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Psychoses onset in multiple sclerosis: A systematic review and meta-analysis
I Ketata1, E Ellouz1, A Ketata2
1Neurology Department, University Hospital of Gabes, 6014 Gabes, Tunisia; Sfax University, Faculty of Medicine, Sfax, Tunisia.
Background:
Psychotic symptoms in multiple sclerosis (MS) have been infrequently studied, despite the existence of numerous case reports showing inconsistent findings. Our aim was to assess the timing of psychosis onset and examine its characteristics in MS cases.
Material And Methods:
We conducted a systematic review and meta-analysis according to PRISMA 2020. We searched for case reports and case series of psychosis in MS on MEDLINE through PubMed, Google Scholar, Web of Science, and Cochrane. SPSS 26 was used to perform the data analysis.
Results:
Overall, 43 cases were reviewed. Bipolar disorder and schizophrenia (SCZ) were the most frequently observed types. Psychosis was often present before or at the time of MS diagnosis. For patients with prior psychosis before MS diagnosis, those with SCZ were less likely to develop neurologic symptoms compared to those with other psychosis types. Polymorphic delusions were significantly associated with psychosis onset either after or concurrently with MS. Extensive periventricular white matter lesions, cerebellar peduncles, and cerebellar lesions were significantly associated with the onset of psychosis following MS diagnosis. Resistant-treatment psychosis occurred in 59.4% of cases. A favorable outcome was significantly more common in patients with relapsing-remitting MS compared to those with other forms of MS.
Conclusion:
Our study highlights the importance of considering MS in patients with psychoses, especially those with SCZ or treatment-resistant psychosis. Some white matter lesions may trigger psychosis after MS diagnosis. While managing psychosis in MS can be challenging, MS-specific treatments have proven effective.
Insights
Psychosis can occur in multiple sclerosis (MS), sometimes before diagnosis. Certain brain lesions may trigger psychosis after MS onset, and MS-specific treatments can be effective for managing these challenging symptoms.
Area of Science:
- Neurology
- Psychiatry
- Neuroimmunology
Background:
- Psychotic symptoms are infrequently studied in multiple sclerosis (MS).
- Existing case reports show inconsistent findings regarding psychosis in MS.
- This study aimed to clarify the timing and characteristics of psychosis in MS patients.
Purpose of the Study:
- To assess the timing of psychosis onset in relation to multiple sclerosis diagnosis.
- To examine the specific characteristics and types of psychosis observed in MS cases.
- To identify potential associations between neurological findings and psychosis in MS.
Main Methods:
- Systematic review and meta-analysis of case reports and case series.
- Searched multiple databases including MEDLINE, PubMed, Google Scholar, Web of Science, and Cochrane.
- Data analysis performed using SPSS 26, adhering to PRISMA 2020 guidelines.
Main Results:
- Reviewed 43 cases; bipolar disorder and schizophrenia (SCZ) were most common.
- Psychosis often preceded or coincided with MS diagnosis.
- White matter lesions were associated with psychosis onset after MS diagnosis; 59.4% had treatment-resistant psychosis.
- Favorable outcomes were more common in relapsing-remitting MS.
Conclusions:
- Highlights the need to consider MS in patients presenting with psychosis, particularly schizophrenia or treatment-resistant cases.
- Specific white matter lesions may precipitate psychosis post-MS diagnosis.
- While challenging, psychosis in MS can be effectively managed with MS-specific treatments.
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