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Review
. 2024 Aug 8;16(8):e66432.
doi: 10.7759/cureus.66432. eCollection 2024 Aug.

Factors Contributing to the Development of Neuropsychiatric Manifestations in Persons With Multiple Sclerosis: A Systematic Review

Elizabeth Sangster  1   2 , Nidhi Lanka  3 , Prakash Acharya  4   3 , Shikha Virani  5   3 , Sumayya Afreen  6   7 , Arvin Perthiani  8   9 , Sondos T Nassar  10   3
Affiliations
Review

Factors Contributing to the Development of Neuropsychiatric Manifestations in Persons With Multiple Sclerosis: A Systematic Review

Elizabeth Sangster et al. Cureus. .

Abstract

Multiple sclerosis (MS) is the most common chronic demyelinating disease affecting the central nervous system (CNS) and is distinguished by neuroinflammation and neurodegeneration. It has four categories based on clinical course, with relapsing-remitting being the most common type. MS predominantly manifests with motor and sensory dysfunctions. However, neuropsychiatric manifestations such as depression, anxiety, schizophrenia, and bipolar disorder are not uncommon. Various factors may contribute to the development of these manifestations; therefore, this study aimed to unravel them. This systematic review implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Five databases (PubMed, PubMed Central (PMC), ScienceDirect, Cochrane Library, and Google Scholar) were used to acquire articles published in the past five years. After screening and quality appraisal were completed, eight articles were deemed eligible for inclusion in this study. The study designs included cohort, cross-sectional, randomized-controlled trial (RCT), case report, case-control, and narrative review. The development of neuropsychiatric manifestations in persons with MS is influenced by various factors. These were categorized into morphological changes of the brain, immunological mechanisms, socioeconomic factors, and individual factors for discussion. Each factor was found to intermingle with the others, requiring further research to understand the features that each factor contributes. This is crucial for improving the quality of life (QOL) and prognosis for persons living with MS.

Keywords: anxiety; cognitive impairment; depression; mental health; mood disorder; multiple sclerosis; neurodegeneration; neuropsychiatric symptoms; quality of life; risk factors.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. PRISMA 2020 flow diagram illustrating the screening process for systematic review
PMC: PubMed Central; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Figure 2
Figure 2. The main morphological changes and manifestations of neuropsychiatric symptoms in persons with multiple sclerosis (MS).
Created in Biorender.com
Figure 3
Figure 3. The four main immunologic mechanisms contributing to neuropsychiatric symptoms in persons with MS.
CRH: corticotrophin-releasing hormone; ACTH: adrenocorticotropic hormone; GABA: gamma-aminobutyric acid; PGs: prostaglandins; C3: complement 3; C4: complement 4, IL-6: interleukin-4, IL-1β: interleukin-1 beta (); INF-ɣ: interferon-gamma Created in Biorender.com
See this image and copyright information in PMC

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