BAL HARBOUR, FLA. – All people with multiple sclerosis should be screened for anxiety, according to a study presented at the annual meeting of the American Neuropsychiatric Association.
Researchers randomly selected 100 people with multiple sclerosis and screened them for anxiety using DSM-IV criteria. “We found the rates of anxiety were high. They would not have been diagnosed without neuropsychiatry screening for anxiety and depression,” Juan Carlos Urizar, M.D., told this newspaper.
“Data are very preliminary, but this is a good start to see how one can intervene clinically and not forget anxiety and depression in multiple sclerosis. This has implications for quality of life,” said Dr. Urizar of the department of psychiatry at Brigham and Women's Hospital, Boston, who was the second author of the study.
Early in multiple sclerosis, patients can also experience decreased memory and concentration. Some anxiety also may be related to demyelinization and brain function. “Although we know this is true for depression as many studies have correlated depression to white matter changes and undermining of cortical fibers by subcortical lesions,” lead author Zeina Chemali, M.D., said in a follow-up interview. “Not much is published in regard to anxiety.”
The researchers did not assess patient anxiety according to lesions visible on magnetic resonance imaging (MRI) or disease burden, but they plan to do so in the future. Dr. Chemali is the director of neuropsychiatry at the Brigham Behavioral Neurology Group at Brigham and Women's Hospital.
Researchers grouped the 70 women and 30 men according to the types of multiple sclerosis episodes. Participants included 49% with relapse-remitting disease, 32% with secondary progressive multiple sclerosis, 16% who experienced their first multiple sclerosis attack, and 3% with primary progressive disease.
Results indicate that anxiety is not related to severity or chronicity of multiple sclerosis, suggesting that screening is appropriate for all patients with the disease.
Researchers assessed prevalence of affective disorders, anxiety disorders, and comorbidity between the two. “An interesting finding is the higher level of anxiety than depression,” Dr. Urizar said.
A total of 37% of participants had an anxiety disorder, 20% had depression, and 20% had comorbid anxiety and depression. In addition, 21% presented with cognitive decline. Manic-depressive disorder was included with depression in the study, Dr. Chemali said.
The neuropsychological battery of tests included:
▸ The Boston Naming Test for language.
▸ The Drilled Word Span Test or the Buschke Selective Reminding Test for memory.
▸ The Trail Making Test (Parts A and B), a digit span test, and letter cancellation tested for attention.
▸ Beck Depression Inventory for mood assessment.
▸ Beck Anxiety Inventory for anxiety.
Participants also were asked to copy a cube and place the numbers and hands in a clock, and were given the Rey-Osterrieth Complex Figure Test.
The prevalence of anxiety was higher among women than men. “The gender difference … reflects the fact that MS is more common in women than in men,” Dr. Chemali said. The disparity could also reflect the reportedly higher prevalence of anxiety in women compared with men in the general population–a highly debated subject, because women present at or use more medical/psychiatric services than do men, which may result in prevalence being recorded as higher among women.
The study findings demonstrate that patients with multiple sclerosis can suffer debilitating anxiety with or without an affective disorder. However, the authors wrote in their poster, “Further study is needed to confirm these findings.”