A NEW APPROACH TO AFFECTIVE SYMPTOMS IN RELAPSING-REMITTING MULTIPLE-SCLEROSIS

A variety of psychiatric disorders accompany multiple sclerosis (MS), affecting the spheres of cognition, affect, and personality. These dis orders may be of primary and/or secondary nature, reflecting, respecti vely, neurologic damage and/or functional distress associated with a d isabling disease. Evaluation of the nature, severity, and frequency of affective symptoms of MS patients is of importance to sensitize the t reating physician to the possible need for specific psychiatric treatm ent. We conducted a prospective cross-sectional study assessing correl ations of psychiatric symptomatology and the neurologic parameters of disease duration, disease activity (as expressed by the number of dise ase exacerbations per year), and disease severity (as measured by the Kurtzke Expanded Disability Status Scale [EDSS]) in 20 relapsing-remit ting (RR)-MS patients. Patients were also evaluated by a semistructure d psychiatric interview and the following rating scales: Hamilton Anxi ety Scale (HAS), Hamilton Depression Scale (HDS), Hackett-Cassem Denia l Scale, and Lubin Adjective Affective List. Results demonstrated a hi gh prevalence of anxiety (90%) and to a lesser extent depression (50%) in RR MS patients. Depression and anxiety were found to be associated with disease activity, but not with disease duration or severity. The mechanism of denial played a significant role in the psychiatric prof ile of the disease and was correlated with disease duration, We sugges t that in RR-MS patients, psychiatric evaluation should also include a ssessment of defense and coping mechanisms, which in turn could guide specific individualized treatment. (C) 1995 by W.B. Saunders Company