Neuroimmune, clinical and treatment challenges in multiple sclerosis-related psychoses

Abstract

In recent years, epidemiological and genetic studies have shown an association between autoimmune diseases and psychosis. The question arises whether patients with schizophrenia are more likely to develop multiple sclerosis (MS) later in life. It is well known that the immune system plays an important role in the etiopathogenesis of both disorders. Immune disturbances may be similar or very different in terms of different types of immune responses, disturbed myelination, and/or immunogenetic predispositions. A psychotic symptom may be a consequence of the MS diagnosis itself or a separate entity. In this review article, we discussed the timing of onset of psychotic symptoms and MS and whether the use of corticosteroids as therapy for acute relapses in MS is unfairly neglected in patients with psychiatric comorbidities. In addition, we discussed that the anti-inflammatory potential of antipsychotics could be useful and should be considered, especially in the treatment of psychosis that coexists with MS. Autoimmune disorders could precipitate psychotic symptoms, and in this context, autoimmune psychosis must be considered as a persistent symptomatology that requires continuous and specific treatment.

Keywords: Multiple sclerosis; Psychosis; Schizophrenia; Corticosteroids; Antipsychotics

Core Tip: Immunological perturbations in multiple sclerosis (MS) can lead to the development of psychotic symptoms. The use of corticosteroids and antipsychotics might prove beneficial and in patients with MS-related psychosis and outweigh their adverse effects.