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Evidence-based guideline: Assessment and management of psychiatric disorders in individuals with MS: Report of the Guideline Development Subcommittee of the American Academy of Neurology
Open accessAbstract
OBJECTIVE: To make evidence-based recommendations for screening, diagnosing, and treating psychiatric disorders in individuals with multiple sclerosis (MS). METHODS: We reviewed the literature (1950 to August 2011) and evaluated the available evidence. RESULTS AND RECOMMENDATIONS: Clinicians may consider using the Center for Neurologic Study Emotional Lability Scale to screen for pseudobulbar affect (Level C). Clinicians may consider the Beck Depression Inventory and a 2-question tool to screen for depressive disorders and the General Health Questionnaire to screen for broadly defined emotional disturbances (Level C). Evidence is insufficient to support/refute the use of other screening tools, the possibility that somatic/neurovegetative symptoms affect these tools' accuracy, or the use of diagnostic instruments or clinical evaluation procedures for identifying psychiatric disorders in MS (Level U). Clinicians may consider a telephone-administered cognitive behavioral therapy program for treating depressive symptoms (Level C). Although pharmacologic and nonpharmacologic therapies are widely used to treat depressive and anxiety disorders in individuals with MS, evidence is insufficient to support/refute the use of the antidepressants and individual and group therapies reviewed herein (Level U). For pseudobulbar affect, a combination of dextromethorphan and quinidine may be considered (Level C). Evidence is insufficient to determine the psychiatric effects in individuals with MS of disease-modifying and symptomatic therapies and corticosteroids; risk factors for suicide; and treatment of psychotic disorders (Level U). Research is needed on the effectiveness in individuals with MS of pharmacologic and nonpharmacologic treatments frequently used in the non-MS population.
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“The Consensus Group for depression in MS [12] and the American Academy of Neurology [13] stated that the best approach to screening for depression in general MS populations is to use the BDI-II, with a cut-off score of 13.”
From The efficacy of a Mindfulness Based Intervention for depressive symptoms in patients with Multiple Sclerosis and their caregivers: study protocol for a randomized controlled clinical trial. (2016) · cites this paper as [13]
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“They determined that the BDI and a two-question screen may be effective for identifying individuals with depression, but that evidence is insufficient to support or refute the use of the CES-D.”
From Systematic review and meta-analysis of interventions for depression and anxiety in persons with multiple sclerosis (2016) · cites this paper as Minden et al., 2014
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“Well-developed evidence to guide the treatment of depression and anxiety in MS is lacking (Minden et al., 2014”
From Systematic review and meta-analysis of interventions for depression and anxiety in persons with multiple sclerosis (2016) · cites this paper as Minden et al., 2014
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“The American Academy of Neurology (AAN) published guidelines on the assessment and management of psychiatric disorders in MS, specifically evaluating the evidence-base of tools for assessing symptoms and making diagnoses (Minden et al., 2014”
From Systematic review and meta-analysis of interventions for depression and anxiety in persons with multiple sclerosis (2016) · cites this paper as Minden et al., 2014
In the citing paper
“For these reasons the Goldman Consensus Conference (Goldman Consensus Group, 2005) and the American Academy of Neurology (Minden et al., 2014) have highlighted the importance of diagnosing and treating depression in people with MS.”
