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The varieties of psychosis in multiple sclerosis: A systematic review of cases

Multiple Sclerosis and Related Disorders, Volume 12, February 2017, Pages 9-14

Abstract

Objectives

Multiple Sclerosis (MS) is known to be associated with a wide range of psychiatric symptoms, particularly with affective disorders. However, a link to psychotic disorders has not been fully established.

Methods

A systematic review of the PubMed/MEDLINE database was performed to identify cases of MS presenting with psychotic symptoms. Variables analyzed included patient demographics, clinical presentation, imaging characteristics and treatment.

Results

Ninety-one cases were identified. The mean age was 34.4, and there was a female predominance. The majority of patients did not have a prior history of MS or psychiatric disease. The majority of cases could be classified as having either Psychotic Disorders or Mood Disorders with psychotic features. Most patients received some type of antipsychotic therapy, with variable success. At least 26 patients were treated with corticosteroids in the acute phase of their psychotic symptoms, and the majority responded favorably. Imaging data was available for 50 patients. Of these, 60% had predominantly fronto-temporal lesions, and most had contrast enhancing lesions.

Conclusions

MS can present with a variety of psychotic symptoms. The presence of enhancing lesions and steroid-responsiveness suggests these could be characterized as flares.

Highlights

  • Multiple Sclerosis (MS) is associated with psychosis.
  • The presentation of psychotic symptoms in patients with MS is heterogeneous.
  • This includes both Psychotic Disorders and Mood Disorders with psychotic features.
  • Psychosis in MS may be associated with white matter lesions and respond to steroids.
  • This suggests that psychotic episodes could constitute a “flare”.

Keywords: Multiple Sclerosis, Psychosis, Schizophrenia, Psychiatric manifestations.

Footnotes

a Neurology Service. University Hospital, "Dr. Jose E. Gonzalez", Autonomous University of Nuevo Leon, Monterrey, Mexico

b Division of Endocrinology, University Hospital "Dr. Jose E. Gonzalez", Autonomous University of Nuevo Leon, Monterrey, Mexico

c Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA

d Department of Neurology, Multiple sclerosis Center, University of Massachusetts Memorial Medical Center, Worcester, MA, USA

Correspondence to: Departamento de Neurología. Hospital Universitario “Dr. José E. González”. Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, Monterrey NL 64460, México.