Abstracts of the RCPsych International Congress 2022, 20-23 June

AIMS

Multiple sclerosis (MS) is an autoimmune disease characterized by focal demyelinating lesions that can affect any part of the central nervous system. The highlight of the disease is the wide range of neurological deficits; however, psychiatric manifestations are not uncommon. MS is associated with psychiatric comorbidities, such as depression and anxiety disorders. This is due to either its disease process or its therapies that have been well documented in the literature. However, the link between psychosis as a prodrome and MS remains understudied and relatively uncommon.

METHODS

We present a 40-year-old gentleman who developed isolated psychiatric manifestations for about 10 years in the form of progressive behavioral changes, social and occupational dysfunction, coupled with persecutory delusions. No personal or family history of mental illnesses. He was diagnosed and treated as a case of schizophrenia by a psychiatrist with multiple antipsychotics with a minimal improvement of his symptoms. Three months before our assessment the patient had a history of difficulty walking associated with urine and fecal incontinence. On examination, he had restricted affect and was easily agitated. Neurological examination revealed hypertonia and hyperreflexia in his left upper and lower limbs with normal power bilaterally. T2-weighted magnetic resonance imaging (MRI) brain showed multiple non-enhancing characteristic demyelinating lesions with typical shape and distribution. Further work-up was done to confirm the diagnosis of MS and exclude differentials, including a negative autoimmune screen, anti-aquaporin-4 (AQP4), and Myelin oligodendrocyte glycoprotein (MOG) antibodies. Visual evoked potentials documented bilateral severe disturbance in the visual pathway in both eyes, suggesting axonal loss. The patient is a candidate for a disease-modifying therapy for MS. Natalizumab or Ocrelizumab was selected based on his clinical criteria and will be started after proper preparation.

RESULTS

Psychiatric comorbidities in MS are associated with reduced compliance to disease-modifying therapies and lower quality of life. Studies reported that lesions in the periventricular area in the temporal region may be associated with psychosis, but not as an isolated presentation in patients with MS.

CONCLUSION

MS is one of the differentials of psychotic disorder due to a medical condition, and rarely may present with pure psychiatric manifestations preceding any obvious neurological deficits, leading to delay in the diagnosis. Despite being uncommon, a high index of suspicion should be kept in patients with atypical presentations associated with limited response to multiple antipsychotics. This highlights the importance of conducting a thorough physical examination and work-up to exclude an organic pathology, necessitating proper management.

Validation of the Arabic Version of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale

BACKGROUND

The Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) has become the gold standard for evaluating different domains in Parkinson's disease (PD), and it is commonly used in clinical practice, research, and clinical trials.

OBJECTIVES

The objectives are to validate the Arabic-translated version of the MDS-UPDRS and to assess its factor structure compared with the English version.

METHODS

The study was carried out in three phases: first, the English version of the MDS-UPDRS was translated into Arabic and subsequently back-translated into English by independent translation team; second, cognitive pretesting of selected items was performed; third, the Arabic version was tested in over 400 native Arabic-speaking PD patients. The psychometric properties of the translated version were analyzed using confirmatory factor analysis (CFA) as well as exploratory factor analysis (EFA).

RESULTS

The factor structure of the Arabic version was consistent with that of the English version based on the high CFIs for all four parts of the MDS-UPDRS in the CFA (CFI ≥0.90), confirming its suitability for use in Arabic.

CONCLUSIONS

The Arabic version of the MDS-UPDRS has good construct validity in Arabic-speaking patients with PD and has been thereby designated as an official MDS-UPDRS version. The data collection methodology among Arabic-speaking countries across two continents of Asia and Africa provides a roadmap for validating additional MDS rating scale initiatives and is strong evidence that underserved regions can be energically mobilized to promote efforts that apply to better clinical care, education, and research for PD. © 2022 International Parkinson and Movement Disorder Society.

Parkinson's Disease in the Middle East, North Africa, and South Asia: Consensus from the International Parkinson and Movement Disorder Society Task Force for the Middle East

BACKGROUND

Understanding the regional needs and available healthcare resources to treat Parkinson's disease (PD) is essential to plan appropriate future priorities. The International Parkinson and Movement Disorder Society (MDS) Task Force for the Middle East was established to raise awareness and promote education across the region on PD and other movement disorders. Broadly, the task force encompasses the countries of the Middle East but has included North Africa and South Asia as well (MENASA).

OBJECTIVE

To create a list of needs and priorities in the advancement of PD in MENASA countries based on consensuses generated by the MDS task force for the Middle East.

METHODS

A Strengths Weaknesses-Opportunities-Threats (SWOT) analysis was conducted by the task force members to generate consensus about PD care this region.

RESULTS

Eight overarching principles emerged for the consensus statement on current needs: more movement disorders specialists, multidisciplinary care, accurate epidemiologic data, educational programs, availability of drugs, and availability of more advanced therapy, enhanced health care resources and infrastructure, and greater levels of awareness within the general population and among health care professionals.

CONCLUSION

This pilot study sheds light on unmet needs for providing care to people with PD in the MENASA region. These data offer directions on priorities to increase awareness of PD, to develop better infrastructure for research and management of PD, to foster healthcare policy discussions for PD and to provide educational opportunities within these countries.