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The varieties of psychosis in multiple sclerosis: A systematic review of cases
Carlos R Camara-Lemarroy1, Beatriz E Ibarra-Yruegas1, Rene Rodriguez-Gutierrez2
1Neurology Service. University Hospital, "Dr. Jose E. Gonzalez", Autonomous University of Nuevo Leon, Monterrey, Mexico.
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.
Insights
Multiple Sclerosis (MS) can manifest with psychotic symptoms, often presenting as primary psychotic or mood disorders. Treatment with corticosteroids may be effective, suggesting these episodes could be MS flares.
Area of Science:
- Neurology
- Psychiatry
Background:
- Multiple Sclerosis (MS) is frequently linked to psychiatric symptoms, especially affective disorders.
- The association between MS and psychotic disorders requires further clarification.
Purpose of the Study:
- To systematically review and characterize cases of MS presenting with psychotic symptoms.
- To establish the link between Multiple Sclerosis and psychotic disorders.
Main Methods:
- A systematic review of the PubMed/MEDLINE database was conducted.
- Identified cases of MS with psychotic symptoms were analyzed for demographics, clinical presentation, imaging, and treatment.
Main Results:
- Ninety-one cases of MS with psychotic symptoms were identified, predominantly affecting females around age 34.
- Most patients lacked prior MS or psychiatric history; diagnoses included psychotic disorders or mood disorders with psychotic features.
- Sixty percent of cases with available imaging showed fronto-temporal lesions, often contrast-enhancing. Corticosteroid treatment was effective in the majority.
Conclusions:
- Multiple Sclerosis can present with diverse psychotic symptoms.
- The findings suggest that MS-associated psychotic episodes, characterized by enhancing lesions and steroid-responsiveness, may represent disease flares.
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