Psychopathological symptoms and magnetic resonance imaging findings in multiple sclerosis

Abstract

A mild, flat emotional state, even mild euphoria, has been reported to be typical in multiple sclerosis (MS), at least in the later stages of the disease. The emotional symptom patterns usually do not conform to the psychiatric diagnostic criteria (Berrios and Quemada 1990; Schiffer et al 1986) developed for nosological differentiation. These emotional disturbances have been regarded as reactive or the result of illness denial (Mclvor et al 1984), but causation by lesions of central nervous system structures involved in information processing for emotional experience has also been proposed (Honer et ai 1987). In an initial exploratory study, we found a relation between psychological symptoms rated by clinicians and cerebral pathology shown by magnetic resonance imaging (MRI) (Reischies et al 1988). It is the aim of this second investigation to confirm a relation between emotional symptoms in MS and cerebral manifestations of the disease in a new sample of patients by using improved methods of MRI analysis and the addition of self-rating to avoid any observer bias. Research is h~mpered by problems in assessing symptoms by the conventional scales used for psychological investigation because items in these instruments implicate more or less directly some of the physical disabilities caused by MS (Meyerink et i~! 1988), We wished to determine whether the self-rating of elementary emotions that we chose would result in more sensitive, objective information about the emotional status of the patient. Our hypothesis was that certain neuropathological lesions may disturb functional systems that are n~ecessary either for the subjective experience of emotions or for their control.