Sabe Michel, Sentissi Othman
Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, Thonex, Switzerland.
Int J Psychiatry Clin Pract. 2022 Sep;26(3):287-293. doi: 10.1080/13651501.2021.1973506. Epub 2021 Sep 6.
We aimed to examine the clinical features of psychotic symptoms preceding or concomitant to multiple sclerosis (MS) diagnosis.
From the 1st to 10th of January 2020 a systematic review was conducted through an electronic search of different databases. Results were limited to English, French, German, Italian and Spanish language articles.
We identified 599 titles, and included 32 cases from case-report and case series. One case report from our department was added. The mean age of first psychiatric symptoms was 25.8 ± 10.2 years, the mean age of MS diagnosis was 31.2 ± 10.7 years and the mean delay until MS diagnosis was 2.7 ± 3 years. Most reported symptoms were delusions (81%), auditory hallucinations (59%) and visual hallucinations (50%). Upon the MS diagnosis, immunosuppressive therapy was significantly more effective for psychotic symptoms than antipsychotics (OR = 9.0; 95%CI: 2.15-37; = 0.002). Diffuse periventricular lesions were found in 95.6% of cases, with mostly temporal or frontal predominant lesions. In cases affected by predominant temporal lesions, 83% of cases presented visual hallucinations ( < 0.05).
Poor response or resistance to antipsychotics treatment should alert clinicians on the need to consider a differential diagnosis. Considering the impact of delay in MS diagnosis further research regarding this subject is warranted.KEY POINTSInsight into the occurrence of psychotic symptoms in multiple sclerosis (MS) is mainly limited to case reports and case series.Delay in MS management between initial psychotic symptoms and the MS diagnosis is 2.73 ± 3 years and 0.8 ± 1.2 years for patients presenting a first episode of psychosis.The resistance and poor response to antipsychotics found in most cases (75%) were associated with an excellent improvement (95%) of both psychiatric and neurologic symptoms with corticosteroids.Prospective studies are needed to investigate the spectrum of psychosis in MS.
我们旨在研究多发性硬化症（MS）诊断之前或同时出现的精神病性症状的临床特征。
2020年1月1日至10日，通过对不同数据库进行电子检索开展了一项系统综述。结果仅限于英文、法文、德文、意大利文和西班牙文的文章。
我们筛选出599篇文献，并纳入了32例病例报告和病例系列研究。另外补充了我们科室的1例病例报告。首次出现精神症状的平均年龄为25.8±10.2岁，MS诊断的平均年龄为31.2±10.7岁，至MS诊断的平均延迟时间为2.7±3年。报告的大多数症状为妄想（81%）、幻听（59%）和幻视（50%）。在MS诊断后，免疫抑制疗法对精神病性症状的疗效显著优于抗精神病药物（OR=9.0；95%CI：2.15-37；P=0.002）。95.6%的病例发现有脑室周围弥漫性病变，主要以颞叶或额叶病变为主。在以颞叶病变为主的病例中，83%的病例出现幻视（P<0.05）。
对抗精神病药物治疗反应不佳或抵抗应提醒临床医生需要考虑鉴别诊断。鉴于MS诊断延迟的影响，有必要对此主题进行进一步研究。要点
对多发性硬化症（MS）中精神病性症状发生情况的了解主要限于病例报告和病例系列研究。
首发精神病性症状与MS诊断之间的MS管理延迟时间，对于首次出现精神病发作的患者为2.73±3年，对于首次发作的患者为0.8±1.2年。
大多数病例（75%）中发现的对抗精神病药物的抵抗和反应不佳与使用皮质类固醇后精神和神经症状的显著改善（95%）有关。
需要开展前瞻性研究以调查MS中的精神病谱系。
