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Article ; Online: Chemotherapy-associated hemorrhagic posterior reversible encephalopathy syndrome (PRES) with considerations for circle of Willis variants on cerebral blood flow and autoregulation: A case report.

Srichawla, Bahadar S / Presti, Kendall / Kipkorir, Vincent / Berrios Morales, Idanis

2024 Volume 103, Issue 8, Page(s) e37250

Abstract: Rationale: Hodgkin lymphoma, a lymphatic system cancer, is treated by chemotherapy, radiation therapy, and hematopoietic stem cell transplantation. Posterior reversible encephalopathy syndrome (PRES) is a rare neurotoxic effect associated with several ... ...

Abstract	Rationale: Hodgkin lymphoma, a lymphatic system cancer, is treated by chemotherapy, radiation therapy, and hematopoietic stem cell transplantation. Posterior reversible encephalopathy syndrome (PRES) is a rare neurotoxic effect associated with several drugs and systemic conditions. This case study emphasizes the potential risks of intensive chemotherapy regimens and postulates the impact of the circle of Willis variants on the heterogeneity of hemispheric lesions in PRES. Patient concerns: A 42-year-old woman diagnosed with stage IIA nodular sclerosing Hodgkin lymphoma and chronic thrombocytopenia presented after 6 years of initial diagnosis and 4 years post-haploidentical transplant. She underwent planned chemotherapy with ifosfamide, carboplatin, and etoposide. Diagnoses: She developed an alteration in her mental status. A computerized tomography scan and angiogram of the head and neck revealed findings consistent with PRES and a left fetal-type posterior cerebral artery with an aplastic A1 segment of the left anterior cerebral artery. One hour later she was found comatose with clinical sequelae of an uncal herniation. Interventions: Subsequent events led to emergent intubation, and administration of 23.4% hypertonic saline. A repeat computerized tomography scan showed a right intraparenchymal hemorrhage with fluid-fluid levels measuring up to 4.7 cm, bilateral subarachnoid hemorrhage, right uncal herniation, and 15 mm of leftward midline shift. She emergently underwent a right decompressive hemi-craniectomy. Outcomes: An magnetic resonance imaging of the brain demonstrated bilateral cytotoxic edema involving the parieto-occipital lobes. Despite interventions, the patient's neurological condition deteriorated, leading to a declaration of brain death on the 8th day. Lessons: This case underscores the importance of recognizing the severe neurological complications, including PRES, associated with chemotherapeutic treatments in Hodgkin lymphoma. PRES may also be exacerbated by coagulopathies such as thrombocytopenia in this case. The circle of Willis variants may influence cerebral blood flow, autoregulation, and other factors of hemodynamics, leading to increased susceptibility to both radiographic lesion burden and the worst clinical outcomes.
MeSH term(s)	Humans ; Female ; Adult ; Posterior Leukoencephalopathy Syndrome/chemically induced ; Posterior Leukoencephalopathy Syndrome/diagnostic imaging ; Hodgkin Disease/complications ; Circle of Willis ; Brain Diseases/complications ; Hemorrhage/complications ; Thrombocytopenia/complications ; Cerebrovascular Circulation ; Homeostasis
Language	English
Publishing date	2024-02-23
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	80184-7
ISSN	1536-5964 ; 0025-7974
ISSN (online)	1536-5964
ISSN	0025-7974
DOI	10.1097/MD.0000000000037250
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Article ; Online: Case of primary Sjogren's syndrome preceded by dystonia.

Ararat, Kerime / Berrios, Idanis / Hannoun, Anas / Ionete, Carolina

BMJ case reports

2018 Volume 2018

Abstract: There are only six cases in literature that describe development of dystonia with Sjogren's syndrome (SS). We describe a case of a 43-year-old woman who presented with symptoms including movement disorder, sensory neurogenic bladder, sensory loss and ... ...

