The Neuropsychiatry of Multiple Sclerosis – What Should Psychiatrists Know?

Posted on June 12, 2017

Multiple sclerosis (MS) is an autoimmune disorder that is characterized by muscle weakness and numbness as well as problems with vision and bladder control. It is caused by the immune system attacking the nerve-insulating myelin sheath, which disrupts the communication between brain and peripheral parts of the body.

Oligodendrocytes are the cells that form the myelin sheath around nerve axons in the central nervous system (CNS). These cells are critical in the development of the brain as well as the correct functioning of the nerve cells. The myelin sheath they produce acts as insulation that protects long nerve projections as well as allowing the conduction of a nerve signal.

Oligodendrocyte

In MS, there is a loss of myelin in defined areas (lesion sites) in the brain and spinal cord. The disease is characterized by a large array of invading immune cells that attack and degrade the myelin sheath, the myelin producing oligodendrocytes and the nerve itself. These lesion sites develop with time and initially result in clinically benign symptoms but can progress in to profound disabilities.

rsz_pathogenesis_of_ms

Most treatments for MS are immunosuppressive drugs that manage the symptoms without reversing neurological damage. Although they have shown efficacy, there is still a high demand for effective and safe treatments that focus on mitigating autoimmunity, stimulating regeneration and restoring lost functionality.

 

References

1. Neuropsychiatric manifestations of multiple sclerosis

Diaz-Olavarrieta C et al., Neuropsychiatric manifestations of multiple sclerosis. Journal of Neuropsychiatry and Clinical Neuroscience. 1999

2. The relationship between disability and depression in multiple sclerosis

Lynch S et al., The relationship between disability and depression in multiple sclerosis: the role of uncertainty, coping, and hope. Multiple Sclerosis. 2001

3. Structural brain abnormalities in multiple sclerosis patients with major depression

Feinstein A et al., Structural brain abnormalities in multiple sclerosis patients with major depression. Neurology. 2004

4. Pharmacologic treatment of depression in multiple sclerosis

Koch M et al., Pharmacologic treatment of depression in multiple sclerosis. Cochrane Database of Systematic Reviews. 2011

5. The link between multiple sclerosis and depression.

Feinstein A et al., The link between multiple sclerosis and depression. Nature Reviews Neurology. 2014

6. Treatment of mood disorders in multiple sclerosis

Perez L et al., Treatment of mood disorders in multiple sclerosis. Current Treatment Options in Neurology. 2015

7. Psychotic disorders in MS: population-based evidence of an association

Patten S et al., Psychotic disorders in MS: population-based evidence of an association. Neurology. 2005

8. The spectrum of psychosis in multiple sclerosis

Gilberthorpe T et al., The spectrum of psychosis in multiple sclerosis: a clinical case series. Neuropsychiatric Disease and Treatment. 2017

9. Psychotic illness in multiple sclerosis - Imaging Study

Feinstein A et al., Psychotic illness in multiple sclerosis. A clinical and magnetic resonance imaging study. British Journal of Psychiatry. 1992

10. Steroid psychosis

Sirois F, Steroid psychosis: a review. General Hospital Psychiatry. 2003

11. Psychiatric side effects of interferon-beta in multiple sclerosis

Goeb J et al., Psychiatric side effects of interferon-beta in multiple sclerosis. European Journal of Psychiatry. 2006

12. Physiopathology of fatigue in multiple sclerosis.

Leocani, L., Colombo, B., & Comi, G. (2008). Physiopathology of fatigue in multiple sclerosis. Neurological Sciences, 29(2), 241-243.

13. Effect of interferon-beta-1b on cognitive functions in multiple sclerosis

Barak Y and Achiron A, Effect of interferon-beta-1b on cognitive functions in multiple sclerosis. European Journal of Neurology. 2002

14. Multiple sclerosis and behavior

Pinkston J et al., Multiple sclerosis and behavior. International Review of Neurobiology. 2007