Contributions
Abstract: 18
Type: Educational Session
Abstract Category: N/A
Major Depression - may affect up to 50% of people with MS patients (pwMS) over the course of their lifetime. It is associated with a poorer quality of life, heightened suicidal intent and additional cognitive problems. Major Depression may respond well to cognitive behavior therapy. Pharmacotherapy offers modest benefits offset by concerns over side effects from the medication. Mindfulness- based therapy may also prove effective.
Bipolar Affective Disorder is twice as common in pwMS. There are no RCT MS data, but principles borrowed from General Psychiatry reveal that mood stabilizing medication (lithium carbonate, valproic acid) is the treatment of choice. Sedating medications (benzodiazepines) and on occasion, antipsychotic drugs are also necessary.
Pseudobulbar Affect - may affect up to 10% of pwMS. It is more common in individuals with significant physical disability and longstanding MS. It is characterized by laughter in the absence of subjective happiness or tears in the absence of subjective sadness. The syndrome responds well to a combination of Dextromethorphan and Quinidine.
Euphoria - should be viewed as a fixed personality change that may occur in a median or 40% of pwMS. It is invariably linked to advanced MS, significant cognitive compromise, a heavy lesion load on brain MRI and atrophy. The syndrome reflects an unrealistic optimism on the part of the patient that they may recover from their multiple sclerosis notwithstanding the severe nature of their disease. Here the greatest burden of care is often carried by family members and caregivers.
Psychosis - Finally, uncertainty surrounds the question of whether psychosis is increased in individuals with multiple sclerosis. As with Bipolar Affective Disorder, there are no known treatment trials in MS. Antipsychotic medication is the mainstay of treatment. Side effects are often troublesome.
It is important for clinicians to detect and treat the behavioral manifestations of multiple sclerosis. Treatment response in the case of pseudobulbar affect is often excellent while good results can be obtained with depression.
Disclosure: Grant support from the MS Society of Canada and the Canadian Institute of Health Research. Speakers honoraria from Sanofi-Genzyme, Teva, Roche and Biogen. Member of an Advisory Board for Akili Interactive.
Abstract: 18
Type: Educational Session
Abstract Category: N/A
Major Depression - may affect up to 50% of people with MS patients (pwMS) over the course of their lifetime. It is associated with a poorer quality of life, heightened suicidal intent and additional cognitive problems. Major Depression may respond well to cognitive behavior therapy. Pharmacotherapy offers modest benefits offset by concerns over side effects from the medication. Mindfulness- based therapy may also prove effective.
Bipolar Affective Disorder is twice as common in pwMS. There are no RCT MS data, but principles borrowed from General Psychiatry reveal that mood stabilizing medication (lithium carbonate, valproic acid) is the treatment of choice. Sedating medications (benzodiazepines) and on occasion, antipsychotic drugs are also necessary.
Pseudobulbar Affect - may affect up to 10% of pwMS. It is more common in individuals with significant physical disability and longstanding MS. It is characterized by laughter in the absence of subjective happiness or tears in the absence of subjective sadness. The syndrome responds well to a combination of Dextromethorphan and Quinidine.
Euphoria - should be viewed as a fixed personality change that may occur in a median or 40% of pwMS. It is invariably linked to advanced MS, significant cognitive compromise, a heavy lesion load on brain MRI and atrophy. The syndrome reflects an unrealistic optimism on the part of the patient that they may recover from their multiple sclerosis notwithstanding the severe nature of their disease. Here the greatest burden of care is often carried by family members and caregivers.
Psychosis - Finally, uncertainty surrounds the question of whether psychosis is increased in individuals with multiple sclerosis. As with Bipolar Affective Disorder, there are no known treatment trials in MS. Antipsychotic medication is the mainstay of treatment. Side effects are often troublesome.
It is important for clinicians to detect and treat the behavioral manifestations of multiple sclerosis. Treatment response in the case of pseudobulbar affect is often excellent while good results can be obtained with depression.
Disclosure: Grant support from the MS Society of Canada and the Canadian Institute of Health Research. Speakers honoraria from Sanofi-Genzyme, Teva, Roche and Biogen. Member of an Advisory Board for Akili Interactive.