Abstract	There are only six cases in literature that describe development of dystonia with Sjogren's syndrome (SS). We describe a case of a 43-year-old woman who presented with symptoms including movement disorder, sensory neurogenic bladder, sensory loss and neuropathic pain, migraine like headaches, musculoskeletal pain, Raynaud's phenomenon and dysautonomia. Symptoms started in 2000, with weakness that progressed to dystonia in 2003. Diagnostic work-up was inconclusive with negative inflammatory serologies, cerebrospinal fluid and MRI for many years. After patient developed sicca syndrome with dry eyes and mouth in 2009, her rheumatoid factor titre was elevated (550 IU/mL), erythrocyte sedimentation rate, anti-Sjogrens syndrome-related antigen A (anti-Ro/SSA) and anti-SSB/La: anti-Sjogrens syndrome-related antigen B (anti-La/SSB) became positive. Lip biopsy confirmed diagnosis of SS. She was diagnosed with primary SS with neurological involvement. Her symptoms responded well to intravenous methylprednisolone. Symptoms stabilised with trials of immune-suppressive therapy. This is a case that demonstrates the delay of diagnosing SS with preceding unique neurological association.
MeSH term(s)	Adult ; Antibodies, Antinuclear/immunology ; Dystonia/diagnosis ; Dystonia/etiology ; Dystonia/immunology ; Female ; Humans ; Immunosuppressive Agents/therapeutic use ; Migraine Disorders/diagnosis ; Migraine Disorders/etiology ; Migraine Disorders/immunology ; Neuralgia/diagnosis ; Neuralgia/etiology ; Neuralgia/immunology ; Primary Dysautonomias/diagnosis ; Primary Dysautonomias/etiology ; Primary Dysautonomias/immunology ; Raynaud Disease/diagnosis ; Raynaud Disease/etiology ; Raynaud Disease/immunology ; Salivary Glands, Minor/pathology ; Sensation Disorders/diagnosis ; Sensation Disorders/etiology ; Sensation Disorders/immunology ; Sjogren's Syndrome/complications ; Sjogren's Syndrome/diagnosis ; Sjogren's Syndrome/drug therapy ; Sjogren's Syndrome/immunology ; Syncope/diagnosis ; Syncope/etiology ; Syncope/immunology ; Urinary Bladder, Neurogenic/diagnosis ; Urinary Bladder, Neurogenic/etiology ; Urinary Bladder, Neurogenic/immunology
Chemical Substances	Antibodies, Antinuclear ; Immunosuppressive Agents ; SS-A antibodies ; SS-B antibodies
Language	English
Publishing date	2018-06-04
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2017-223468
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Article ; Online: Implementing Shared Decision-Making for Multiple Sclerosis: The MS-SUPPORT Tool.

Col, Nananda F / Solomon, Andrew J / Alvarez, Enrique / Pbert, Lori / Ionete, Carolina / BerriosMorales, Idanis / Chester, Jennifer / Kutz, Christen / Iwuchukwu, Crystal / Livingston, Terrie / Springmann, Vicky / Col, Hannah V / Ngo, Long H

Multiple sclerosis and related disorders

2023 Volume 80, Page(s) 105092

Abstract: Background: Disease modifying therapies (DMTs) offer opportunities to improve the course of multiple sclerosis (MS), but decisions about treatment are difficult. People with multiple sclerosis (pwMS) want more involvement in decisions about DMTs, but ... ...

