Personality disorders in pateints with multiple sclerosis : Prevalence and association with depressive and anxiety disorders and clinical features

Objective: This study examines the current prevalence of mood, anxiety and personality disorders in patients with multiple sclerosis (MS), the impact of personality disorders on clinical features of MS and the existence of depressive and anxiety disorders. Methods: The study sample comprised of 55 patients with relapsing-remitting MS and 56 control subjects. Axis I diagnoses including mood and anxiety disorders and personality disorders were ascertained by means of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition / Clinical Version and the Structured Clinical Interview for DSM, Revised Third Edition Personality Disorders, respectively. The Expanded Disability Status Scale (EDSS) was used to determine degree of disability due to MS. Results: The prevalence of any mood, any anxiety and any personality disorders in patients with MS were 40.0%, 38.2% and 45.5%, respectively, which are significantly higher than the control subjects. Major depression, generalized anxiety disorder, avoidant personality disorder and obsessivecompulsive personality disorder were more frequent in patients with MS compared to the controls. In comparison to MS patients without personality disorders, MS patients with personality disorders had a more frequent occurence of any mood disorder, any anxiety disorder, major depression, posttraumatic stress disorders and MS attacks, and higher scoresof EDSS. Conclusions: Mood, anxiety and personality disorders are frequently seen in patients with MS. The results also suggest that personality disorders may negatively affect the existence of mood and anxiety disorders as well as the clinical course of MS in the patients. Neurology Asia 2016; 21(1) : 55 – 61 Address correspondence to: Ali ULVİ UCA, Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi, Nöroloji Anabilim Dalı, Akyokuş, 42080 Konya, TURKEY. Tel: +90 332 223 7981, E-mail: aulviuca@hotmail.com INTRODUCTION Multiple sclerosis (MS) is a chronic inflammatory demyelinating neurological disease with an onset age primarily between 20 and 55 years, which may lead to different degrees of disability and reduction in quality of life of patients. The annual incidence of MS is 7.6 per 100,000 people. Despite considerable advances in the treatment, MS is considered one of the commonest causes of nontraumatic disabilities in young people in developed countries. MS is associated with not only physical disabilities (e.g., visual loss, bowel and bladder incontinence) but also a high prevalence (up to 80.0%) of neuropsychiatric symptoms. Various studies have suggested that patients with MS showed higher levels of depressive and anxiety symptoms comparedto control subjects. Major depression appears to be the most common psychiatric disorder with prevalence rates between 30% and 50% in MS patients. 8,12-15 Psychiatric disturbances are also important factors affecting the quality of life in MS patients. Although personality aspects of MS patients are better understood over the last decade, personality features or disorders were less frequently investigated in comparison to mood and anxiety disorders. Various studies have reported that patients with MS showed personality traits such as more anxious avoidant, neuroticism, and reduction in empathy, agreeableness and conscientiousness. Previous studies have also suggested the clinical importance of personality features in these patients. Neuropsychiatric complications and poor treatment adherence in MS was related to neuroticism and low Neurology Asia March 2016 56 conscientiousness. Akbar et al. reported that conscientiousness contributes to patients’ perceptions of their cognitive failings. In addition, personality characteristics may also affect the patients’ employment status. However, almost all of the available studies on personality disturbances are were based on personality scales rather than structural clinical interviews. On the other hand, personality traits are seen as the underpinnings of personality disorders and are themselves not necessarily pathological. In the current study, we aimed to examine the frequency of personality disorders and their impact on clinical features of MS and risk of mood and anxiety disorder in the patients.