Abstract
Multiple sclerosis (MS) is a chronic inflammatory disorder of the central nervous system. Psychiatric comorbidities, in particular depression and anxiety, are frequent in MS patients.
These disorders are underdiagnosed and undertreated although they have been associated with decreased adherence to treatment, functional status, and quality of life. Behavioral disorders are more common than severe psychiatric disorders and are probably secondary to cognitive impairment. Addictions may be underestimated. Although the high frequency of psychiatric co-morbidity might be due to psychosocial factors, the role of demyelinization and inflammation is possible. Psychiatric comorbidities in MS deserve clinical attention because they are associated with an increase risk of suicide.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Patten SB, Beck CA, Williams JVA, Barbui C, Metz LM. Major depression in multiple sclerosis. A population based perspective. Neurology. 2003;61:1524–7.
Patten SB, Metz LM, Reimer MA. Biopsychosocial correlates of lifetime major depression in a multiple sclerosis population. Mult Scler. 2000;6:115–20.
Kessler RC, Berglund P, Demler O, et al. The Epidemiology of Major Depressive Disorder Results from the National Comorbidity Survey Replication. JAMA. 2003;289:3095–105.
Korostil M, Feinstein A. Anxiety disorders and their clinical correlates in multiple sclerosis patients. Mult Scler. 2007;13:67–72.
Galeazzi GM, Ferrari S, Giaroli G, et al. Psychiatric disorders and depression in multiple sclerosis outpatients: impact of disability and interferon beta therapy. Neurol Sci. 2005;26:255–62.
Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994;51:8–19.
Kessler RC, Keller MB, Wittchen HU. The epidemiology of generalized anxiety disorder. Psychiatry Clin North Am. 2001;1:19–39.
Edwards LJ, Constantinescu CS. A prospective study of conditions associated with multiple sclerosis in a cohort of 658 consecutive outpatients attending a multiple sclerosis clinic. Mult Scler. 2004;10:575–81.
Benazzi F. Bipolar disorder—focus on bipolar II disorder and mixed Depression. Lancet. 2007;369:935–45.
Marrie RA, Fisk JD, Yu BN, Leung S, Elliott L, Caetano P. Mental comorbidity and multiple sclerosis : validating administrative data to support population-based surveillance. BMC Neurol. 2013;13:16.
Pioro EP, Brooks BR, Cummings J, Schiffer R, Thisted RA, Wynn D, et al. Dextromethorphan Plus Ultra Low-Dose Quinidine Reduces Pseudobulbar Affect. Ann Neurol. 2010;68:693–702.
Espinola-Nadurille M, Colin-Piana R, Ramirez-Bermudez J, Lopez-Gomez M, Flores J, Arrambide G, Corona T. Mental Disorders in Mexican Patients With Multiple Sclerosis. J Neuropsychiatry Clin Neurosci. 2010;22:63–9.
Johnson SK, DeLuca J, Natelson BH. Personality dimensions in the chronic fatigue syndrome: a comparison with multiple sclerosis and depression. J Psychiatr Res. 1996;30(1):9–20.
Quesnel S, Feinstein A. Multiple sclerosis and alcohol: a study of problem drinking. Mult Scler. 2004;10(2):197–201.
Schuckit MA. Alcohol-used disorders. Lancet. 2009;373:492–501.
Fishman I, Benedict RHB, Bakshi R, Priore R, Weinstock-Guttman B. Construct validity and frequency of euphoria sclerotic in multiple sclerosis. J Neuropsychiatry Clin Neurosci. 2004;16:350–6.
Feinstein A, O’Connor P, Gray T, Feinstein KJ. The prevalence and neurobehavioral correlates of pathological laughing and crying in multiple sclerosis. Arch Neurol. 1997;54:1116–21.
Bombardier CH, Blake KD, Ehde DH, Gibbons LE, Moore D, Kraft GH. Alcohol and drug abuse among persons with multiple sclerosis. Mult Scler. 2004;10:35.