Abstract	Background: Disease modifying therapies (DMTs) offer opportunities to improve the course of multiple sclerosis (MS), but decisions about treatment are difficult. People with multiple sclerosis (pwMS) want more involvement in decisions about DMTs, but new approaches are needed to support shared decision-making (SDM) because of the number of treatment options and the range of outcomes affected by treatment. We designed a patient-centered tool, MS-SUPPORT, to facilitate SDM for pwMS. We sought to evaluate the feasibility and impact of MS-SUPPORT on decisions about disease modifying treatments (DMTs), SDM processes, and quality-of-life. Methods: This multisite randomized controlled trial compared the SDM intervention (MS-SUPPORT) to control (usual care) over a 12-month period. English-speaking adults with relapsing MS were eligible if they had an upcoming MS appointment and an email address. To evaluate clinician perspectives, participants' MS clinicians were invited to participate. Patients were referred between November 11, 2019 and October 23, 2020 by their MS clinician or a patient advocacy organization (the Multiple Sclerosis Association of America). MS-SUPPORT is an online, interactive, evidence-based decision aid that was co-created with pwMS. It clarifies patient treatment goals and values and provides tailored information about MS, DMTs, and adherence. Viewed by patients before their clinic appointment, MS-SUPPORT generates a personalized summary of the patient's treatment goals and preferences, adherence, DMT use, and clinical situation to share with their MS clinician. Outcomes (DMT utilization, adherence, quality-of-life, and SDM) were assessed at enrollment, post-MS-SUPPORT, post-appointment, and quarterly for 1 year. Results: Participants included 501 adults with MS from across the USA (84.6% female, 83% white) and 34 of their MS clinicians (47% neurologists, 41% Nurse Practitioners, 12% Physician Assistants). Among the 203 patients who completed MS-SUPPORT, most (88.2%) reported they would recommend it to others and that it helped them talk to their doctor (85.2%), understand their options (82.3%) and the importance of taking DMTs as prescribed (82.3%). Among non-users of DMTs at baseline, the probability ratio of current DMT use consistently trended higher over one-year follow-up in the MS-SUPPORT group (1.30 [0.86-1.96]), as did the cumulative probability of starting a DMT within 6-months, with shorter time-to-start (46 vs 90 days, p=0.24). Among the 222 responses from 34 participating clinicians, more clinicians in the MS-SUPPORT group (vs control) trended towards recommending their patient start a DMT (9 of 108 (8%) vs 5 of 109 (5%), respectively, p=0.26). Adherence (no missed doses) to daily-dosed DMTs was higher in the MS-SUPPORT group (81.25% vs 56.41%, p=.026). Fewer patients forgot their doses (p=.046). The MS-SUPPORT group (vs control) reported 1.7 fewer days/month of poor mental health (p=0.02). Conclusions: MS-SUPPORT was strongly endorsed by patients and is feasible to use in clinical settings. MS-SUPPORT increased the short-term probability of taking and adhering to a DMT, and improved long-term mental health. Study limitations include selection bias, response bias, social desirability bias, and recall bias. Exploring approaches to reinforcement and monitoring its implementation in real-world settings should provide further insights into the value and utility of this new SDM tool.
MeSH term(s)	Adult ; Humans ; Female ; Male ; Multiple Sclerosis/drug therapy ; Decision Making, Shared ; Quality of Life ; Physicians
Language	English
Publishing date	2023-10-21
Publishing country	Netherlands
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	2645330-7
ISSN	2211-0356 ; 2211-0348
ISSN (online)	2211-0356
ISSN	2211-0348
DOI	10.1016/j.msard.2023.105092
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Article ; Online: A real-world cohort analysis of alemtuzumab outcomes in relapsing multiple sclerosis.

Herman, Jorge Acevedo / Khalighinejad, Farnaz / York, Katherine / Radu, Irina / Berrios Morales, Idanis / Ionete, Carolina / Hemond, Christopher C

Multiple sclerosis and related disorders

2020 Volume 47, Page(s) 102619

Abstract: Multiple sclerosis (MS) is a chronic and progressive neurological disease characterized by recurrent episodes of inflammatory demyelination of the brain and spinal cord. Alemtuzumab has been previously shown in large phase III trials to be an effective ... ...

Abstract	Multiple sclerosis (MS) is a chronic and progressive neurological disease characterized by recurrent episodes of inflammatory demyelination of the brain and spinal cord. Alemtuzumab has been previously shown in large phase III trials to be an effective therapy in reducing MS clinical flares as well as new radiological activity and atrophy rates. The purpose of this study was to examine real-world effectiveness and safety data from a large cohort of people treated with alemtuzumab at an academic medical center, including those who failed B-cell depletion therapy. Over an average of 2.6 years follow-up, there were small but significant improvements in neurological disability scores, and a 61% rate of the composite "No Evidence of Disease Activity" (NEDA-3) outcome at 2-year follow-up. There were no substantial safety issues encountered in our review; rates of adverse events were similar or below those reported in Phase III trials. We compare and contrast our results to other available real-world data using alemtuzumab in multiple sclerosis.
MeSH term(s)	Alemtuzumab/adverse effects ; Cohort Studies ; Humans ; Immunologic Factors/adverse effects ; Multiple Sclerosis ; Multiple Sclerosis, Relapsing-Remitting/drug therapy
Chemical Substances	Immunologic Factors ; Alemtuzumab (3A189DH42V)
Language	English
Publishing date	2020-11-05
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2645330-7
ISSN	2211-0356 ; 2211-0348
ISSN (online)	2211-0356
ISSN	2211-0348
DOI	10.1016/j.msard.2020.102619
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Article ; Online: Lymphomatosis cerebri: diagnostic challenges and review of the literature.

Lee, Paul J / Berrios, Idanis / Ionete, Carolina / Smith, Thomas

BMJ case reports

2016 Volume 2016

Abstract: Lymphomatosis cerebri (LC) is a rare variant of a primary central nervous system non-Hodgkin's lymphoma (PCNSL) characterised by diffuse infiltration of tumour cells throughout the brain parenchyma. We present a 68-year-old immunocompetent woman with ... ...

