The neuropsychiatry of multiple sclerosis: a review of recent developments

Abstract

The aim of this review is to summarize the current literature on the neuropsychiatry of multiple sclerosis (MS). Data from community samples have supported earlier findings from tertiary referral centres of high rates of depression in MS patients. Neuroimaging offers important clues as to the pathogenesis of depression, but psychosocial factors cannot be ignored and emerge as equally important predictors. Cognitive-behavioural therapy is an effective treatment, rivalling standard dosing of sertraline in patients with depression. An allied disorder--pseudobulbar affect--occurs in up to 10% of MS patients and responds well to a combination of dextromethorphan and quinidine. Cognitive dysfunction affects approximately 40% of MS patients. Markers of cerebral atrophy have emerged as more important correlates of impaired cognition than lesion volume. Moreover, functional MRI studies have demonstrated the brain's ability to compensate, in part, for damage. Should the disease burden be too severe, however, compensatory mechanisms fail and cognitive deficits increase accordingly. Neuropsychiatric abnormalities are common in MS patients. No aspect of mentation is spared. Advances in neuroimaging are increasing our understanding of the pathogenesis of these disorders. Translating these findings into improved methods of treatment for patients presents researchers with pressing challenges.