Neuropsychiatric Symptoms in Demyelination Disorders

*Any Docu Axelerad, Silviu Docu Axelerad and Alina Zorina Stroe*

## **Abstract**

Inflammatory demyelinating diseases are defined as being a miscellaneous group of disorders that develop as a consequence of an acute or chronic inflammatory process. The types of demyelinating disease with a high prevalence are multiple sclerosis, neuromyelitis optica and acute-disseminated encephalomyelitis. Patients with multiple sclerosis frequently experience depressive and anxiety symptoms including cognitive impairments. Depression is correlated with an unsatisfatory quality of life, having a conceivably important psychological impact on all the aspects of the patient's live, including less efficient coping mechanisms and a decreased compliance with disease-modifying drugs. As a general rule among population, depression in multiple sclerosis patients is regularly correlated with anxiety. The clinical importance of neuropsychiatric symptoms should not be neglected because multiple sclerosis patients are more prone to be affected in all the aspects of life, in view of the morbidity that these symptoms bring in patients with neurodegenerative diseases.

**Keywords:** neuropsychiatric symptoms, demyelination disorders, multiple sclerosis, depression, anxiety

## **1. Introduction**

In the history of multiple sclerosis, noted as the first notation of the disease in the title of a neuropathological disorder was made by Charcot in 1868 [1].

In the evolution of multiple sclerosis, related to the diagnosis of the disease, a requirement is the apparition and subsequent demonstration of demyelinating lesions that are dispersed in time and location. In conjunction to the neurologic symptoms, the discovery of lesions through the magnetic resonance imaging are accordant with the diagnostic of multiple sclerosis [2, 3].

Further investigations include the evidence of the presence of oligoclonal bands located in the cerebrospinal fluid [4], and/or the discovery of pathological optical induced potentials (interruption with a conserved wave form) are suggested to acquire a proper diagnosis [5]. A monosymptomatic course of the disease could be existent in patients with multiple sclerosis, as well as an evolution including a classical relapsing remitting course of the disease or even a primary or secondary progressive disease.

The evolution of multiple sclerosis can be characterized by a constant degradation of symptoms from the neurological area, regardless of the lack of presence of

#### *Demyelination Disorders*

new MRI lesions and also a infrequent prevalence of lesions enhanced by contrast. The principal course of the disease for the most patients includes an onset represented by a relapsing remitting form of multiple sclerosis, with a subsequent evolution consisting of secondary progressive disease.

In the primary progressive form of multiple sclerosis, the evolution of the disease includes a continuous progression from since the commencement of the disease. Regarding the pathophysiological mechanism subsidiary to the progression of multiple sclerosis, the disruption of inflammatory nature of the blood–brain barrier is incriminated.

The underlying morphopathologic emblem of multiple sclerosis is the production of inflammation-related demyelinating lesions with variable lesions located at the axonal level, accompanied by deterioration as long as astrocytic gliosis.

In the course of the disease, including both early and late stages of multiple sclerosis, the lesions present in the following locations of the nervous system: neurons and the axonal level of the neurons, also synapses can be affected by the disease, the term used at large scale being represented by neurodegeneration [6, 7].

The axonal injuries and also the subsidiary loss have been proposed to represent a fundament to the extent of perpetual motor impairment in multiple sclerosis [8]. The acute injury with the location in axonal level is most enhanced in the active demyelinating injuries and can be recognized through immunohistochemistry.

Patients with MS commonly encounter through the evolution of the disease: signs and symptoms that are not especially a result of a relapse or the progressive stage, as fatigue, chronic pain, and urogenital dysfunction.

## **2. Depression in multiple sclerosis**

Multiple sclerosis is correlated with a wide spectrum of neuropsychiatric disorders of which depression is the most frequent. Depression is a complex disorder taking into consideration, firstly, the symptom of madness and, secondly, the entire syndrome diagnosis of major depression.

The major depression syndrome was characterized by the American Psychiatric Association being a selection that includes nine signs and symptoms with the nominalization of five or more that are required be positive for minimum 2 weeks as a sequence for the positive diagnosis.

The symptomatology contains depressed disposition during the majority of the day, a disappearance of enthusiasm or enjoyment concerning occupations that consisted as pleasant previously, modifications in appetite related to weight loss or weight gain, insomnia or hypersomnia, a reduction or an increase in psychomotricity, agitation or lag, fatigue, impressions of uselessness or improper and exaggerated culpability, a decrease in the ability to concentrate, and persisting thoughts related to death.

For the medical health personal that is in relation with MS patients, the presented description can represent a possible issue taking into consideration the particularity of the symptoms that represent the base of depression's diagnosis that can further be induced by multiple sclerosis. The most occurring coincidental symptoms are those of fatigue, decreased concentration, and impairments related to sleep.