Abstract	Lymphomatosis cerebri (LC) is a rare variant of a primary central nervous system non-Hodgkin's lymphoma (PCNSL) characterised by diffuse infiltration of tumour cells throughout the brain parenchyma. We present a 68-year-old immunocompetent woman with headaches, dizziness, blurred vision, localised right leg weakness and rapidly progressive dementia. A brain MRI demonstrated diffuse T2 hyperintense white matter lesions that did not enhance with contrast. The clinical differential diagnosis of these lesions included metastatic disease, infectious or inflammatory process such as sarcoidosis, lymphoma, demyelinating disease and less likely vascular aetiology, such as vasculitis or ischaemic stroke. A right frontal stereotactic brain biopsy was non-diagnostic. The patient eventually died from aspiration pneumonia following a pneumonectomy for a primary lung adenocarcinoma. The diagnosis of LC was established on postmortem examination of the brain.
MeSH term(s)	Aged ; Brain Neoplasms/diagnosis ; Diagnosis, Differential ; Fatal Outcome ; Female ; Humans ; Lymphoma, Non-Hodgkin/diagnosis
Language	English
Publishing date	2016-11-24
Publishing country	England
Document type	Case Reports ; Journal Article ; Review
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2016-216591
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Article ; Online: A Novel Tool to Improve Shared Decision Making and Adherence in Multiple Sclerosis: Development and Preliminary Testing.

Col, Nananda / Alvarez, Enrique / Springmann, Vicky / Ionete, Carolina / Berrios Morales, Idanis / Solomon, Andrew / Kutz, Christen / Griffin, Carolyn / Tierman, Brenda / Livingston, Terrie / Patel, Michelle / van Leeuwen, Danny / Ngo, Long / Pbert, Lori

MDM policy & practice

2019 Volume 4, Issue 2, Page(s) 2381468319879134

Abstract: ... ...

Abstract	Background
Language	English
Publishing date	2019-10-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	2861432-X
ISSN	2381-4683 ; 2381-4683
ISSN (online)	2381-4683
ISSN	2381-4683
DOI	10.1177/2381468319879134
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Article ; Online: The impact of socioeconomic status on mental health and health-seeking behavior across race and ethnicity in a large multiple sclerosis cohort.

Pimentel Maldonado, Daniela A / Eusebio, Justin R / Amezcua, Lilyana / Vasileiou, Eleni S / Mowry, Ellen M / Hemond, Christopher C / Umeton Pizzolato, Raffaella / Berrios Morales, Idanis / Radu, Irina / Ionete, Carolina / Fitzgerald, Kathryn C

Multiple sclerosis and related disorders

2021 Volume 58, Page(s) 103451

Abstract: Background: Psychiatric symptoms are common in multiple sclerosis (MS) and may contribute to worse MS outcomes. Previous studies suggest the burden of symptoms may vary by race, ethnicity and socioeconomic status (SES). Our objective was to expand upon ... ...

