Comorbidity In Multiple Sclerosis Research Articles

Adverse childhood experiences and psychiatric comorbidity in multiple sclerosis, inflammatory bowel disease, and rheumatoid arthritis in the Canadian longitudinal study on aging

ObjectivesAdverse childhood experiences (ACE) are associated with immune-mediated inflammatory diseases (IMID). We evaluated whether: (i) ACE associate with psychiatric comorbidity among individuals with IMID, including rheumatoid arthritis (RA), multiple sclerosis (MS), and inflammatory bowel disease (IBD); (ii) whether psychiatric disorders mediate the relationship between ACE and IMID; and (iii) whether these findings differ from those in individuals with other chronic physical disorders. MethodsUsing data from the Canadian Longitudinal Study on Aging (CLSA) we performed a retrospective case-control study of participants aged 45–85 years recruited between 2010 and 2015. ACE were queried using questions derived from the Childhood Experiences of Violence Questionnaire-Short Form and the National Longitudinal Study of Adolescent to Adult Health Wave III questionnaire. We used multivariable logistic regression and causal mediation analysis to address our objectives. ResultsWe included 13,977 CLSA participants. Among the 31 % of IMID participants who reported a comorbid psychiatric disorder, 79 % reported a history of ACE. ACE associated with increased odds (OR [95 % CI]) of a psychiatric disorder (2.55 [1.02–6.35]) among participants with IMID; this did not differ across IMID. The total effect (OR [95 % CI]) of ACE on IMID was 1.11 (1.07–1.16), of which 10.60 % (8.04–17.47) was mediated by psychiatric disorders. We found similar associations among participants with other chronic physical disorders. ConclusionOur findings suggest that psychiatric disorders partially mediate the association between ACE and IMID. Most participants with IMID and comorbid psychiatric disorders report a history of ACE and may benefit from trauma-informed mental health care.

The coincidence of multiple sclerosis and primary vasculitis; from the bench of pathology to the bedside of treatment: a systematic review of case reports.

Multiple sclerosis (MS) is a chronic, disabling neurodegenerative disease, leads to reduced quality of life. The increasing prevalence of MS around the world and its comorbidities increase its burden. Primary vasculitis subtypes, one of autoimmune diseases with different prevalence in different ages and genders, should be considered one of the important differential diagnosis in patients with MS. This study aims to verify the relationship between MS and primary vasculitis by conducting a systematic review. We searched PubMed, Scopus, EMBASE, Web of Science, and Google Scholar, from January 1974 to July 2023. We included original articles that reported characteristics of patients involved with any type of Primary Vasculitis with MS. From an initial 816 publications, 18 studies consisting of 18 individual patients from 14 countries with confirmed MS and one of different subtypes of primary vasculitis met the inclusion criteria. The female/male ratio was 0.38:1, the mean (SD) age was 40.44 (14.37) years with the range of 16 to 70 years old, and the relapsing/progressive ratio was 1.57:1. Most of them, 14 (77%) experienced MS before vasculitis, and mostly received Corticosteroids, interferon, cyclophosphamide, Glatiramer acetate as MS treatment. The concurrence of Takayasu Arteritis (2 cases), Polyarteritis Nodosa (2 cases), Churg-Strauss Syndrome (1 case), Wegener's Granulomatosis (2 cases), Microscopic Polyangiitis (1 case), Cutaneous leukocytoclastic vasculitis (5 cases), Good pasture's disease (5 cases) were reported with MS. Our study suggested that different primary vasculitis can be an important comorbidity of MS and can mimic its symptoms and MRI. Any atypical syndrome for PwMS, whether clinical or radiological, must be evaluated in terms of other differential diagnoses including vasculitis.

Editorial: Comorbidity in multiple sclerosis and related disorders

Editorial: Comorbidity in multiple sclerosis and related disorders

The Prevalence of Comorbidities Associated with Multiple Sclerosis in Saudi Arabia.

