Psychiatry Rotation Assignment

Anand Kumar
[email protected]
Psychiatry – Block 6
Lancaster General Hosital
!"#$"#%!&
'ord (ount) #9$
The Role of Psychiatric Disorders in Multiple Sclerosis
*ultile sclerosis +*,- is the most common disa.lin/ neurolo/ical disease o0 youn/
adults1 and it resents 2ith increased risks o0 sychiatric symtoms and disorders. 3hese
sychiatric distur.ances si/ni0icantly increase the risks o0 suicidality and sel0 harm
.eha4ior in *, atients. 5eath6certi0icate studies ha4e in 0act estimated suicidality as the
immediate cause o0 death in as hi/h as !$7 o0 *, atient deaths +!-. 5eression is the
most rominent risk 0actor 0or suicidality and sel06harm .eha4ior in *, atients1
0ollo2ed .y anxiety disorders. 8ther minor associations 2ould include social isolation1
history o0 rior suicide attemts1 and recent 0unctional deterioration. 9nterestin/ly1 the
le4el o0 neurolo/ical disa.ility 0rom the *, itsel0 had no associations 0ound 2ith suicidal
.eha4ior. 84erall1 the results o0 these studies ha4e /oaded an exert anel to conclude
that .etter identi0ication and treatment o0 deressi4e disorders is the most imortant 0orm
o0 rimary re4ention o0 suicide in *, atients +#-.
5eression is a 2ell6studied sychiatric disorder in *, atients1 .ut research on the
imacts o0 anxiety disorders1 su.stance use disorders1 and schi:ohrenia in *, is still
lackin/. 'hile keein/ .oth neurolo/ical disa.ility and 0ati/ue constant1 decreased
er0ormance on neurosycholo/ical measures is 0re;uently seen in deressed *,
atients. 3he decline is esecially su.stantial in the le4el o0 su.<ecti4e co/niti4e
imairment and memory imairment +&-. 5eressed *, atients ha4e .een researched to
ha4e increased lost time 0rom 2ork +=-1 and decreased comliance 2ith treatment
re/imens. >emarka.ly1 treatment comliance had imro4ed in *, atients 2ith the
treatment o0 their deression +$-. A recent meta6analysis has con0irmed the association o0
acute *, exacer.ations 0ollo2in/ ma<or li0e stressors. (urrently there is no study to
su//est an association .et2een ma<or deressi4e disorder or any other sychiatric
disorders on the neurohysiolo/ical course o0 *,1 thou/h an association is 2idely
hyothesi:ed.
REFERENCES
!. ,ado4nick A51 ?isen K1 ?.ers G(1 Paty 5'. (ause o0 death in atients attendin/
multile sclerosis clinics. @eurolo/y. !99!A=!)!!9&–!!96.
#. Goldman (onsensus Grou. 3he Goldman (onsensus statement on deression in
multile sclerosis. *ult ,cler. #%%$A!!)&#8–&&B.
&. Gilchrist A(1 (reed CH. 5eression1 co/niti4e imairment and social stress in
multile sclerosis. D Psychosom >es. !99=A&8)!9&–#%!.
=. ,mith **1 Arnett PA. Cactors related to emloyment status chan/es in
indi4iduals 2ith multile sclerosis. *ult ,cler. #%%$A!!)6%#–6%9.
$. *ohr 5(1 Goodkin 5?1 Likosky '1 et al. 3reatment o0 deression imro4es
adherence to inter0eron .eta6!. theray 0or multile sclerosis. Arch @eurol.
!99BA$=)$&!–$&&.