Personality characteristics and disorders in multiple sclerosis patients: Assessment and treatment

Department of Psychiatry, University of Patras Medical School, General University Hospital, Rio-Patras, Greece.
International Review of Psychiatry (Impact Factor: 1.8). 02/2010; 22(1):43-54. DOI: 10.3109/09540261003589349
Source: PubMed


Multiple sclerosis (MS) is a major inflammatory and demyelinating disease of the central nervous system. Although a significant incidence and prevalence of psychological disorders in MS has been reported there is limited data on the prevalence of personality disorders (PD) in these patients. Recent findings indicate the need for early diagnosis and treatment of PD in MS patients in the interests of prognosis, conformity to treatment and patient's quality of life improvement. This article summarizes existing evidence on prevalence, types and diagnostic criteria of PD in MS, clinical manifestations of personality pathology or changes in MS patients, and instruments currently used for diagnosis and assessment of PD in this group of patients. Underlying mechanisms suggested as causes of personality changes in MS patients are also discussed. The article reviews therapeutic strategies, including pharmacotherapy and psychotherapy interventions and emphasizes the need for a multidisciplinary approach to patient's treatment.

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    • "Low levels of concern about falling, on the other hand, were protective for falling through a positive outlook on life, and maintained physical activity and community participation (Delbaere et al., 2010). The same phenomenon could also occur in people with MS, especially given that this group has a high prevalence of generalized anxiety (20%) (Korostil & Feinstein, 2007), depressive symptoms (30%) (Beiske et al., 2008) and personality changes (20–40%) (Stathopoulou, Christopoulos, Soubasi, & Gourzis, 2010). It has also been found that increased concern of falls is associated with restricted participation in physical and social activities, which could trigger a downhill spiral of functional decline through avoidance of activities (Delbaere et al., 2010; Delbaere et al., 2004; Friedman, Munoz, West, Rubin, & Fried, 2002). "
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    ABSTRACT: BACKGROUND: Concern about falling can have devastating physical and psychological consequences in people with multiple sclerosis (MS). However, little is known about physical and cognitive determinants for increased concern about falling in this group. OBJECTIVE: To investigate direct and indirect relationships between MS severity and concern about falling using structural equation modelling (SEM). METHODS: Two hundred and ten community-dwelling people (21-73 years) with MS Disease Steps 0-5 completed several physical, cognitive and psychological assessments. Concern about fallingwas assessed using the Falls Efficacy Scale-International. RESULTS: Concern about falling was significantly associated with MS Disease Step and also balance, muscle strength, disability, previous falls, and executive functioning. SEM revealed a strong direct path between MS Disease Step and concern about falling (r = 0.31, p < 0.01), as well as indirect paths explained by impaired physical ability (r = 0.25, p < 0.01) and reduced cognitive function (r = 0.13, p < 0.01). The final model explained 51% of the variance of concern about falling in people with MS and had an excellent goodness-of-fit. CONCLUSIONS: The relationship between MS severity and increased concern about falling was primarily mediated by reduced physical ability (especially if this resulted in disability and falls) and less so by executive functioning. This suggests people with MS have a realistic appraisal of their concern about falling.
    Neurorehabilitation 08/2015; 37(1):139-147. DOI:10.3233/NRE-151246 · 1.12 Impact Factor
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    ABSTRACT: The goal of the present review was to present a critical description of psychological research and practice in neurorehabilitation with regard to the efficacy of treatments proposed in the clinical and neuropsychological field. PubMed, Web of Science and Cochrane databases were searched by using the keywords "psychological intervention" and one of the following neurological diseases: "stroke", "TBI", "Parkinson", "ALS", "multiple sclerosis", "dementia". Randomized and pseudo-randomized trials, reviews and single case studies were included. We identified 134 papers: 54 concerning dementia, 24 stroke, 20 multiple sclerosis, 16 Parkinson, 13 TBI and 7 ALS. Most of these papers concern the evaluation of the effectiveness of psychological treatments in chronic or progressive neurological diseases. However, they are often characterized by methodological limitations, such as a small sample size, absence of a follow-up study or a control group. Further, high quality studies could help better understand treatment effects. There was some evidence for effectiveness of cognitive-behavioural and cognitive therapies, often applied both in clinical and neuropsychological interventions. Evidence coming from individualized treatment and single case studies are also described. In line with the data collected, we summarize some evidence available for psychological testing and treatment and argue that a multidisciplinary approach and a multidimensional evaluation should be adopted. According to this position, both randomized trials and single-case studies could be taken into account. Finally, it is proposed that in order to establish the efficacy of a given treatment, both standardized and individualized measures are to be used.
    Giornale italiano di medicina del lavoro ed ergonomia 01/2011; 33(1 Suppl A):A19-28.
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    ABSTRACT: Patients with multiple sclerosis (MS) frequently experience depression and anxiety. Several studies also document personality differences between MS patients and controls. Few studies, however, have examined the relationship between mood/anxiety and core personality traits in MS. The purpose of the present investigation was to examine the association between anxiety, mood, and personality disturbances in MS. A structured psychiatric interview and validated self-report measures of personality, depression, and anxiety were administered to 85 MS patients and 20 normal controls. Findings suggested a significant association between psychopathology and core personality dysfunction in MS. Depressed/anxious MS patients exhibited more neuroticism, less extroversion, less agreeableness, and less conscientiousness than mentally healthy MS patients and normal controls. In contrast, nondepressed/nonanxious MS patients' core personality traits did not substantially differ from normal controls. Though longitudinal studies are needed, findings provide hope that the successful treatment of MS patients' mood and anxiety symptoms may also partially ameliorate disordered personality characteristics. Consistent with previous research, an increased understanding of MS patients' personality characteristics may also aid with preventative psychiatric and medical treatment.
    Journal of psychosomatic research 05/2011; 70(5):479-85. DOI:10.1016/j.jpsychores.2010.12.010 · 2.74 Impact Factor
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