Multiple sclerosis (MS) is a chronic, immune mediated demyelinating illness of the central nervous system. This study looks at various comorbidities associated with MS, focusing on their impact on disease progression. Understanding comorbidities in MS is important as it can impact treatment selection and overall disease management and prognosis. Our aim is to show the prevalence of comorbidities along with MS. This research focuses on the comorbidities associated with MS and their impact on disease progression in the Arab Gulf region, with a special emphasis on Jeddah, Saudi Arabia. A retrospective record review was conducted from July 2022 to July 2023. The study included 286 patients, selected based on a definitive MS diagnosis in accordance with McDonald's 2017 criteria. Data collected included demographic information, MS type, duration of diagnosis, type of disease modifying therapy (DMT) used, Expanded Disability Status Scale (EDSS) score, and type of comorbidities. The majority of the patients were female (70%) with an average age of 36 years. Most patients had relapsing remitting MS, and the majority were on DMTs, with fingolimod being the most common. Nearly half of the patients had comorbidities, with mood disorders, diabetes mellitus (DM), migraine, and hypertension (HTN) being prevalent. A significant positive association was found between the EDSS scores and both DM and HTN, but there was no significant link with migraine. The findings indicate that individuals with MS have an increased risk of developing comorbidities such as migraine, DM, and HTN. Emphasizing a healthy lifestyle could potentially reduce the incidence of DM and HTN and their related vascular complications. The research also notes the prevalence of mood disorders among the MS population, although it remains inconclusive whether these are separate comorbid conditions or inherent symptoms of MS.

Impact of multiple sclerosis comorbidities on quality of life and job activity

Background: Multiple sclerosis (MS) is frequently accompanied by comorbid conditions. Objectives: This study aimed to determine the prevalence of key comorbid conditions in people with multiple sclerosis (pwMS) and assess their impact on quality of life and work-related activities. Methods: A cross-sectional study involving 755 pwMS from two third-level Italian MS centers was conducted. Comorbidities were identified from medical records, and quality of life was assessed using the EQ-5D-3L questionnaire. Work-related challenges were evaluated using the Multiple Sclerosis Questionnaire for Job Difficulties (MSQ-Job). Results: 53.8% of pwMS had at least one comorbidity. Hypertension, depression, and anxiety were the most prevalent. Comorbidity presence was associated with reduced quality of life scores in almost all EQ-5D-3L domains and greater job difficulties in all but one MSQ-Job domain. Conclusion: Comorbidities in pwMS are prevalent and have a profound influence on quality of life and work-related activities. This comprehensive study offers new insights into the role of comorbidities in MS within the Italian context, emphasizing the need for a multidisciplinary approach in MS management. Further research is crucial to deepen our understanding of these findings in the broader Italian MS community.

Incidence and determinants of seizures in multiple sclerosis: a meta-analysis of randomised clinical trials

BackgroundSeizures are reported to be more prevalent in individuals with multiple sclerosis (MS) compared with the general population. Existing data predominantly originate from population-based studies, which introduce variability in methodologies...

Dietary Modification Combined with Nutrition Education and Counseling for Metabolic Comorbidities in Multiple Sclerosis: Implications for Clinical Practice and Research.

Metabolic comorbidities such as obesity, diabetes, hypertension, and dyslipidemia are common to multiple sclerosis (MS) and are associated with negative outcomes of the disease. Dietary intervention has the potential to improve MS co-morbidities; thus, it is a high priority for people livingwith MS to self-manage their disease. The present review aimed to summarize the recent evidence on the impacts of combining dietary modification with nutrition education and counseling on managing metabolic comorbidity markers in MS. Evidence suggests important roles for tailored dietary change strategies and nutrition education and counseling in managing metabolic comorbiditiesfor MS. There is also indirect evidence suggesting a relationship between dietary fiber, the gut microbiome, and improved metabolic markers in MS, highlighting the need for more research in this area. For people livingwith MS, addressing both barriers and facilitators to dietary changes through behavior change techniques can help them achieve sustainable and tailored dietary behavior changes. Thiswillsupport person-centered care, ultimately improving metabolic comorbidity outcomes. Metabolic comorbidities in MS are considered modifiable diseases that can be prevented and managed by changes in dietary behavior. However, the impact of targeted dietary interventions on mitigating MS-related metabolic comorbidities remains inadequately explored. Therefore, this review has provided insights into recommendations to inform future best practices in MS. Further well-designed studies based on tailored dietary strategies applying behavior change theories are needed to address the underlying determinants of dietary practice in this population.

