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15. Multiple sclerosis

Multiple sclerosis causes isolated patches of damage to myelin (the covering of long nerve axons). A scar results, and later the nerve axon is damaged. It is one of the most common diseases of the nervous system in temperate climates. It affects the central nervous system and causes an enormous variety of symptoms and signs. There is a tendency to remission and relapse. It can be a relatively benign disease. For others, there is a poorer prognosis.

Psychiatric symptoms, especially anxiety and depression, are found in about 40% of people with multiple sclerosis while they are in remission and in about 90% when they are in an active phase of the illness.

Their symptoms may be very mild to severe. In one study, the degree of psychiatric difficulty was found to be related to the amount of social stresses present at that time.

The vulnerability to psychiatric illness, brought about by the multiple sclerosis, seemed to increase the harmful effect of stress in the environment – it acts as a magnifying agent. Psychiatric illness in multiple sclerosis should not be seen as an inevitable or untreatable part of the illness. It is as amenable to treatment as depression caused by any other cause.

It is always essential to treat depression in these circumstances, since somebody who is disabled and depressed is far more incapacitated than someone who is disabled with a normal mood.

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