J Affect Disord 2001 Oct;66(2-3):193-8
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Feinstein A, Feinstein K.
Department of Psychiatry, Sunnybrook
and Women's Health Science Centre, University of Toronto, 2075 Bayview
Avenue, ON, M4N 3M5, Toronto, Canada
Background:
While it is recognised that patients
with multiple sclerosis have a high lifetime risk for major depression,
less is known about sub-syndromal presentations of affective instability,
i.e., irritability, sadness and tearfulness and how these symptoms of emotional
dyscontrol may affect a subject's overall degree of psychological distress.
Methods:
A consecutive sample of 100 out-patients
with clinically definite multiple sclerosis attending their yearly neurological
examination were assessed for major depression [Structured Clinical Interview
for DSM-IV (SCID-1)], pathological laughing and crying [Pathological Laughing
and Crying Scale (PLACS)], self report questionnaires documenting mood
[Beck Depression Inventory (BDI)] and overall psychological distress [the
28 item General Health Questionnaire (GHQ)].
Results:
Seventeen percent of subjects received
a diagnosis of major depression, 8% had pathological laughing and crying
(PLC), 48% had symptoms of emotional dyscontrol without meeting criteria
for a formal psychiatric diagnosis and 27% had minimal psychiatric symptoms
(emotionally stable). The groups did not differ with respect to neurological
variables. However, on a validated index of psychological distress (i.e.,
GHQ scores >/=5), there were significantly more subjects with major depression
and emotional dyscontrol than those deemed emotionally stable (P<0.0001).
Limitations:
The small number of patients with
PLC (N=8) curtailed statistical power when it came to analysing this sub-group.
Conclusions:
Clinicians should be sensitive to
complaints such as irritability and sadness in patients with multiple sclerosis,
even when symptoms do not fulfil criteria for formal, psychiatric diagnoses.
Our data demonstrate that such complaints are associated with levels of
psychological distress that approach those experienced by patients with
major depression. Given that these sub-syndromes of affective instability
respond well to pharmacotherapy, detection and treatment can significantly
reduce one important aspect of morbidity associated with multiple sclerosis.
PMID: 11578672 [PubMed - in process]