423 Innovation in MS Patient Care: Linking Cognitive Health and Myelin Integrity

OBJECTIVES/GOALS: Our objective is to develop a patient-friendly application addressing the progression of cognitive impairments in multiple sclerosis (MS) patients. This initiative aims to augment individualized care and precision management of a major MS comorbidity by generating a cognitive health brain map for each patient. METHODS/STUDY POPULATION: Using the UAMS COMS Database, featuring high-resolution multi-contrast MRIs, and a comprehensive clinical, behavioral, and demographic dataset, we are developing a hierarchical learning-based software tool to compute maps correlating brain structure-function and individual cognitive function. Our MRI analysis employs a three-compartment model (NNLS>0.96). Functional scores are defined by individualized accuracy during the modified information processing speed task (e.g., m-SDMT). We utilize a Bayesian classifier with explicit Pearson’s correlation for tissue classification (BF10>100) to compute an index of the likelihood of correlation with cognitive impairment throughout brain tissue. RESULTS/ANTICIPATED RESULTS: This approach allows us to reveal subtle cognitive changes and their potential links to myelin integrity, offering vital insights into disease progression and management. The m-SDMT strongly correlates with the standard SDMT (r=0.79, p<0.001), confirming reliability as a cognitive assessment tool in clinical and research contexts. Analysis of the COMS dataset emphasized insights into the role of fine myelin structure in MS patients' cognitive functionality. Our findings heightened the pivotal significance of myelin integrity in preserving cognitive abilities and identify disruptions in myelin synthesis and homeostasis as primary contributors to cognitive decline. This discovery stresses the critical role that specialized brain pathways, influenced by myelin integrity, play in the pathology of MS. DISCUSSION/SIGNIFICANCE: This development bridges advanced neuroimaging techniques with practical clinical applications, emphasizing the nuanced role of myelin integrity in MS-related cognitive deficits. Our findings advocate for a multidisciplinary approach to MS management, demanding collaborative workforce development and education in translational science.

Qualification and predictors of the development of affective disorders in multiple sclerosi

Affective disorders occupy one of the leading places in the structure of comorbidity in multiple sclerosis, but the questions concerning etiopathogenesis, qualification, diagnosis, and prediction of these disorders remain controversial. The most important consequences of affective disorders in MS include a decrease in the patient's quality of life, adherence to treatment, and their daily activities, and an increased risk of suicide and death from cardiovascular diseases. In this regard, the need for early detection and prediction of the development of depression in patients with MS is obvious. The following factors are considered among the predictors of the development of emotional distress and affective disorders: social, psychological, demographic, neurocognitive, and treatment-related factors, neuroimaging data, lifestyle features, comorbidities, characteristics of multiple sclerosis and its social implications. Specifically, younger age at the time of diagnosis, the presence of dyssomnia, fatigue, consumption of dairy products, atrophy of cortical areas in the frontal lobes, and decreased white matter volume of the uncinate fasciculus predict the development of depression. This article reviews the features of depressive and bipolar spectrum disorders in patients with MS.

Comorbidities in multiple sclerosis and their influence on the choice of treatment

Clinical trials of disease-modifying therapies (DMTs) for people with multiple sclerosis (pMS) are conducted in selected populations, excluding patients with comorbidities or concomitant medications. However, a large percentage of pMS have some additional disease, which could affect the response and choice of the DMT. The objective of this review is to assess how concurrent pathologies can impact the choice of DMTs. Relevant articles were selected through a systematic search in PubMed. Comorbidities were grouped for better classification into autoimmune, chronic infections, cardiovascular and metabolic, oncological and neuropsychiatric. In autoimmune pathologies, it is key to take into account the effects of TME on them and the possibility of interaction with their specific treatments. Immunomodulatory therapies are safe for people with chronic infections. Immunosuppressive treatments are generally contraindicated in people with active infections. In cardiovascular and metabolic comorbidities, infusion reactions associated with monoclonal antibodies, and the phenomena of starting treatment with S1P modulators, must be taken into account. DMTs with an immunosuppressive effect are contraindicated in people with active malignancies. Although psychiatric pathology per se does not preclude the use of DMTs, caution should be exercised when new psychiatric symptoms appear. For these reasons, among the multiple factors that must be considered when starting or changing a DMT in pMS, comorbidities constitute a decisive element.

Comorbidities in Multiple Sclerosis, Results of a Retrospective Algerian Study

Comorbidities in Multiple Sclerosis, Results of a Retrospective Algerian Study

Association of Higher Mediterranean Diet Adherence With Lower Prevalence of Disability and Symptom Severity, Depression, Anxiety, Stress, Sleep Quality, Cognitive Impairment, and Physical Inactivity in Older Adults With Multiple Sclerosis.

