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Pulse steroid therapy in multiple sclerosis and mood changes: An exploratory prospective study

  • Author Footnotes
    1 These authors equally contributed.
    Lorena Lorefice
    Correspondence
    Corresponding author.
    Footnotes
    1 These authors equally contributed.
    Affiliations
    Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, Department of Medical Sciences and Public Health, University of Cagliari, via Is Guadazzonis, 2, 09126 Cagliari, Italy
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  • Author Footnotes
    1 These authors equally contributed.
    Giuseppe Fenu
    Footnotes
    1 These authors equally contributed.
    Affiliations
    Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, Department of Medical Sciences and Public Health, University of Cagliari, via Is Guadazzonis, 2, 09126 Cagliari, Italy
    Search for articles by this author
  • Michela Fois
    Affiliations
    Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, Department of Medical Sciences and Public Health, University of Cagliari, via Is Guadazzonis, 2, 09126 Cagliari, Italy
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  • Jessica Frau
    Affiliations
    Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, Department of Medical Sciences and Public Health, University of Cagliari, via Is Guadazzonis, 2, 09126 Cagliari, Italy
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  • Giancarlo Coghe
    Affiliations
    Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, Department of Medical Sciences and Public Health, University of Cagliari, via Is Guadazzonis, 2, 09126 Cagliari, Italy
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  • Maria Giovanna Marrosu
    Affiliations
    Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, Department of Medical Sciences and Public Health, University of Cagliari, via Is Guadazzonis, 2, 09126 Cagliari, Italy
    Search for articles by this author
  • Eleonora Cocco
    Affiliations
    Multiple Sclerosis Center, Binaghi Hospital, ATS Sardegna, Department of Medical Sciences and Public Health, University of Cagliari, via Is Guadazzonis, 2, 09126 Cagliari, Italy
    Search for articles by this author
  • Author Footnotes
    1 These authors equally contributed.
Published:January 19, 2018DOI:https://doi.org/10.1016/j.msard.2018.01.012

      Highlights

      • Psychiatric side effects are frequently reported in multiple sclerosis (MS) patients after high-dose corticosteroids (HDC).
      • We explored the HDC effect on mood and factors that influence mood changes in MS.
      • Our results indicated caution in HDC use for MS patients with bipolar symptoms.
      • An accurate screening for mood disorders is useful prior to pulse steroid therapy initiation.

      Abstract

      Background

      Several reports suggest a higher risk of psychiatric disorders after high-dose corticosteroids (HDC), routinely used to treat clinical relapses in multiple sclerosis (MS).
      The present study aimed to examine the possible effect of HDC on mood in patients with MS and to determine the specific factors that influence mood changes.

      Methods

      The study included MS patients prior to receive HDC. The presence of depressive and bipolar symptoms was determined with the Beck Depression Inventory-Second Edition (BDI-II) and the Mood Disorder Questionnaire (MDQ). These assessments were made at three time points: prior to HDC initiation, after HDC completion, and 1 month after HDC.

      Results

      The study included 101 MS patients. At baseline, 32 (31.7%) patients had depressive symptoms (BDI-II scores ≥ 14) and 20 (19.8%) patients had bipolar symptoms (MDQ scores ≥ 7). While it was observed a reduction of BDI-II scores after HDC, an increase in MDQ score was found in patients with MDQ positivity at baseline, resulting associated with a higher number of HDC infusions (p 0.018).

      Conclusions

      Our results emphasize the importance of accurate screening for mood disorders in patients with MS prior to HDC initiation, and indicate that HDC should be used with caution in patients with MDQ positivity.

      Keywords

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