多发性硬化(MS)  对每个人的影响都不同. 如果你或你爱的人患有多发性硬化症，你就是 probably familiar with symptoms such as difficulty walking, fatigue, and 麻木或刺痛. 这些和其他身体症状可能很严重，而且 限制. 然而，情绪变化和心理健康挑战可以 就像(如果不是更)致残一样.

康复神经心理学家Meghan Beier博士.D. , discusses three common mood and mental health concerns for people with MS 以及如何解决这些问题.

1. 抑郁症

抑郁症  can occur in up to 50 percent of MS patients and is three times more common than in the general population. 高达40%的支持伙伴, 比如照顾者和配偶, 也可能在人生的某个阶段经历抑郁. 家庭角色的变化和财务问题, as well as depression and cognitive symptoms in the person with MS, 是否所有因素都可能导致照顾者痛苦.

抑郁症 was identified in connection with multiple sclerosis back in the 1870s by the French neurologist Jean-Martin Charcot. However, it hasn’t been studied and seriously addressed by physicians until recent decades. 尽管我们对抑郁症的影响有了更好的了解, it is still frequently underdiagnosed and undertreated in people with MS.

多发性硬化症中的抑郁:一种症状或反应?

“It is easy to assume that people with a chronic illness like MS will inevitably become depressed,比尔说。. This incorrect assumption relies on the idea that depression is a reaction to MS. While this is possible, recent research has discovered that depression may also be a symptom.

"对于有 复发缓和多发性硬化症, early in the disease, depression appears to be linked to inflammatory processes. 晚些时候, 在继发性发展阶段, 无益的思想, 比如内疚感, 更常见的是毫无价值或绝望. So the depression in this case is thought to be more reactive — linked to frustrations with lifestyle changes or loss of function,贝尔解释道。.

如何应对ms相关的抑郁症

抑郁症, together with 焦虑, may worsen thoughts of suicide and shouldn’t be left untreated. 在大多数情况下, it can be effectively managed with a combination of antidepressants and cognitive behavioral therapy. This type of therapy focuses on identifying and shifting thoughts, beliefs and behaviors that may contribute to emotional distress.

2. 焦虑

Approximately half of people who have MS and depression also experience 焦虑. 但焦虑也可以在没有抑郁的情况下独立发生. 焦虑 disorders are three times more common in MS than in the general population. 焦虑与社交互动减少有关, 增加过度饮酒的风险, increased levels of pain and may even impact cognitive skills such as how fast your brain processes information.

ms相关焦虑的原因

When it comes to living with multiple sclerosis, 焦虑 often stems from the 不确定第二天会发生什么. 在复发缓解型多发性硬化症中，发作可能出乎意料地发生. “你永远不知道情况是否会恶化, how severe the symptoms will be if an exacerbation occurs or if MS symptoms will progress over time,比尔说。. 不担心是很难的, especially if you have many responsibilities around caring for your health, 家庭或孩子和工作.

焦虑的危险:回避行为

If you’ve ever experienced 焦虑, you know it can make daily life difficult. One way some people deal with 焦虑 is by avoiding its source. 当你担心开车时头晕的时候, 你的本能可能是避免上车. 或者如果你害怕在公共场合大便意外, 不出家门似乎是个好办法. These avoidance behaviors could make you skip a doctor’s appointment, reduce your time with friends or stop you from doing what you enjoy.

“People who have both MS and 焦虑 are more likely to have suicidal thoughts,” adds Beier. Although data varies, it is estimated that up to 15 percent of people with MS die of suicide. 如果你注意到逃避行为, 或者是影响日常生活的焦虑, 开始和医生交谈是很重要的.

解决ms相关焦虑

The treatment for 焦虑 includes behavioral therapy and exposure exercises to help build confidence and tolerance. 另一种方法是接受和承诺疗法(ACT). “We identify what is most valuable to a person and then find a way to pursue that value despite their MS symptoms,比尔说。. Talk therapy and medications help address specific causes of 焦虑.

3. Pseudobulbar影响

Pseudobulbar affect is a condition rooted in a disconnect between how you feel and express emotions. If you have this condition, you may start crying suddenly, although you don’t feel sad or upset. Or you may start laughing uncontrollably over something that you don’t even find that funny.

This happens due to the breakdown in communication between the front and the back of the brain. 多发性硬化症患者, brain lesions that disrupt the functioning of neurotransmitters may cause this breakdown. It may also result from the overall atrophy of the brain in later stages of MS. Steroid use can increase the risk of developing pseudobulbar affect, 减少或停用类固醇可能会使其消失.

假性球损与其他疾病的鉴别

Pseudobulbar affect can sometimes be confused with conditions such as depression, 情绪波动和躁郁症. The inappropriate outbursts of emotion can also be a source of embarrassment and 焦虑.

It’s important to have this condition properly diagnosed because, 不像抑郁或焦虑, 它不能通过谈话治疗或咨询来治疗. Certain antidepressants or a specially manufactured drug targeting a certain chemical in your nervous system can be used to treat pseudobulbar affect.

不要害怕和你的医生交谈

如果你患有多发性硬化症，并认为自己可能患有抑郁症, 焦虑或假性球影响, 和你的初级保健医生谈谈你的症状. 他们可以把你介绍给a 专攻多发性硬化症的康复心理学家 或者其他能提供帮助的专家.

如果你是MS患者的支持伙伴, watch for signs of depression and 焦虑 both in your loved one and in yourself. They may not always be obvious and can often look like irritability, 愤怒或越来越脱离社会生活.

#TomorrowsDiscoveries: How the Brain Processes Incentives and Rewards | Vikram S. Chib, Ph值.D.

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约翰霍普金斯大学的研究人员Vikram S. Chib studies the way incentives and rewards work in the brain and how this can lead to breakthroughs in depression treatment.