Progress in Neuro-Psychopharmacology and Biological Psychiatry
Case reportAntipsychotic treatment of psychosis associated with multiple sclerosis
Introduction
Multiple sclerosis (MS) is frequently associated with psychiatric manifestations Pine et al., 1995, Stevens, 1998. A recent meta-analysis of psychiatric syndromes in patients with multiple sclerosis (n=4081) demonstrated that a total of 40.4% had psychiatric symptoms and, in this cohort, 1.1% suffered from psychosis (Schifferdecker et al., 1995). The treatment of psychosis in multiple sclerosis with typical neuroleptics has usually yielded poor responses and high risk of extrapyramidal symptoms Pine et al., 1995, Stevens, 1998. We now describe a case involving apparently effective treatment with ziprasidone in a psychotic patient with multiple sclerosis.
Section snippets
Case report
A 58-year-old woman with a 30-year history of multiple sclerosis and several neurological hospitalizations was admitted for the first time to a psychiatric service. She had been described sometimes as somewhat euphoric with low self-criticism, sometimes during treatment with corticosteroids which had been a major component in her long-term treatment, but not in the preceding 4 years. At admission, she demonstrated ataxic gait with generalized hyperreflexia and extensor plantar reflexes, with
Discussion
This patient's clinical history included findings of increased intrathecal immunoglobulin synthesis reflected by raised IgG indices and an oligoclonal pattern, as well as visually and somatosensoric evoked responses and MRI that fulfilled standard diagnostic criteria for multiple sclerosis Poser et al., 1983, Offenbacher et al., 1993, Zipoli et al., 2003. Diagnoses of differentiation to discuss ranging from traumatic or ischemic brain disease to hereditary, toxic, cortico-steroid related
Conclusion
This case suggests that ziprasidone may be a plausible option for psychosis associated with multiple sclerosis. While clozapine has been tested in several neurological disorders like multiple sclerosis, Parkinson's disease and Huntington's disease and has been shown to be superior to typical neuroleptics Safferman et al., 1994, Chong and Ko, 1997, systematic investigation of the newer atypical antipsychotics is now required. A general superiority of ziprasidone in the treatment of psychotic
Acknowledgements
We thank Dr. Ross J. Baldessarini, Belmont (MA, USA) for helpful comments.
References (12)
- et al.
Priapism following olanzapine administration in a patient with multiple sclerosis
Psychosomatics
(1998) - et al.
Ziprasidone: an atypical antipsychotic drug for the treatment of schizophrenia
Clin. Ther.
(2002) - et al.
Ziprasidone: the fifth atypical antipsychotic
Ann. Pharmacother.
(2002) - et al.
Clozapine treatment of psychosis associated with multiple sclerosis
Can. J. Psychiatry
(1997) - et al.
Optimal dosing of atypical antipsychotics in adults: a review of the current evidence
Harv. Rev. Psychiatr.
(2002) - et al.
Assessment of MRI criteria for a diagnosis of MS
Neurology
(1993)
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Successful treatment of co-morbid schizophrenia and multiple sclerosis
2010, Asian Journal of PsychiatryCitation Excerpt :This report demonstrates successful concurrent use of clozapine and risperidone with interferon-beta-1a. However, one need to be cautious while using this combination and monitoring is necessary while using these drugs in view of potential drug interactions and side effects; neuroleptics, except clozapine, worsen neurological deficits in MS (Davids et al., 2004), and similarly, interferon may worsen psychosis (Goeb et al., 2006). In addition both can cause agranulocytosis (Tueth, 1994; Rieckmann et al., 2004).
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