Chwastiak L, Ehde DM, Gibbons LE, Sullivan M, Bowen JD, Kraft GH. Depressive symptoms and severity of illness in multiple sclerosis: epidemiologic study of a large community sample. Am J Psychiatry. 2002;159:1862–8.
Rosti-Otajärvi E, Hämäläinen P. Behavioural symptoms and impairments in multiple sclerosis: a systematic review and meta-analysis. Mult Scler. 2013;19:31.
Fromont A, Binquet C, Rollot F, Despalins R, Weill A, Clerc L, Bonithon-Kopp C, Moreau T. Comorbidities at multiple sclerosis diagnosis. J Neurol. 2013;260(10):2629–37.
Tarrants, M Oleen-Burkey M., Castelli-Haley J, Lage MJ. The impact of comorbid depression on adherence to therapy for multiple sclerosis. Mult Scler Int. 2011;2011:271321.
Amato MP, Ponziani G, Rossi F, Liedl CL, Stefanile C, Rossi L. Quality of life in multiple sclerosis: the impact of depression, fatigue and disability. Mult Scler. 2001;7(5):340–4.
Fredrikson S, Cheng Q, Jiang GX, Wasserman D. Elevated suicide risk among patients with multiple sclerosis in Sweden. Neuroepidemiology. 2003;22(2):146–52.
Bronnum-Hansen H. Suicide among Danes with multiple sclerosis. J Neurol Neurosurg Psychiatry. 2005;76(10):1457–9.
Sadovnick AD, Eisen K, Ebers GC, Paty DW. Cause of death in patients attending multiple sclerosis clinics. Neurology. 1991;41:1193–6.
Leray E, Morrissey S, Yaouanq J, Coustans M, Le Page E, Chaperon J, Edan G. Long-term survival of patients with multiple sclerosis in West France. Mult Scler. 2007;13(7):865–74.
Grytten Torkildsen N, Lie SA, Aarseth JH, Nyland H, Myhr KM. Survival and cause of death in Multiple sclerosis : results from a 50 year follow-up in Western Norway. Mult Scler. 2008;14:1191–8.
Feinstein A. An examination of suicidal intent in patients with multiple sclerosis. Neurology. 2002;59:674–8.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed., text rev (DSM-IV-TR). American Psychiatric Association 2000.
Jones KH, Ford DV, Jones PA, John A, Middleton RM, Lockhart-Jones H, et al. A large-scale study of anxiety and depression in people with Multiple Sclerosis: a survey via the web portal of the UK MS Register. PLoS One. 2012;7(7), e41910.
Crawford JR, Henry JD, Crombie C, Taylor EP. Normative data for the HADS from a large non-clinical sample. Br J Clin Psychol. 2001;40:429–34.
Schiffer RB, Wineman NM. Antidepressant pharmacotherapy of depression associated with multiple sclerosis. Am J Psychiatry. 1990;147:1493–7.
Frye M. Bipolar disorder –a focus on depression. N Engl J Med. 2011;364:51–9.
Marrie RS, Horwitz R, Cutter G, Tyry T, Campagnolo D, Vollmer T. The burden of medical comorbidity in multiple sclerosis: frequent, underdiagnosed and undertreated. Mult Scler. 2009;15:385–92.
Fisk JD, Morehouse SA, Brown MG, Skedgel C, Murray TJ. Hospital-based psychiatric service utilization and morbidity in multiple sclerosis. Can J Neurol Sci. 1998;25(3):230–5.
Carta MG, Moro MF, Lorefice L, Trincas G, Cocco E, Del Giudice E, Fenu G, Colom F, Marrosu MG. The risk of Bipolar Disorders in Multiple Sclerosis. J Affect Disord. 2014;155:255–60.
Lacovides A, Androulakis E. Bipolar disorders and resembling special psychopathological manifestations in Multiple Sclerosis: a review. Curr Opin Psychiatry. 2011;24:336–340.
Zephir H, De Seze J, Stojkovic T, Delisse B, Ferriby D, Cabaret M, Vermersch P. Multiple sclerosis and depression: influence of interferon beta therapy. Mult Scler. 2003;9(3):284.
