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Should a psychotic or manic episode be considered an early manifestation of Multiple Sclerosis? A multiple case study
1Department of Psychiatry, University Hospital of Strasbourg, INSERMU1114, Strasbourg, France; University of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, France.
Background:
Early manifestations of Multiple Sclerosis (MS) can be atypical and misleading, and several case report studies have highlighted that MS onset sometimes takes the form of a psychotic or manic episode.
Methods:
All neurologists belonging to the French Multiple Sclerosis Observatory network were contacted by email and were asked to find patients with MS who presented with a history of psychiatric episode(s) near MS onset.
Results:
Seventeen patients were selected that met the criteria of presenting with psychotic or manic symptoms either before the diagnosis of MS (N=8), or at the time of the first neurological episode or shortly after (N=9). Patients with a history of a psychiatric episode occurring before the first neurological episode were diagnosed on average 7 years later than patients with either a first neurological or a mixed (both neurological and psychiatric) episode. However, psychiatric symptoms in the first group and the first neurological symptoms of MS in the second group occurred at a similar age.
Conclusion:
Based on this multiple case study, we question whether past psychotic or manic episode should be considered equivalent to a first manifestation of MS.
Insights
Psychotic or manic episodes may precede Multiple Sclerosis (MS) diagnosis, sometimes delaying it by years. This study suggests considering these psychiatric events as potential early MS manifestations.
Area of Science:
- Neurology
- Psychiatry
Background:
- Early Multiple Sclerosis (MS) can present atypically.
- Psychotic or manic episodes are sometimes reported near MS onset.
Purpose of the Study:
- To investigate the relationship between psychiatric episodes and Multiple Sclerosis onset.
- To determine if psychiatric manifestations should be considered early signs of MS.
Main Methods:
- Neurologists from the French Multiple Sclerosis Observatory network were surveyed.
- Patients with MS and preceding psychiatric episodes near onset were identified.
Main Results:
- Seventeen patients met the criteria, with 8 having psychiatric episodes before MS diagnosis and 9 experiencing them concurrently with or shortly after the first neurological episode.
- Patients with prior psychiatric episodes were diagnosed with MS an average of 7 years later than those with neurological or mixed episodes.
- The age of onset for psychiatric symptoms and first neurological MS symptoms was similar between groups.
Conclusions:
- Past psychotic or manic episodes may represent an early manifestation of Multiple Sclerosis.
- This finding warrants further consideration of psychiatric history in MS diagnosis.
- The diagnostic delay associated with psychiatric-first onset MS is significant.
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