Abstract	Background: Psychiatric symptoms are common in multiple sclerosis (MS) and may contribute to worse MS outcomes. Previous studies suggest the burden of symptoms may vary by race, ethnicity and socioeconomic status (SES). Our objective was to expand upon this previous work and explore the associations between SES, race, and ethnicity, as predictors of psychiatric symptoms, mental health attitudes, and health-seeking behavior in patients with MS. Methods: Persons with MS answered a national web-based survey including demographic characteristics (including race, ethnicity and measures of SES), mental health attitudes, the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder 7-item (GAD-7) scale, the Modified Fatigue Impact Scale 5-item version (MFIS-5), and the Alcohol Use Disorders Identification Test (AUDIT). The survey also queried mental health availability and perceptions of care. We measured neighborhood-level SES (nSES) of each participant using the Agency for Healthcare Research and Quality (AHRQ) index that was calculated from 5-digit postal codes. Other indicators of participant-level SES included education level and self-reported household income. We assessed the association between race, ethnicity, and neighborhood/participant-level SES indicators and affective symptom burden using generalized linear models that were adjusted for age, sex, and MS characteristics. Results: 2095 participants answered the survey (mean AHRQ index 54.6 ± 5.4, age 51.3 ± 12.2 years, 7% Black/African American, 5.4% Hispanic/Latino, and 81.8% female). Those in the lowest quartile of nSES (most disadvantaged) were more likely to be either Black/African American or Hispanic/Latino as compared to those in highest quartile (least disadvantaged). Those in the lowest quartile of nSES had higher mean MFIS-5 (1.02 points; 95% CI: 0.39, 1.43), PHQ-9 (1.24 points; 95% CI: 0.49, 1.98), and GAD-7 (0.69 points; 95% CI: -0.01, 1.38) scores relative to those in the highest quartile. Of those who consumed alcohol (n = 1489), participants in the lowest AHRQ quartile had lower mean AUDIT scores (-0.73 points; 95% CI: -1.18, -0.29) as compared to those in higher quartiles. Race and ethnicity were not associated with self-reported psychiatric symptom burden in this cohort. SES was also associated with self-reported improvement of symptoms after receiving mental health care. A higher proportion of Black/African American (44.1% vs 30.2%, p = 0.003) and Hispanic/Latino (49.1% vs 30.6%, p<0.001) participants were more likely to report they would "definitely go" receive mental health care if services were co-located with their MS care as compared to white and Non-Hispanic/Latino participants, respectively. Conclusion: Higher SES was associated with a lower burden of psychiatric symptoms and with a higher likelihood of self-reported symptom recovery after receiving mental health treatment. Attitudes regarding mental health care delivery in MS varied according to racial and ethnic background. Future longitudinal studies in more diverse populations should assess whether co-location of mental health services with MS care helps to reduce the gap between access and need of mental health care in MS.
MeSH term(s)	Adult ; Alcoholism ; Ethnicity ; Female ; Humans ; Male ; Mental Health ; Middle Aged ; Multiple Sclerosis/epidemiology ; Patient Acceptance of Health Care ; Social Class
Language	English
Publishing date	2021-12-05
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2645330-7
ISSN	2211-0356 ; 2211-0348
ISSN (online)	2211-0356
ISSN	2211-0348
DOI	10.1016/j.msard.2021.103451
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Article ; Online: A case of neurosarcoidosis secondary to treatment of etanercept and review of the literature.

Berrios, Idanis / Jun-O'Connell, Adalia / Ghiran, Sorina / Ionete, Carolina

BMJ case reports

2015 Volume 2015

Abstract: There are only three cases in the literature that describe development of neurosarcoidosis in a patient who is on tumour necrosis factor α inhibitors. We describe a case of a 33-year-old woman with a history of juvenile rheumatoid arthritis and ... ...

Abstract	There are only three cases in the literature that describe development of neurosarcoidosis in a patient who is on tumour necrosis factor α inhibitors. We describe a case of a 33-year-old woman with a history of juvenile rheumatoid arthritis and refractory uveitis (with previous treatment trials of adalimumab, infliximab, mycophenolate, methotrexate) who had been stable for 2 years on etanercept. She was diagnosed with biopsy-proven systemic sarcoidosis with meningeal and parenchymal neurosarcoidosis. She was switched to infliximab and methotrexate, with clinical and imaging improvements. This is a case that demonstrates the difficulty of choosing tumour necrosis factor α (TNF-α) inhibitors when treating patients with multiple clinical autoimmune entities. It is also a case where a change in the mechanism of TNF-α inhibition pathway can still be used to treat refractory sarcoidoisis and rheumatoid arthritis. It is still unclear what the exact difference between the TNF-α blockers and their neurological complications is, and who the patients at risk of developing neurological complications are.
MeSH term(s)	Adult ; Antirheumatic Agents/therapeutic use ; Arthritis, Juvenile/complications ; Arthritis, Juvenile/drug therapy ; Central Nervous System Diseases/diagnosis ; Central Nervous System Diseases/drug therapy ; Central Nervous System Diseases/physiopathology ; Cognition Disorders/etiology ; Cognition Disorders/physiopathology ; Etanercept/therapeutic use ; Female ; Humans ; Immunosuppressive Agents/therapeutic use ; Infliximab/therapeutic use ; Methotrexate/therapeutic use ; Sarcoidosis/diagnosis ; Sarcoidosis/drug therapy ; Sarcoidosis/physiopathology ; Treatment Outcome ; Tumor Necrosis Factor-alpha/antagonists & inhibitors ; Uveitis/drug therapy ; Uveitis/etiology ; Uveitis/physiopathology
Chemical Substances	Antirheumatic Agents ; Immunosuppressive Agents ; Tumor Necrosis Factor-alpha ; Infliximab (B72HH48FLU) ; Etanercept (OP401G7OJC) ; Methotrexate (YL5FZ2Y5U1)
Language	English
Publishing date	2015-07-06
Publishing country	England
Document type	Case Reports ; Journal Article ; Review
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2014-208188
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Article ; Online: The varieties of psychosis in multiple sclerosis: A systematic review of cases.

