenetics Laboratory, 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Aeginition Hospital, Vasilissis Sofias 72-74, 115 28, Athens, Greece.
| | - Nikolaos Markoglou
- Immunogenetics Laboratory, 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Aeginition Hospital, Vasilissis Sofias 72-74, 115 28, Athens, Greece
| | - George Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
49
|
Fisher PL, Salmon P, Heffer-Rahn P, Huntley C, Reilly J, Cherry MG. Predictors of emotional distress in people with multiple sclerosis: A systematic review of prospective studies. J Affect Disord 2020; 276:752-764. [PMID: 32736185 DOI: 10.1016/j.jad.2020.07.073] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/20/2020] [Accepted: 07/05/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Emotional distress (defined as any negative mood state, including anxiety, depression, trauma symptoms and global distress) is common in people with multiple sclerosis (PwMS). To develop more integrated care for PwMS requires a better understanding of causal variables underlying persistent emotional distress. This systematic review critically appraised and synthesised the findings of prospective studies investigating predictors of emotional distress in PwMS. METHOD CINAHL, Medline, and PsycINFO, were systematically searched for: i) prospective cohort studies with ≥1-month follow-up period, which; ii) evaluated baseline clinical and demographic, social and/or psychosocial predictors of emotional distress; iii) presented results for adults with MS; and iv) used validated measures to assess emotional distress. Risk of bias was assessed using an adapted version of the Newcastle-Ottawa Scale. RESULTS Thirteen studies, reported in 17 papers, were included. A wide range of outcome measures and statistical methods were used. The most reliable finding was that baseline emotional distress and stress-coping variables predicted emotional distress. Less robust support was found for income, negative cognitive illness appraisals and poor social support. No other variables often predicted emotional distress. LIMITATIONS Lack of consistency across included studies may limit confidence in the results obtained. CONCLUSIONS Little is currently known about how or why some people become and remain distressed following a diagnosis of MS, whilst others do not. However, psychological and social factors such as emotional distress and stress-coping variables appear to be important. A better understanding of the psychological factors underpinning distress in PwMS is needed.
Collapse
Affiliation(s)
- Peter L Fisher
- Department of Psychological Sciences, University of Liverpool, Whelan Building, Quadrangle, Brownlow Hill, Liverpool L69 3GB, United Kingdom; Clinical Health Psychology Service, Linda McCartney Centre, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, United Kingdom.
| | - Peter Salmon
- Department of Psychological Sciences, University of Liverpool, Whelan Building, Quadrangle, Brownlow Hill, Liverpool L69 3GB, United Kingdom; Clinical Health Psychology Service, Linda McCartney Centre, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, United Kingdom
| | - Phillip Heffer-Rahn
- Department of Psychological Sciences, University of Liverpool, Whelan Building, Quadrangle, Brownlow Hill, Liverpool L69 3GB, United Kingdom
| | - Chris Huntley
- Department of Psychological Sciences, University of Liverpool, Whelan Building, Quadrangle, Brownlow Hill, Liverpool L69 3GB, United Kingdom
| | - James Reilly
- Department of Psychological Sciences, University of Liverpool, Whelan Building, Quadrangle, Brownlow Hill, Liverpool L69 3GB, United Kingdom
| | - Mary Gemma Cherry
- Department of Psychological Sciences, University of Liverpool, Whelan Building, Quadrangle, Brownlow Hill, Liverpool L69 3GB, United Kingdom; Clinical Health Psychology Service, Linda McCartney Centre, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, United Kingdom
| |
Collapse
|
50
|
Alessi MG, Bennett JM. Mental health is the health of the whole body: How psychoneuroimmunology & health psychology can inform & improve treatment. J Eval Clin Pract 2020; 26:1539-1547. [PMID: 32171052 DOI: 10.1111/jep.13386] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/12/2020] [Accepted: 02/20/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Converging and accumulating evidence for the cross-communication among the nervous, immune, and endocrine systems, a field of study known as psychoneuroimmunology, implicates immunological dysfunction as a shared and common mechanism of both mental and physical illness. For example, psychiatric disorders like schizophrenia, bipolar disorder, major depression, and anxiety disorders have higher prevalence rates across a spectrum of autoimmune conditions compared to the general population. Additionally, subclinical immunological abnormalities are observed in a variety of psychiatric conditions, with chronic inflammation most extensively studied in the pathophysiology of depression. These observations blur the historical distinctions between mental and physical illness, yet clinical practice remains fragmented and primarily focused on differentially treating individual symptoms. PROPOSED THESIS Therapeutically targeting inflammation offers translational opportunities for integrating mental and physical healthcare, a key niche of the interdisciplinary field of health psychology. CONCLUSION Utilizing a psychoneuroimmunological lens, health psychologists and clinicians can reconceptualize healthcare through integrative treatment approaches and advocacy for comprehensive policy-level reform at both the individual-level of care as well as community-wide prevention approaches.
Collapse
Affiliation(s)
- Maria G Alessi
- Health Psychology PhD Program, UNC Charlotte, Charlotte, North Carolina, USA
| | - Jeanette M Bennett
- Health Psychology PhD Program, UNC Charlotte, Charlotte, North Carolina, USA.,Department of Psychological Science, UNC Charlotte, Charlotte, North Carolina, USA
| |
Collapse
|