1Saloua Mrabet, 1Sirine Boudriga, 1Amira Souissi, 1Alya Gharbi, 1Amina Nasri, 1Mouna Ben Djebara, 1Amina Gargouri, 1Imen Kacem, 1Riadh Gouider
1Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health, University Hospital Razi, Manouba, Tunisia; 2Faculty of medicine, University Tunis El Manar, Tunis, Tunisia
Multiple sclerosis (MS) is a disabling chronic inflammatory disease of the central nervous system. Psychiatric disorders in MS are highly prevalent and are often underdiagnosed and poorly treated. The main psychiatric disturbances in MS are depressive, bipolar, anxiety, schizophrenic, and obsessive-compulsive syndromes. The aim of our study was to evaluate the type of psychiatric disorders in a cohort of patients with MS and to correlate the results with sociodemographic, clinical and radiological data.
Material(s) and Method(s):
We conducted a cross-sectional study, including patients who were followed in our MS Unit in the neurology department of Razi University Hospital between June and September 2021.
We used the structured interview of DSM-IV (MINI). We evaluated the severity of symptoms of depression and anxiety using the HAD (Hospital Anxiety and Depression scale) and MADRS (Montgomery–Åsberg Depression Rating Scale), and we measured the difficulty in identifying and describing emotions with the Toronto alexithymia scale (TAS). We reviewed their medical records and collected their demographic, clinical, and radiological characteristics as well as their outcome profile.
The mean age of our 55 patients was 33 years old with a sex ratio (F/M) of 3.2. MS was Relapsing remitting (RR MS) in 49 of our patients and secondary progressive MS in six of them.
Depression was diagnosed in 62.5 % of our population with 5.7% of the patients suffering from severe depression. Attempted drug-induced suicide was found in the medical history of 3 patients. Depression was correlated to a younger age of MS onset (p=0.003) and to MRI lesions load (p = 0.025). Among our patients, general anxiety disorder was diagnosed in 57.1%, while obsessive-compulsive disorder and panic disorder were identified in respectively 12.2% and 24.5%. Annual relapses rate was correlated with the occurrence of a social anxiety disorder (p= 0.003). As for anxiety, female gender (p= 0.69) and young age at disease onset (p=0.548) were not found to be risk factors. Furthermore, our patients presented a high prevalence of Alexithymia (62.5%). It was found to be inversely correlated to disease duration.
Our study showed that psychiatric comorbidity, particularly depression, alexithymia, and anxiety, was common in MS playing an important role in patients with MS life. The occurrence depressive and anxious symptoms in our cohort were higher than what was reported in MS patients in several studies (respectively 25–50% for depression and 13-31.7% for anxiety). It was correlated to an early age of the disease onset, which is in contrast with the 2014’s Tunisian study conducted in another University Hospital. Disease activity, but not its duration, was associated with Anxiety in our patients which is consistent with previous studies. White matter lesion load on MRI was associated to depression in MS patients as reported in several studies.