Biomedical subjects

K Feinstein

Publications and source records attributed to K Feinstein.

5 recordsLinked to original sources

PubMed2004

Structural brain abnormalities in multiple sclerosis patients with major depression.

OBJECTIVE: To assess the association between major depression and structural brain abnormalities in patients with multiple sclerosis (MS). METHODS: Two groups of patients with clinically definite MS were studied: 21 with Diagnostic and Statistical Manual of Mental Disorders (4th ed.)-defined major depression and 19 without. The groups did not differ on demographic, disease, or cognitive measures. All subjects underwent brain MRI. Tissue segmentation and regional brain masking were applied to the MRI data. RESULTS: Compared with the euthymic subjects, those with major depression had a greater T2-weighted lesion volume (p = 0.003) and more extensive T1-weighted lesion volume in the left medial inferior prefrontal cortex (p = 0.01) and less gray matter volume (p = 0.01) and more CSF volume in the left anterior temporal region (p = 0.005). A logistic regression analysis identified two independent predictors of depression: left medial inferior prefrontal cortex T2 lesion volume and left anterior temporal CSF volume. These variables accounted for 42% of the depression variance score. CONCLUSION: Whereas both lesion burden and atrophy are important in the pathogenesis of depression in MS, psychosocial influences should also be considered.

Adult↗

PubMed2001

Depression associated with multiple sclerosis. Looking beyond diagnosis to symptom expression.

BACKGROUND: While it is recognised that patients with multiple sclerosis have a high lifetime risk for major depression, less is known about sub-syndromal presentations of affective instability, i.e., irritability, sadness and tearfulness and how these symptoms of emotional dyscontrol may affect a subject's overall degree of psychological distress. METHODS: A consecutive sample of 100 out-patients with clinically definite multiple sclerosis attending their yearly neurological examination were assessed for major depression [Structured Clinical Interview for DSM-IV (SCID-1)], pathological laughing and crying [Pathological Laughing and Crying Scale (PLACS)], self report questionnaires documenting mood [Beck Depression Inventory (BDI)] and overall psychological distress [the 28 item General Health Questionnaire (GHQ)]. RESULTS: Seventeen percent of subjects received a diagnosis of major depression, 8% had pathological laughing and crying (PLC), 48% had symptoms of emotional dyscontrol without meeting criteria for a formal psychiatric diagnosis and 27% had minimal psychiatric symptoms (emotionally stable). The groups did not differ with respect to neurological variables. However, on a validated index of psychological distress (i.e., GHQ scores > or =5), there were significantly more subjects with major depression and emotional dyscontrol than those deemed emotionally stable (P<0.0001). LIMITATIONS: The small number of patients with PLC (N=8) curtailed statistical power when it came to analysing this sub-group. CONCLUSIONS: Clinicians should be sensitive to complaints such as irritability and sadness in patients with multiple sclerosis, even when symptoms do not fulfil criteria for formal, psychiatric diagnoses. Our data demonstrate that such complaints are associated with levels of psychological distress that approach those experienced by patients with major depression. Given that these sub-syndromes of affective instability respond well to pharmacotherapy, detection and treatment can significantly reduce one important aspect of morbidity associated with multiple sclerosis.

Adult↗

PubMed1999

Pathological laughing and crying in multiple sclerosis: a preliminary report suggesting a role for the prefrontal cortex.

As part of a wide ranging study investigating the prevalence, demographic and disease related characteristics of pathological laughing and crying (PLC) in multiple sclerosis (MS), a putative role for the prefrontal cortex was also explored. Eleven multiple sclerosis (MS) patients with carefully defined PLC were compared to a control group of 13 MS patients without PLC on various cognitive indices known to be sensitive to frontal lobe dysfunction. Although the two groups did not differ with respect to age, sex, physical disability, disease course, duration of MS, years of education, premorbid IQ, and depression, the PLC group performed more poorly on the Stroop test and a measure of verbal fluency. They also showed a trend to make more total errors on the Wisconsin Card Sort Test. The relevance of these findings to the pathogenesis of PLC is discussed, in particular whether the syndrome is, in part, mediated by dysfunction of the prefrontal cortex.

Adult↗

PubMed1999

The effects of anxiety on psychiatric morbidity in patients with multiple sclerosis.

Our objective was to assess the point prevalence and effects of clinically significant anxiety in patients with Multiple Sclerosis (MS). One hundred and fifty two consecutive patients with MS attending an outpatient clinic underwent neurological examination and were assessed for psychopathology with the Hospital Anxiety and Depression Scale, the 28 item General Health Questionnaire and a questionnaire probing suicidal thoughts or intent. Clinically significant anxiety, either with or without depression, was endorsed by 25% of patients, three times the rate for depression. Females were significantly more anxious than males. Anxiety co-morbid with depression, rather than anxiety or depression alone, was associated with increased thoughts of self harm, more somatic complaints and greater social dysfunction. Patients with increased psychopathology were not more likely to be taking psychotropic medication. The results provide preliminary evidence that anxiety, which may be often overlooked clinically, is a frequent accompaniment to depression, thereby adding to the morbidity associated with MS. The implications of the findings to MS patients' quality of life are emphasised.

Adult↗

PubMed1997

Prevalence and neurobehavioral correlates of pathological laughing and crying in multiple sclerosis.

OBJECTIVES: To establish the point prevalence of pathological laughing and crying (PLC) in multiple sclerosis (MS). To define associated neurological, emotional, and cognitive correlates of PLC. DESIGN: A consecutive sample of 152 patients with clinically or laboratory definite MS were screened for PLC, defined as sudden, involuntary displays of laughing or crying or both, without associated subjective feelings of depression or euphoria. Thereafter, a case-control design was followed with patients with PLC matched to patients with MS without PLC on age, gender, physical disability (Expanded Disability Status Scale), duration of MS, and premorbid IQ. SETTING: An MS outpatient clinic, the population representative of a large urban catchment area. PATIENTS: Fifteen of 152 patients had PLC, 11 of whom (mean [SD] age, 43.7 [8.3] years, 7 women) agreed to further testing. Thirteen patients with MS without PLC acted as controls. MAIN OUTCOME MEASURES: Neurological examination, Pathological Laughter and Crying Scale, Hospital Anxiety and Depression Scale, 28-item General Health Questionnaire, and the Wechsler Adult Intelligence Scale-Revised. RESULTS: The point prevalence of PLC in MS was 10%. Patients had a mean Expanded Disability Status Scale score of 6.5, had had MS for a mean (SD) of 10 (5.8) years, and had entered a chronic-progressive phase of their illness. Pathological laughing and crying was not associated with disease exacerbations. Compared with controls, patients were not more depressed or anxious, but had a greater decline in IQ. CONCLUSIONS: Pathological laughing and crying as distinct from emotional lability affects 1 in 10 patients with MS. It occurs in severely physically disabled patients, generally with long-standing disease. The presence of cognitive deficits relative to controls implies more extensive brain involvement.

Adult↗