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Prof Anthony Feinstein: The psychiatric aspects of MS in general - The neuropsychiatry

Prof. Anthony Feinstein

In this session, Prof Feinstein reviews neuropsychiatry abnormalities in people with MS, including depression, anxiety, pseudobulbar affect, euphoria, and bipolar affective disorder.

Depression is the most frequent condition and is observed in up to 50% of MS patients over their lifetime. Depression impacts on quality of life and may lead to self-harm or suicide. The American Academy of Neurology endorses cognitive behaviour therapy as the treatment of choice in MS patients. Although medications can be effective, they come with concerning side effects, but may be the only choice available in many clinics.

The Beck Depression Inventory-Fast Screen (BDI-FS) or the Hospital Anxiety and Depression Scale have been developed specifically for those with physical and neurological illness. Recent research has shown that a brain MRI might also be useful, as several MRI markers are correlated with depression.

Pseudobulbar affect, where people cry when they don’t feel sad, or laugh when they don’t feel happy can be effectively treated with a selective serotonin reuptake inhibitor (SSRI), or a low-dose tricyclic antidepressant medication. In 2010, the FDA-approved dextromethorphan hydrobromide/quinidine sulfate capsules (Nuedexta) specifically for treating this condition.

Anxiety in MS is very common, but research specifically in MS patients is lacking. What little research there is suggests that cognitive behaviour therapy can be effective.

Bipolar affective disorder appears to be twice as common in people with MS compared to the general population. There are no randomized controlled trials for MS patients with bipolar affective disorder, so clinicians must borrow from the data on the general population. Treatments include mood stabilizing medications such as lithium carbonate, or in severe cases an antipsychotic drug.

Prof Feinstein concluded that it is important for neurologists working in an MS clinic to address these neuropsychological problems in their patients, as effective treatment strategies are available.

Professor Anthony Feinstein, Psychiatry Department, University of Toronto, Canada

This video was recorded at ECTRIMS 2016, September 14-17 2016, London, United Kingdom.