Neuropsychiatric Manifestations in Multiple Sclerosis and Other Demyelinating Diseases

In multiple sclerosis (MS) and other inflammatory demyelinating diseases of the central nervous system (CNS), neuropsychiatric manifestations frequently occur, and some of them may be diagnosed as psychiatric disorders. Especially in MS, neurodegeneration, gray matter changes, and axonal damage have been identified as significant contributors to regional neural network dysfunction. It is noteworthy that psychiatric symptoms rarely manifest as a primary symptom or relapse in CNS inflammatory demyelinating diseases, requiring vigilant attention from clinicians. Beyond brain lesions, various mechanisms contribute to the emergence of psychiatric symptoms, encompassing neuroendocrine perturbations, medication effects, and socio-economical influences. Distinguishing neurological symptoms caused by relapse from concurrent psychotic symptoms can be challenging but hold importance, as they are closely linked to the prognosis of the disease and directly impact patients’ quality of life. Conversely, as CNS symptoms can potentially be misconstrued as psychiatric disorders, implementing specific tools may be necessary for their accurate assessment. Understanding the complexities of psychiatric manifestations in CNS inflammatory demyelinating diseases is imperative for comprehensive patient care and improving clinical outcomes.