Psychiatric aspects of multiple sclerosis

Psychiatric manifestations of neurological disease are frequent in clinical practice and neurologists as well as psychiatrists are usually aware of the disability and poor quality of life associated with these comorbid conditions (Lyketsos, Kozauer, & Rabins, 2007). Multiple sclerosis (MS) is the commonest cause of neurological disability in young and middle-aged adults and psychiatric symptoms are highly prevalent in this population (Ghaffar & Feinstein, 2007). Psychiatric disability is manifested through behavioural symptoms pertaining to mood, affect, behaviour and cognition, thus severely affecting patients’ quality of life (Ghaffar & Feinstein, 2007). Prevalence of psychiatric symptoms in MS is sufficiently high relative to that in the general population and consequently MS may sometimes be misdiagnosed as a psychiatric disorder, especially when psychiatric symptoms predate the neurological signs (Kosmidis et al., 2010, see pp. 55–66). As MS can vary from a relatively benign illness with minimal impairment to a rapidly evolving and incapacitating disease with both physical and neuropsychiatric symptoms the close collaboration of neurologists and psychiatrists is necessary in order to provide successful treatment interventions for a disease requiring major lifestyle adjustments.

This special issue, entitled ‘Psychiatric aspects of multiple sclerosis’, includes a series of papers reflecting the current literature on the neuropsychiatry of multiple sclerosis. Specifically, the first paper by Koutsouraki et al. provides an overview of MS epidemiological data in Europe and outlines the variability in prevalence and incidence rates across Europe. The paper by Paparrigopoulos et al. focuses on the disorders of mood, affect and behaviour that may accompany MS and reviews the recent literature on these issues. The papers by Stathopoulou et al. and Kosmidis, Giannakou, Messinis, & Papathanasopoulos, pertain to the personality characteristics and disorders, and psychotic features associated with MS, and provide an overview of recent treatment modalities for these conditions. The papers by Messinis et al. and Lyros et al. deal with a frequently under-recognized manifestation of MS, i.e. cognitive dysfunction, which has been associated with significant disability in this population, and also provide an overview of the most recent neuropsychological assessment methods, as well as recent developments on pharmacological interventions for cognitive dysfunction. The paper by Kargiotis et al. describes the results of studies that have assessed the efficacy of pharmacological interventions on quality of life (QoL) indices in MS and provides an overview of methods used to assess QoL in MS. The final paper by Kouzoupis et al. reviews the influence of this debilitating disease on the family and caregiver of the MS patient, within a psychosocial framework.