Enderami Athena, Fouladi Rose, Hosseini Seyed Hamzeh
Department of Psychiatry, School of Medicine, Mazandaran University of Medical Sciences, Mazandaran, Sari, Iran.
Sport Injuries and Corrective Exercise, University of Mazandaran, Mazandaran, Babolsar, Iran.
Int Med Case Rep J. 2018 Apr 5;11:73-76. doi: 10.2147/IMCRJ.S157287. eCollection 2018.
Multiple sclerosis (MS) is an inflammatory disease that affects the central nervous system (CNS). MS with episode of psychosis is a rare entity, and to the best of our knowledge, no case has been reported from Iran till date.
We report a case of MS with first-episode psychosis in a 27-year-old single man with no history of psychiatric disorder or drug abuse. The patient developed neurological symptoms after 3 months and was finally diagnosed as a case of MS. His symptoms started with behavioral dysfunctions and progressively resulted in depression. Subsequently, treatment was performed with citalopram 20 mg daily, risperidone 2 mg three times a day, and biperiden 2 mg three times a day; however, no improvements in the symptoms were observed. T2-weighted magnetic resonance imaging has demonstrated periventricular and white matter multiple sclerotic plugs with lesions. Eventually, MS was diagnosed after the appearance of paresthesia, upper and lower limb muscle weakness, ataxia, and urinary incontinency as typical signs. Then, the medications were changed to methylprednisolone and interferon therapy, which resulted in improvements in the clinical conditions of the patient.
Based on the fact that organic disorders such as MS may sometimes appear with initial pure psychiatric symptoms without any neurological signs and symptoms, examinations for symptoms linked to CNS dysfunction, cognitive changes, atypical symptoms, detailed neurological examination, and limited response to conventional antipsychotic drugs are highly recommended to be carried out for patients with first-episode psychosis and even in the followup period.
多发性硬化症（MS）是一种影响中枢神经系统（CNS）的炎症性疾病。伴有精神病发作的MS是一种罕见的情况，据我们所知，迄今为止伊朗尚未有病例报告。
我们报告一例27岁单身男性首次发作精神病的MS病例，该患者无精神疾病史或药物滥用史。患者在3个月后出现神经症状，最终被诊断为MS。他的症状始于行为功能障碍，并逐渐导致抑郁。随后，给予每日20毫克西酞普兰、每日三次每次2毫克利培酮和每日三次每次2毫克安坦进行治疗；然而，症状未见改善。T2加权磁共振成像显示脑室周围和白质有多个硬化斑和病变。最终，在出现感觉异常、上下肢肌肉无力、共济失调和尿失禁等典型体征后诊断为MS。然后，药物改为甲基泼尼松龙和干扰素治疗，患者的临床状况得到改善。
基于MS等器质性疾病有时可能最初仅表现为单纯精神症状而无任何神经体征和症状这一事实，强烈建议对首次发作精神病的患者甚至在随访期间进行与中枢神经系统功能障碍相关症状的检查、认知变化、非典型症状、详细的神经系统检查以及对传统抗精神病药物的有限反应评估。