A good nutritional status and healthy diets may decelerate disease disability and symptom severity and quality of life of peoples with multiple sclerosis (MS). Mediterranean diet (MD) can prevent several chronic diseases, including neurodegenerative disease. This is an observational, cross-sectional study on 279 older adults with MS, aiming to investigate the effects of MD against several aspects of mental health. Qualified questionnaires were used to assess disability and symptom severity, depression, anxiety, stress, sleep quality, cognitive status, physical activity, and MD adherence. Multivariate analysis showed that enhanced MD adherence was independently associated with lower prevalence of disability and symptom severity (P = .0019), depression (P = .0201), anxiety (P = .0287), perceived stress (P = .0021), inadequate sleep quality (P = .0033), cognitive impairment (P = .0018) and physical inactivity (P = .0028). Adopting MD may ameliorate mental health disturbances in older adults with MS. Future public health policies should inform older adults with MS for the favorable impacts of MD in improving the mental health MS comorbidities.

Emotional burden among MS patients: associations between specific chronic pain diagnoses and psychological features.

Central neuropathic pain (CNP) and musculoskeletal pain (MSP) are often comorbid with multiple sclerosis (MS), yet data on the emotional burden entailed by this comorbidity are very limited. We studied whether MS patients with CNP exhibited greater emotional burden and pain severity than those with MSP and whether this emotional burden was attributed to the MS, the chronic pain, or both. Participants were 125 MS patients (55 with CNP; 30 with MSP; 40 MS pain-free) and 30 healthy controls (HCs). Participants completed questionnaires assessing pain interference, pain catastrophizing, depression, anxiety, stress, hypervigilance, and chronic pain. Group comparisons and a two-step cluster analysis were performed, and the association between cluster membership and clinical group membership was evaluated. Chronic pain was stronger and more widespread in the CNP group than in the MSP group. Both pain groups had higher pain interference, pain catastrophizing, and stress compared to MS pain-free and HC groups. All MS groups had greater depression levels compared to HCs, and the CNP group had the highest anxiety level. The "high psychological distress" cluster comprised mainly participants with CNP (57%), and the "minimal psychological distress" cluster comprised mainly the MS pain-free and HC groups. In conclusion, CNP seems to induce greater emotional burden and pain severity than does MSP. Whereas depression may be attributed to MS, and anxiety to CNP, enhanced pain interference, catastrophizing, and stress may be attributed to the comorbidity of MS and chronic pain. Identifying these traits among MS patients and targeting them in management programs may contribute to more effective, individually based care.

Prevalence of fibromyalgia in a Brazilian series of patients with multiple sclerosis.

The prevalence of pain in patients with multiple sclerosis is remarkable. Fibromyalgia has been considered as one of the forms of chronic pain encompassed in multiple sclerosis, but data are restricted to studies from Europe and North America. To assess the prevalence of fibromyalgia in a series of Brazilian patients with multiple sclerosis and the characteristics of this comorbidity. The present cross-sectional study included 60 consecutive adult patients with multiple sclerosis. Upon consent, participants underwent a thorough evaluation for disability, fatigue, quality of life, presence of fibromyalgia, depression, and anxiety. The prevalence of fibromyalgia was 11.7%, a figure similar to that observed in previous studies. Patients with the comorbidity exhibited worse scores on fatigue (median and interquartile range [IQR]: 68 [48-70] versus 39 [16.5-49]; p < 0.001), quality of life (mean ± standard deviation [SD]: 96.5 ± 35.9 versus 124.8 ± 28.8; p = 0.021), anxiety (mean ± SD: 22.7 ± 15.1 versus 13.8 ± 8.4; p = 0.021), and depression (median and IQR: 23 [6-28] versus 6 [3-12.5]; p = 0.034) indices than patients without fibromyalgia. There was a strong positive correlation between depression and anxiety scores with fatigue (r = 0.773 and r = 0.773, respectively; p < 0.001). Conversely, a moderate negative correlation appeared between the Expanded Disability Status Scale (EDSS), fatigue, and depression scores with quality of life (r= -0.587, r= -0.551, r= -0.502, respectively; p < 0.001). Fibromyalgia is a comorbidity of multiple sclerosis that can enhance fatigue and decrease quality of life, although depression, anxiety, and disability are factors that can potentiate the impact of the comorbidity.