Diaz-Olavarrieta C, Cummings JL, Velazquez J. Garcia de la Cadena C. Neuropsychiatric manifestations of multiple sclerosis. J Neuropsychiatry Clin Neurosci. 1999;11:51–7.
Sanfilipo MP, Benedict RH, Weinstock-Guttman B, Bakshi R. Gray and white matter brain atrophy and neuropsychological impairment in multiple sclerosis. Neurology. 2006;66:685–92.
Parvizi J, Archiniegas DB, Bernardini GL, Hoffmann MW, Mohr JP, Rapoport MJ, et al. Diagnosis and management of pathological laughter and crying. Mayo Clin Proc. 2006;81:1482–6.
Ghaffar O, Chamelian L, Feinstein A. Neuroanatomy of pseudobulbar affect: a quantitative MRI study in multiple sclerosis. J Neurol. 2008;255:406–12.
Seliger GM, Hornstein A. Serotonin, fluoxetine, and pseudobulbar affect. Neurology. 1989;39(10):1400.
Udaka F, Yamao S, Nagata H, et al. Pathologic laughing and crying treated with levodopa. Arch Neurol. 1984;41:1095–6.
Panitch HS, Thisted RA, Smith RA, et al. Randomized controlled trial of dextromethorphan/quinidine for pseudobulbar affect in multiple sclerosis. Ann Neurol. 2006;59(5):780–7.
Van Os J, Kapur S. Schizophrenia. Lancet. 2009;374:635–45.
Blanc F, Berna F, Fleury M, Lita L, Ruppert E, Ferriby D, et al. Inaugural psychotics events in Multiple Sclerosis. Rev Neurol. 2010;166:39–48.
Patten SB, Svenson LW, Metz LM. Psychotic disorders in MS : population-based evidence of an association. Neurology. 2005;65:1123–5.
Benedikt RHB, Priore RL, Miller CMunschauer F, Jacobs L. Personality disorders in Multiple sclerosis correlates with cognitive impairment. J Neuropsychiatry Clin Neurosci. 2001;13:70–6.
De Assis Aquino Gondim F, Thomas F. Episodic hyperlibidinism in multiple sclerosis. Mult Scler. 2001;7:67.
Allanson J, Bass C, Wade DT. Characteristics of patients with persistent severe disability and medically unexplained neurological symptoms: a pilot study. J Neurol Neurosurg Psychiatry. 2002;73:307–9.
Caplan LR, Nadelson T. Multiple sclerosis and hysteria. Lessons learned from their association. JAMA. 1980;243(23):2418–21.
Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet. 2013;382(9904):1575–86.
Syed YY, McKeage K, Scott LJ. Delta-9-tetrahydrocannabinol/cannabidiol (sativex(®)): a review of its use in patients with moderate to severe spasticity due to multiple sclerosis. Drugs. 2014;74(5):563–78.
Clark AJ, Ware MA, Yazer E, et al. Patterns of cannabis use among patients with multiple sclerosis. Neurology. 2004;62:2098–100.
Chong MS, Wolff K, Wise K, Tanton C, Winstock A, Silber E. Cannabis use in patients with multiple sclerosis. Mult Scler. 2006;12(5):646–51.
Honarmand K, Tierney MC, O’Connor P, Feinstein A. Effects of cannabis on cognitive function in patients with multiple sclerosis. Neurology. 2011;76(13):1153–60.
Ghaffar O, Feinstein A. Multiple sclerosis and cannabis: a cognitive and psychiatric study. Neurology. 2008;71:164–9.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Heinzlef, O. (2015). Psychiatric Comorbidity. In: Brochet, B. (eds) Neuropsychiatric Symptoms of Inflammatory Demyelinating Diseases. Neuropsychiatric Symptoms of Neurological Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-18464-7_6
Download citation
DOI: https://doi.org/10.1007/978-3-319-18464-7_6
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-18463-0
Online ISBN: 978-3-319-18464-7
eBook Packages: MedicineMedicine (R0)