Contributions
Abstract: 21
Type: Oral
Multiple sclerosis is associated with numerous neuropsychiatric disorders. All apart from euphoria can be well treated. It is therefore imperative that the diagnosis not be missed. Depression has a lifetime prevalence of 50% in people with MS (PwMS) and adversely affects cognition and quality of life. Regional lesion volume, atrophy and more subtle indices of brain pathology as elucidated by DTI may account for close to 50% of the variance in accounting for the depression. Psychosocial factors, most importantly, poor coping strategies are also closely implicated in causing low mood. Cognitive behavior therapy given in person or by telephone is regarded as the treatment of choice, Antidepressant medication may also lead to significant symptom reduction. Bipolar Affective Disorder occurs at higher rates in PwMS relative to the general population. It is characterized by euphoria (or marked irritability), grandiose or persecutory beliefs and motor overactivity. Neuroimaging and treatment data in this population are lacking. Pseudobulbar affect (“crying with sadness, laughter without mirth”) may affect up to 10% of PwMS, albeit in varying degrees of severity. Brain lesions in medial frontal, inferior parietal, cerebellar and brain stem regions are considered important in the pathogenesis. Effective treatments include tricyclic antidepressants, selective serotonin reuptake inhibitors and a combination of dextromethorphan and quinidine. Euphoria (a fixed mental state characterized by a cheerful, optimistic demeanor and unrealistic expectations of future wellbeing) occurs in 9-13% of PwMS, most notably those with marked physical disability, considerable cognitive compromise, heavy lesion burden and extensive atrophy on brain MRI. There is no treatment for it. Finally, epidemiological data are equivocal on the question of elevated rates of psychosis in PwMS. A single MRI study has linked psychosis to an extensive lesion burden in the temporal lobes.
Disclosure: Nothing to disclose
Abstract: 21
Type: Oral
Multiple sclerosis is associated with numerous neuropsychiatric disorders. All apart from euphoria can be well treated. It is therefore imperative that the diagnosis not be missed. Depression has a lifetime prevalence of 50% in people with MS (PwMS) and adversely affects cognition and quality of life. Regional lesion volume, atrophy and more subtle indices of brain pathology as elucidated by DTI may account for close to 50% of the variance in accounting for the depression. Psychosocial factors, most importantly, poor coping strategies are also closely implicated in causing low mood. Cognitive behavior therapy given in person or by telephone is regarded as the treatment of choice, Antidepressant medication may also lead to significant symptom reduction. Bipolar Affective Disorder occurs at higher rates in PwMS relative to the general population. It is characterized by euphoria (or marked irritability), grandiose or persecutory beliefs and motor overactivity. Neuroimaging and treatment data in this population are lacking. Pseudobulbar affect (“crying with sadness, laughter without mirth”) may affect up to 10% of PwMS, albeit in varying degrees of severity. Brain lesions in medial frontal, inferior parietal, cerebellar and brain stem regions are considered important in the pathogenesis. Effective treatments include tricyclic antidepressants, selective serotonin reuptake inhibitors and a combination of dextromethorphan and quinidine. Euphoria (a fixed mental state characterized by a cheerful, optimistic demeanor and unrealistic expectations of future wellbeing) occurs in 9-13% of PwMS, most notably those with marked physical disability, considerable cognitive compromise, heavy lesion burden and extensive atrophy on brain MRI. There is no treatment for it. Finally, epidemiological data are equivocal on the question of elevated rates of psychosis in PwMS. A single MRI study has linked psychosis to an extensive lesion burden in the temporal lobes.
Disclosure: Nothing to disclose