COMORBIDITY OF MULTIPLE SCLEROSIS AND EPILEPSY: MORE QUESTIONS OR ANSWERS?

The literature data of the last three decades on the problem of comorbidity of multiple sclerosis (MS) and epilepsy have been analyzed, such as issues of pathogenesis, clinical course, prognosis, and treatment of this dual pathology. Epileptic seizures occur in 2–3% to 5.9% of patients with MS, which is 3–6 times more common than in the general population. The incidence of epilepsy raises with increasing duration and severity of MS, with its progressive course, and also depends on the effect of drugs for the treatment of MS. There is no unanimity in the literature on the age and gender characteristics of the occurrence of epileptic seizures in MS. Probable mechanisms of MS comorbidity and epilepsy are analyzed. Data on certain common pathophysiology of MS and epilepsy and the concept according to which the model of epilepsy in MS is considered as a network disease are presented. Data on clinical manifestations and diagnosis of comorbid MS with epilepsy are presented. Epileptic seizures can occur at any stage of MS: before the clinical manifestations, at the onset of the disease, in the late stages, or can indicate exacerbation of MS. Types of epileptic seizures with a dual diagnosis (MS + epilepsy) are diverse. The majority of patients (up to 87.5%) have focal seizures (aware or unaware) or focal seizures to bilateral tonic-clonic, and a small share of patients have seizures of unknown origin. Most researchers believe that patients with MS and epilepsy have a more severe MS course and a worse long-term prognosis. The main directions of MS treatment and the impact of such treatment on the development of epileptic seizures are highlighted. Data on the effect of some disease-modifying drugs for the treatment of MS on the course of epilepsy and, on the other hand, on the impact of some antiseizure medications on the course of MS are presented. It is concluded that patients with MS have individual profiles and inter-individual variability of epileptogenicity. The principles of treatment of epileptic seizures/epilepsy in patients with MS are proposed.

Etiology, effects and management of comorbidities in multiple sclerosis: recent advances.

Comorbid conditions commonly affect people with multiple sclerosis (MS). Population-based studies indicate that people with MS have an increased incidence of ischemic heart disease, cerebrovascular disease, peripheral vascular disease, and psychiatric disorders as compared to people without MS. People with MS from underrepresented minority and immigrant groups have higher comorbidity burdens. Comorbidities exert effects throughout the disease course, from symptom onset through diagnosis to the end of life. At the individual level, comorbidity is associated with higher relapse rates, greater physical and cognitive impairments, lower health-related quality of life, and increased mortality. At the level of the health system and society, comorbidity is associated with increased health care utilization, costs and work impairment. A nascent literature suggests that MS affects outcomes from comorbidities. Comorbidity management needs to be integrated into MS care, and this would be facilitated by determining optimal models of care.

The Barancik lecture: Comorbidity in multiple sclerosis—Looking backward, looking forward

Comorbidity is highly prevalent in people with multiple sclerosis (MS) throughout their disease course. In the last 15 years, our understanding of the association between comorbidity and outcomes such as relapses, disability progressive, health-related quality of life, health care use, and mortality has grown substantially. The broad adverse impacts of comorbidity on these outcomes point to the need to prevent and treat comorbidity effectively in people with MS. This requires having the necessary tools to evaluate comorbidity, an understanding of how MS affects management of comorbidity now, testing of interventions tailored to people with MS, and determining the best models of care to optimize comorbidity management.

Clinical and Radiological Features of Possible Normal Pressure Hydrocephalus in a Patient with Multiple Sclerosis

Normal pressure hydrocephalus (NPH) is potentially treatable form of dementia, which along with gait disturbance and impaired urinary control compose a clinical picture of the Hakim-Adams syndrome. In advanced age it could be challenging to distinguish the disease from other form of dementias or brain atrophy. From another prospective, other brain conditions could have a number of similar symptoms that could make it even harder to raise a suspicion of NPH. In this article we describe a clinical picture, neurological examination data, neuroimaging and clinical analysis of blood and cerebrospinal fluid (CSF) of the patient with confirmed multiple sclerosis (MS) and symptoms falling under Hakim-Adams triad criteria. On the other hand, pronounced cortical atrophy and patient`s cognitive decline, could be a consequence of prolonged disease, absence of disease-modifying treatment and poor compliance of the patient. Challenges in management of the patient were not only limited by the duration of the multiple sclerosis, but also a number of comorbidities in the history of the disease and not straightforward data after performing the tap test. Thorough review of a patient with multiple sclerosis with clinical manifestations corresponding to Hakim's triad, and with ventriculomegaly on CT/MRI, should be performed as the comorbidity of MS and NPH has to be excluded.