From The effectiveness of a body-affective mindfulness intervention for multiple sclerosis patients with depressive symptoms: A randomized controlled clinical trial (2017) · cites this paper as Minden et al., 2014
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Multiple Sklerose und psychische Störungen
Fertl, E., & Bauer, K. (2015) · psychopraxis neuropraxis · doi:10.1007/s00739-015-0285-7
Determinants of Depression in Multiple Sclerosis
Berzins, S. A. (2014) · Libraries and Cultural Resources (University of Calgary) · doi:10.5072/prism/25602
Drug Management of Psychiatric Co-morbidity in Multiple Sclerosis
Llorca, P., & Samalin, L. (2015) · Neuropsychiatric symptoms of neurological disease · doi:10.1007/978-3-319-18464-7_8
Cognition, disease activity and MRI changes in early multiple sclerosis
Nygaard, G. O. (2016) · NORA - Norwegian Open Research Archives
Assessing and Managing Depression in Multiple Sclerosis
Naismith, R. T. (2014) · Journal watch · doi:10.1056/nejm-jw.na33247
Symptomatic and Complementary Treatments
Sørensen, P. S., Schreiber, K. I., & Andreasen, A. K. (2016) · Elsevier eBooks · doi:10.1016/b978-0-12-801914-6.00026-x
Ahmad, M. I. B. (2017) · Elsevier eBooks · doi:10.1016/b978-0-323-47904-2.00046-5
Pediatric Multiple Sclerosis Manifesting with Primary Psychiatric Symptoms
Tomko, S., & Lotze, T. E. (2017) · Springer eBooks · doi:10.1007/978-3-319-61407-6_3
Fatigue and associated factors in multiple sclerosis patients in Latvia
Setlere, S., Abelsen, A., Pastare, D., & Millers, A. (2018) · Neurologijos seminarai · doi:10.29014/ns.2018.05
Psychische Veränderungen, Krankheitsbewältigung und Patientenführung
Schifferdecker, M. (2015) · Elsevier eBooks · doi:10.1016/b978-3-437-22083-8.00021-3
Lexique des troubles cognitifs dans la sclérose en plaques
Brochet, B., Clavelou, P., Seze, J. D., Defer, G. L., Delabrousse-Mayoux, J. P., Heinzlef, O., Lebrun‐Frénay, C., Magnin, É., Ruet, A., Péré, J.-J., et al. (2020) · Pratique Neurologique - FMC · doi:10.1016/j.praneu.2020.05.001
An Overview of Neuropsychiatric Symptoms and Pathogenesis in MS
Evans, E. M., Silbermann, E., & Mar, S. (2020) · The Wiley Encyclopedia of Health Psychology · doi:10.1002/9781119057840.ch6
Comorbidities in MS Found to Increase Psychological Problems
Samson, K. (2016) · Neurology Today · doi:10.1097/01.nt.0000482734.99378.9c
Models for Assessing Anxiety and Depression in Multiple Sclerosis: from Mouse to Man
Ellwardt, E., & Luchtman, D. W. (2021) · Neuromethods · doi:10.1007/978-1-0716-1213-2_13
Afeto pseudobulbar e ideação suicida: há relação?
de Freitas, F. A. C., Neto, A. P. G., de Winter, R. F. P., Melo, R. B. D. S., Bicalho, A. L. R., & Christo, P. P. (2020) · Debates em Psiquiatria · doi:10.25118/2763-9037.2020.v10.24
Metadata
- Authors
- Minden, S. L., Feinstein, A., Kalb, R. C., Miller, D., Mohr, D. C., Patten, S. B., Bever, C., Schiffer, R. B., Gronseth, G. S., & Narayanaswami, P.
- Affiliations
- Northwestern University (US)
- ORCID
- Venue
- Neurology
- Published
- 2014-01-14
- Volume
- 82
- Issue
- 2
- Pages
- 174-181
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- PMC
- PMC3897434
- OpenAlex
- W2026795289
- Cited by
- 230
- References
- 39
- Citations by year
- 2026: 10 · 2025: 9 · 2024: 20 · 2023: 15 · 2022: 14 · 2021: 22 · 2020: 24 · 2019: 18 · 2018: 12 · 2017: 27 · 2016: 23 · 2015: 22 · 2014: 13
- FWCI
- 14.49
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Neurology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- Funders
- National Institutes of Health (UL1TR000150)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Clinical Neurology › Multiple Sclerosis Research Studies
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- multiple sclerosis, mental illness, depression, anxiety, pseudobulbar affect, screening, diagnosis, cognitive behavioral therapy, antidepressants, suicide risk, psychosis, emotional lability
- MeSH terms
- Affective Symptoms, Mental Disorders, Depression, Humans, Multiple Sclerosis, Psychiatric Status Rating Scales, Surveys and Questionnaires, Evidence-Based Medicine, Diagnostic and Statistical Manual of Mental Disorders
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