Depression and neuroticism in multiple sclerosis

Psychiatric manifestations of multiple sclerosis and acute disseminated encephalomyelitis

It is unusual for acute disseminated encephalomyelitis and multiple sclerosis to present as purely psychiatric disorders. We report five patients with such demyelinating diseases and symptoms of psychosis, depression or anxiety. The importance of excluding demyelination as the basis for these psychiatric disturbances is emphasized, especially in the presence of unexplained neurologic findings. The possible relationship between psychiatric symptoms and demyelinating disorders is explored.

Emotional distress and activities of daily living functioning in persons with multiple sclerosis

BACKGROUND

Emotional distress is higher in persons with multiple sclerosis (MS) than in other chronic illnesses. Not known is whether personal attributes of the person with MS and/or the presence of social support will function as mediating and/or moderating variables between emotional distress and adaptation to the illness.

OBJECTIVES

Determine if personal attributes and social support function as mediating and/or moderating variables between emotional distress and ADL functioning in persons with MS.

METHODS

Secondary analyses of data obtained from 686 persons with MS through self-report measures of emotional distress, personal attributes, social support, and ADL functioning was conducted. Separate mediation and moderation models were tested using stepwise and hierarchical multiple regression. Demographic variables of education, age, and length of MS illness, were controlled in all analyses.

RESULTS

Personal attributes and social support functioned as mediator variables between emotional distress and ADL functioning. Additionally, personal attributes and not social support functioned as a moderator. Significant main effects were shown for social support and emotional distress in the moderator model.

CONCLUSION

Personal attributes and social support mediated the effects of emotional distress by decreasing its impact on ADL functioning. Personal attributes, as a moderator variable, demonstrated that higher levels were associated with low levels of emotional stress and moderate or lower levels of personal attributes were associated with increased emotional distress suggesting that personal attributes may intervene between emotional distress and ADL functioning by attenuating or preventing a stress appraisal response.

A new approach to affective symptoms in relapsing-remitting multiple sclerosis

A variety of psychiatric disorders accompany multiple sclerosis (MS), affecting the spheres of cognition, affect, and personality. These disorders may be of primary and/or secondary nature, reflecting, respectively, neurologic damage and/or functional distress associated with a disabling disease. Evaluation of the nature, severity, and frequency of affective symptoms of MS patients is of importance to sensitize the treating physician to the possible need for specific psychiatric treatment. We conducted a prospective cross-sectional study assessing correlations of psychiatric symptomatology and the neurologic parameters of disease duration, disease activity (as expressed by the number of disease exacerbations per year), and disease severity (as measured by the Kurtzke Expanded Disability Status Scale [EDSS]) in 20 relapsing-remitting (RR)-MS patients. Patients were also evaluated by a semistructured psychiatric interview and the following rating scales: Hamilton Anxiety Scale (HAS), Hamilton Depression Scale (HDS), Hackett-Cassem Denial Scale, and Lubin Adjective Affective List. Results demonstrated a high prevalence of anxiety (90%) and to a lesser extent depression (50%) in RR-MS patients. Depression and anxiety were found to be associated with disease activity, but not with disease duration or severity. The mechanism of denial played a significant role in the psychiatric profile of the disease and was correlated with disease duration. We suggest that in RR-MS patients, psychiatric evaluation should also include assessment of defense and coping mechanisms, which in turn could guide specific individualized treatment.

Multiple sclerosis: correlation of anxiety, physical impairment and cognitive dysfunction

The aim of the study was to examine the correlation between anxiety and physical impairment and to discover whether anxiety correlated with specific forms of cognitive dysfunction. Ninety-four patients (42 females, 52 males) with definite MS entered the study. Anxiety was measured using the State-Trait Anxiety Inventory, physical impairment by means of the Kurtzke Disability Status scale, and cognitive impairment by using the Trail Making, Symbol Digit Modalities, Auditory Verbal Learning, Story Recall and the Recurring Figures tests. Moderately handicapped patients (DSS 4-5) showed signs of anxiety, and physical impairment correlated with anxiety (p < 0.05; d.f. 1.92). Trail Making also correlated with anxiety (p < 0.01; d.f. 1.86). On the basis of the results of this and previous studies, it is concluded that anxiety can be a sign of cognitive dysfunction, physical impairment or social strain.