Functional neurological symptoms are a frequent and relevant comorbidity in patients with multiple sclerosis.

Functional neurological symptoms (FNS) in multiple sclerosis (MS) have shown to be underinvestigated even though neurological diseases such as MS represent a risk factor for developing FNS. Comorbidity of FNS and MS can produce high personal and social costs since FNS patients have high healthcare utilization costs and a quality of life at least as impaired as in patients with disorders with underlying structural pathology. This study aims to assess comorbid FNS in patients with MS (pwMS) and investigate whether FNS in pwMS are associated with poorer health-related quality of life and work ability. Newly admitted patients (234) with MS were studied during their stay at Kliniken Schmieder, a neurological rehabilitation clinic in Konstanz, Germany. The degree to which the overall clinical picture was explained by MS pathology was rated by neurologists and allied health practitioners on a five-point Likert scale. Additionally, neurologists rated each symptom reported by the patients. Health-related quality of life was assessed using a self-report questionnaire and work ability was assessed using the mean number of hours worked per day and information regarding disability pension as reported by patients. In 55.1% of cases, the clinical picture was completely explained by structural pathology due to MS. 17.1% of pwMS presented an overall clinical picture half or less of which could be explained by underlying structural pathology. PwMS with a higher comorbid FNS burden had a lower health-related quality of life and reported fewer working hours per day than pwMS with symptoms explained by structural pathology. Furthermore, pwMS with a full disability pension had a higher comorbid FNS burden than pwMS with no or partial disability pension. These results show that FNS should be addressed diagnostically and therapeutically since such symptoms are an important comorbidity in MS that is related to poorer health-related quality of life and lower work ability.

A CASE OF MULTIPLE SCLEROSİS PRESENTING AS DEPRESSION IN A YOUNG PERSON

IntroductionMultiple sclerosis(MS)is a chronic immune-mediated, inflammatory disease of the central nervous system. Depression is one of the most common psychiatric conditions associated with MS. Lifetime prevalence of major depression has been estimated to be around 50%.ObjectivesAlthough the prevalence of depression in MS patients has been shown by many studies, there has not been a case in the literature demonstrating the onset of MS disease with depressive symptoms. In this article, a case of multiple sclerosis (undiagnosed before) presenting as depression in a young woman is presented and discussed.MethodsAn eighteen years-old female patient visited the emergency room of Erenkoy Mental and Neurological Diseases Hospital with complaints of unhappiness,malaise,anhedonia,introversion,sleepiness,lack of appetite and nausea. She was admitted to another hospital one and a half years ago with similar complaints and duloxetine 30 mg/day treatment was started. The patient, who did not benefit from this treatment, stopped using the drug by herself and did not consult a doctor again. Her complaints regressed over time without treatment.Her current symptoms started four days prior to her visit. She had no other medically diagnosed condition. No pathology was detected in the emergency blood test parameters of the patient.Her brain tomography was normal. The patient, who had periventricular ovoid hyperintense lesions on cranial MRI, was diagnosed with multiple sclerosis and was admitted to the neurology unit of our hospital. The lumbar puncture was performed during the hospitalization, oligoclonal band positivity was detected. The IgG index was found to be increased at CSF (cerebrospinal fluid). She underwent pulse steroid therapy for seven days. The patient was discharged since her symptoms regressed after treatment.ResultsHere we present a case of MS presenting as depression in a young woman. Depression is a very common, and very important comorbidity in multiple sclerosis. The etiology of depression in MS is likely to be multifactorial, and to include biological, psychological, and social determinants. Although the relationship between depression and MS has been clearly demonstrated in all of these studies, there is no case of MS presenting as depression in the literature.ConclusionsWe know that depression may occur as a prodromal symptom in some organic diseases that affect brain such as dementia and Parkinson. In this case, we wanted to emphasize that organic etiological research is necessary for patients who present with psychiatric complaints for the first time, and that psychiatric complaints may be a symptom of organic diseases that may affect the brain.Disclosure of InterestNone Declared