Camara-Lemarroy, Carlos R / Ibarra-Yruegas, Beatriz E / Rodriguez-Gutierrez, Rene / Berrios-Morales, Idanis / Ionete, Carolina / Riskind, Peter

Multiple sclerosis and related disorders

2017 Volume 12, Page(s) 9–14

Abstract: Objectives: Multiple Sclerosis (MS) is known to be associated with a wide range of psychiatric symptoms, particularly with affective disorders. However, a link to psychotic disorders has not been fully established.: Methods: A systematic review of ... ...

Abstract	Objectives: Multiple Sclerosis (MS) is known to be associated with a wide range of psychiatric symptoms, particularly with affective disorders. However, a link to psychotic disorders has not been fully established. Methods: A systematic review of the PubMed/MEDLINE database was performed to identify cases of MS presenting with psychotic symptoms. Variables analyzed included patient demographics, clinical presentation, imaging characteristics and treatment. Results: Ninety-one cases were identified. The mean age was 34.4, and there was a female predominance. The majority of patients did not have a prior history of MS or psychiatric disease. The majority of cases could be classified as having either Psychotic Disorders or Mood Disorders with psychotic features. Most patients received some type of antipsychotic therapy, with variable success. At least 26 patients were treated with corticosteroids in the acute phase of their psychotic symptoms, and the majority responded favorably. Imaging data was available for 50 patients. Of these, 60% had predominantly fronto-temporal lesions, and most had contrast enhancing lesions. Conclusions: MS can present with a variety of psychotic symptoms. The presence of enhancing lesions and steroid-responsiveness suggests these could be characterized as flares.
MeSH term(s)	Humans ; Multiple Sclerosis/complications ; Multiple Sclerosis/psychology ; Psychotic Disorders/complications
Language	English
Publishing date	2017-02
Publishing country	Netherlands
Document type	Journal Article ; Review
ISSN	2211-0356
ISSN (online)	2211-0356
DOI	10.1016/j.msard.2016.12.012
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Article ; Online: The Prevalence of Bipolar Disorders and Association With Quality of Life in a Cohort of Patients With Multiple Sclerosis.

Jun-O'Connell, Adalia H / Butala, Ankur / Morales, Idanis Berrios / Henninger, Nils / Deligiannidis, Kristina M / Byatt, Nancy / Ionete, Carolina

The Journal of neuropsychiatry and clinical neurosciences

2017 Volume 29, Issue 1, Page(s) 45–51

Abstract: Clinical observations of mood instability in multiple sclerosis (MS) have led to the hypothesis that bipolar disorder (BD) may be more prevalent in persons with MS than in the general population. This cross-sectional study assesses the prevalence of BD ... ...

Abstract	Clinical observations of mood instability in multiple sclerosis (MS) have led to the hypothesis that bipolar disorder (BD) may be more prevalent in persons with MS than in the general population. This cross-sectional study assesses the prevalence of BD among patients with MS using standardized psychiatric diagnostic interviews and evaluates quality of life. This study demonstrates a higher prevalence of BD in patients with MS compared with the general population. It also reveals the negative impact of BD on quality of life, raises the concern that BD can occur before the onset of neurological symptoms in MS, and suggests that, in some cases, BD may delay diagnosis of MS.
MeSH term(s)	Adult ; Bipolar Disorder/complications ; Bipolar Disorder/epidemiology ; Bipolar Disorder/psychology ; Cohort Studies ; Comorbidity ; Cross-Sectional Studies ; Female ; Humans ; Interview, Psychological ; Male ; Middle Aged ; Multiple Sclerosis/complications ; Multiple Sclerosis/epidemiology ; Multiple Sclerosis/psychology ; Prevalence ; Quality of Life ; Self Report ; Tertiary Care Centers
Language	English
Publishing date	2017
Publishing country	United States
Document type	Journal Article
ZDB-ID	1036340-3
ISSN	1545-7222 ; 0895-0172
ISSN (online)	1545-7222
ISSN	0895-0172
DOI	10.1176/appi.neuropsych.15120403
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