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Neurology. 2014 Jan 14;82(2):174-81. doi: 10.1212/WNL.0000000000000013. Epub 2013 Dec 27.

Evidence-based guideline: assessment and management of psychiatric disorders in individuals with MS: report of the Guideline Development Subcommittee of the American Academy of Neurology.

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  • 1From the Department of Psychiatry, Brigham and Women's Hospital (S.L.M.), and Department of Neurology, Beth Israel Deaconess Medical Center (P.N.), Harvard Medical School, Boston, MA; Department of Psychiatry (A.F.), University of Toronto, Canada; National Multiple Sclerosis Society (R.C.K.), New York; Mellen Center (D.M.), Cleveland Clinic, OH; Department of Preventive Medicine (D.C.M.), Northwestern University, Evanston, IL; Department of Community Health Sciences & Hotchkiss Brain Institute (S.B.P.), University of Calgary, Canada; VA Maryland Health Care System (C.B.), Baltimore, MD; Santa Fe, NM (R.B.S.); and Department of Neurology (G.S.G.), University of Kansas Medical Center, Kansas City.



To make evidence-based recommendations for screening, diagnosing, and treating psychiatric disorders in individuals with multiple sclerosis (MS).


We reviewed the literature (1950 to August 2011) and evaluated the available evidence.


Clinicians may consider using the Center for Neurologic Study Emotional Lability Scale to screen for pseudobulbar affect (Level C). Clinicians may consider the Beck Depression Inventory and a 2-question tool to screen for depressive disorders and the General Health Questionnaire to screen for broadly defined emotional disturbances (Level C). Evidence is insufficient to support/refute the use of other screening tools, the possibility that somatic/neurovegetative symptoms affect these tools' accuracy, or the use of diagnostic instruments or clinical evaluation procedures for identifying psychiatric disorders in MS (Level U). Clinicians may consider a telephone-administered cognitive behavioral therapy program for treating depressive symptoms (Level C). Although pharmacologic and nonpharmacologic therapies are widely used to treat depressive and anxiety disorders in individuals with MS, evidence is insufficient to support/refute the use of the antidepressants and individual and group therapies reviewed herein (Level U). For pseudobulbar affect, a combination of dextromethorphan and quinidine may be considered (Level C). Evidence is insufficient to determine the psychiatric effects in individuals with MS of disease-modifying and symptomatic therapies and corticosteroids; risk factors for suicide; and treatment of psychotic disorders (Level U). Research is needed on the effectiveness in individuals with MS of pharmacologic and nonpharmacologic treatments frequently used in the non-MS population.

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