PSYCHIATRIC DISORDERS IN MULTIPLE SCLEROSIS

The incidence of psychiatric disorders in multiple sclerosis is higher than is generally recognized. The majority of multiple sclerosis patients show emotional instability, denial, personality disintegration and, in the late stages, deterioration.

The emotional instability is manifested by irritability, anxiety and depression, as well as euphoria, even to the extent of a manic or depressive psychosis. Denial is manifested by querulousness and projection of frustration and hostility onto other people, or by unrealistic optimism. Personality disintegration is manifested by subjectivity, lability, inappropriateness and poor coordination of emotional reactions with the rest of the personality and the reality of the situation.

The organic interruption of subcortical pathways by demyelinization produces variable loss of emotional control and disorganization of the total personality. This threat to personality functioning produces the compensatory psychological defense mechanisms of denial and projection.

Emotional instability may precede the onset of neurologic findings, and the final diagnosis may be obscure for months or years. Although emotional stress does not cause multiple sclerosis, it can precipitate exacerbations and have a deleterious effect on the course of the disease. Because there is no definitive treatment, psychotherapy is an important, if not the most important, part of the treatment of multiple sclerosis. Psychiatrists are, therefore, especially qualified to treat patients with multiple sclerosis.