Saturday, 28 March 2015

ClinicSpeak: psychiatric comorbidity

Do you suffer from anxiety, depression or substance misuse? #ClinicSpeak #MSBlog #MSResearch

"The meta-analysis below confirms what we know; MSers are likely to have a high rate of psychiatric co-morbidity. This includes depression, anxiety and alcohol and substance abuse. Psychiatric comorbidity is the hidden, often ignored, underbelly of MS. Anxiety and fatigue are so common that they are virtually ubiquitous foes of the MSer. It is very important that anxiety is recognised and managed early. I suspect that alcohol and substance misuse is due to MSers self-medicating. Alcohol is anxiolytic and is almost certainly the most widely used anxiolytic on the planet."

"MSers have reason to be anxious and depressed. The uncertainty that goes with being diagnosed with MS cannot be underestimated. I have recently discovered mindfulness, through the recommendations of some of my patients. Mindfulness is a technique of self-meditation that teaches you to focus on the here and now and not the future; you can't control the future so why worry about it. The NHS and NICE recommends mindfulness training as part of a holistic approach to the management of anxiety. Mindfulness is a useful adjunct to CBT (cognitive behavioural therapy) and exercise to help anxiety. Finally, if anxiety cannot be managed using these, and other, techniques there is also the option of medication, for example the SSRIs. I typically try to avoid SSRIs because of weight gain as a side effect and the increasing recognition of a withdrawal syndrome on stopping them.The latter is called the anti-depressant withdrawal syndrome and occurs in ~30-40% of people who stop SSRIs."


"If you suffer from anxiety, depression, fatigue, alcohol and substance misuse don't ignore the problem please raise it with your GP, neurologist or MS specialist nurse."


Marrie et al. The incidence and prevalence of psychiatric disorders in multiple sclerosis: A systematic review. Mult Scler. 2015 Mar;21(3):305-317.

BACKGROUND: Psychiatric comorbidity is associated with lower quality of life, more fatigue, and reduced adherence to disease-modifying therapy MS.

OBJECTIVES: The objectives of this review are to estimate the incidence and prevalence of selected comorbid psychiatric disorders in MS and evaluate the quality of included studies.

METHODS: We searched the PubMed, PsychInfo, SCOPUS, and Web of Knowledge databases and reference lists of retrieved articles. Abstracts were screened for relevance by two independent reviewers, followed by full-text review. Data were abstracted by one reviewer, and verified by a second reviewer. Study quality was evaluated using a standardized tool. For population-based studies we assessed heterogeneity quantitatively using the I 2 statistic, and conducted meta-analyses.

RESULTS: We included 118 studies in this review. Among population-based studies, the prevalence of anxiety was 21.9% (95% CI: 8.76%-35.0%), while it was 14.8% for alcohol abuse, 5.83% for bipolar disorder, 23.7% (95% CI: 17.4%-30.0%) for depression, 2.5% for substance abuse, and 4.3% (95% CI: 0%-10.3%) for psychosis.

CONCLUSION: This review confirms that psychiatric comorbidity, particularly depression and anxiety, is common in MS. However, the incidence of psychiatric comorbidity remains understudied. Future comparisons across studies would be enhanced by developing a consistent approach to measuring psychiatric comorbidity, and reporting of age-, sex-, and ethnicity-specific estimates.

3 comments:

  1. Thanks for posting this Prof G. My anxiety level is low and that is because I meditate every day. I used to get anxious before I got MS but now I feel I have quite a lot of control of my anxiety. The benefits have accumulated over time and I feel I will keep this up for the rest of my life now.

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  2. I do wonder if my MS was at least partly triggered by anxiety. I was stressed and anxious during my first MS symptom. Vertigo triggered by an ear infection. I know it's a vicious circle. I was anxious about getting the symptoms and then the symptoms made me anxious. Who knows what the anxiety and stress were doing to my immune system. May be it includes adrenal exhaustion. What is released in the body when we get anxious? Cortisol, adrenaline and norepinephrine? I keep hearing that anxiety is harmful to our minds and bodies. Like other MSers I have found meditation has helped me alot to calm my anxiety and stress.

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  3. Prof G it's an interesting area this post, of MS and the mind. When I think of the two relapses i've had triggered by stress it makes me think how powerful our subconcious minds are.

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