Psychological issues in people with multiple sclerosis

Psychological problems, particularly depression and anxiety, are common in people with multiple sclerosis. These disorders are under-diagnosed, under-treated and associated with worsening disability, quality of life and compliance with treatment.

What psychological issues can patients with MS develop?

Three major mental problems are common in people with multiple sclerosis: depression, anxiety and emotional disorders. During the course of the disease, these disorders occur at a much higher frequency than in the general population.

Depression

Depression affects about 30% of people with MS at some point in their lives. In general, it is not depression but depressive episodes of moderate intensity.

They can be represented by different symptoms, namely grief, feelings of shame, guilt or self-judgement, sadness and/or anger.

The onset of depression in a person with multiple sclerosis can have two main origins:

• A psychosocial origin: in this case, depression is reactive, which means that it occurs in response to an event or a situation. It can also be related to a loss of contact with family or friends who are an important source of support.
• A neurological origin: brain damage caused by the disease can trigger a depressive episode.

Anxiety

Anxiety develops in about 22% of people with multiple sclerosis, but its frequency varies considerably. It is more common in women than in men. Anxiety is caused or exacerbated by a variety of triggers: for example, the diagnosis, the unpredictability of the disease, the fear of disability or loss of independence.

The symptoms of anxiety vary from person to person. On a physical level, it can include heart palpitations, heaviness in the chest, difficulty breathing or swallowing, and sometimes even a feeling of being on the verge of fainting. Emotionally, anxiety can cause the patient to become nervous more frequently or more rapidly, and lose patience.

Hyperemotionality

Hyperemotionality affects about 30% of people with multiple sclerosis. This disorder is represented by loss of emotional control and has two main characteristics:

• Emotional instability, i.e. rapid transition from one emotion to another;
  
• Emotional incontinence, which corresponds to an excessive and uncontrollable expression of emotions.
  

As a result, the patient can be happy and then, for a trivial reason, lash out at those around him or her with words that are much more violent than what the patient really feels.

Bipolar disorder

Bipolar disorder is characterised by manic or depressive episodes and affects 13% of MS patients. There are 2 main types of bipolar disorders:

• Type I bipolar disorder, defined by the presence of at least 1 manic episode;
  
• Type II bipolar disorder, defined by the presence of at least one hypomanic episode and at least one major depressive episode.
  

Bipolar disorder is under-diagnosed in the general population and is difficult to distinguish from depression when manic or hypomanic episodes are not identified. Substance abuse is often associated with bipolar disorders and further complicates the management of these patients.

Psychotic disorders

They are identified by the presence of hallucinations or delusions, language disorders and disorganised speech. Such mental disorders include schizophrenia, schizoaffective disorders, brief psychotic disorders, shared psychotic disorders, psychotic disorders due to the patient's general medical condition and substance-induced psychotic disorders.

Personality and behavioural disorders

Personality disorders include paranoid, schizotypal, antisocial, borderline, histrionic (excessive emotionality and attention seeking), narcissistic, avoidant, dependent and obsessive-compulsive personality disorders. The diagnosis of a personality disorder requires an understanding of the individual's long-term functioning patterns.

It is important for patients with multiple sclerosis to have both medical and psychological support, as various mental disorders caused by the disease can be very difficult to handle for patients themselves and for those around them.