Rosalind Kalb

The Goldman Consensus statement on depression in multiple sclerosis

Background. In January 2002 the New York City Chapter of the National Multiple Sclerosis Society convened a panel of experts to review the issue of depressive affective disorders associated with multiple sclerosis (MS). This Consensus Conference was supported by a grant from the Goldman family of New York City. Results. The panel reviewed summaries of current epidemiologic, neurobiologic, and therapeutic studies having to do with depressive disorders among MS patient populations. Depressive disorders occur at high rates among patients with MS, and there is reason to believe that the immunopathology of the disease is involved in the clinical expression of affective disorders. The depressive syndromes of MS have a major, negative impact on quality of life for MS sufferers, but are treatable. At the present time, most MS patients with depression do not receive adequate recognition and treatment. Conclusions. The Goldman Consensus Conference Study Group provides recommendations for improved screening, diagnosis, and clinical management for depressive affective disorders among patients suffering from MS.

The emotional and psychological impact of multiple sclerosis relapses

Acute relapses of multiple sclerosis (MS) are experienced as crises that disrupt the status quo for individuals with MS and their families. These unpredictable--and always unexpected--events elicit strong reactions, including grief, anxiety, anger, and guilt, as people struggle to understand why they occur. Although early relapses are a signal for most MS specialists to recommend treatment with one of the approved disease-modifying therapies, the remissions that follow contribute to patient and family denial about the realities of the disease, making it difficult for patients to begin and to adhere to ongoing treatment. Each ensuing attack confronts this denial, forcing patients and families to acknowledge the MS diagnosis and begin adapting to the demands of the illness in their daily lives. This paper discusses the meaning attributed by individuals and families to relapses leading to the MS diagnosis and the recommendation for disease-modifying therapy, the adjustments that are made by patients and their families to residual deficits following acute episodes, and suggestions for clinicians on how they might facilitate the adjustment process.

Psychoremediation of Communication Skills for Cognitively Impaired Persons with Multiple Sclerosis

Cognitive impairments and emotional distress significantly interfere with the ability of persons with multiple sclerosis (MS) to communicate effectively with family members, friends, employers, and health care providers. This paper describes a step-by-step cognitive-behavioral approach to the treatment of communication skills deficits in cognitively impaired persons with MS. Cognitive problems encountered in MS are discussed in terms of their impact on fundamental elements of communication, including accurate listening, capacity for empathy, making requests of others, making compromises, and giving others feedback about the impact of their behavior. Rehabilitation of these aspects of communication is discussed.

The Impact of Early-Onset Multiple Sclerosis on Cognitive and Psychosocial Indices

Abstract Objective: This study is the first systematic assessment of the impact of early-onset multiple sclerosis (MS) on youngsters’ cognitive abilities and social/emotional functioning. Background: Although adult-onset MS often is characterized by intellectual changes and challenges to psychosocial adaptation, no investigation of these MS-related problems has been done in early-onset MS. Methods: Nine subjects, aged 10 to 20, diagnosed with definite MS before age 18, were evaluated with neuropsychological and psychosocial measures. Results: Although cognitive test scores were generally within normal limits, they were characterized by considerable variability. Subjects scored significantly below the norm on the Wechsler Intelligence Scale for Children (WISC)-III Performance scale (probably indicative of incoordination, motor slowing, and/or perceptual motor difficulties) and on the Controlled Oral Word Association Test (COWAT) (reflecting the semantic verbal memory retrieval deficits reported in adults)....

Efficacy of Rehabilitation in Multiple Sclerosis

The preceding papers described the background of multiple sclerosis (MS) and some of the major issues and approaches in rehabilitation. We will try to offer some data and opinions concerning the efficacy of those approaches. The MS Center at the Albert Einstein College of Medicine was established by Dr. Labe Scheinberg approximately fifteen years ago. It was founded on the belief that in order to serve individuals with MS, one had to adopt a comprehensive approach to treatment (Geronemous et at., 1980; Scheinberg & Smith, 1987; Smith & Scheinberg, 1990). After following this model for a few years, we came to the realization that this kind of comprehensive care actually resembled something that had been going on for a number of years-the field of rehabilitatiott. Our approach to medical care in MS was

A program to facilitate retention of employment among persons with multiple sclerosis

OBJECTIVES The objective was to develop and evaluate the feasibility of a medical-community job-retention model in MS. STUDY DESIGN 43 individuals with MS at risk for losing their jobs were randomized to one of two groups. Both received standard medical care. The experimental group received specialized services geared toward job-retention conducted by medical personnel and an employment specialist. The control group received only standard medical care. Both groups were followed for 1 year. RESULTS The new program was feasible, however, participants made little use of its services. At the I-year follow-up there was no difference between the two groups in job retention. CONCLUSIONS A combined medical-community job-retention program is feasible in MS. However, patients do not generally wish to take advantage of job-retention services until an employment crisis develops. Future programs should develop more effective approaches to early intervention to realize their maximum potential.

Meeting the Needs of People with Primary Progressive Multiple Sclerosis, Their Families, and the Health-Care Community

Although major advances have been made in delaying or preventing progression for the relapsing forms of multiple sclerosis (MS), little progress has been made to date in disease management for primary progressive MS (PPMS). Treatment strategies are largely focused on managing the symptoms of the disease and providing counseling and other forms of psychosocial support. The nurse plays a major role in managing these patients. This article summarizes a collaborative effort by the National Multiple Sclerosis Society and the Multiple Sclerosis Association of America to analyze the needs of this patient population and respond with programs that will meet those needs. This approach to developing a needs assessment is broadly applicable to other patient populations.

Psychosocial, Affective, and Behavioral Consequences of Multiple Sclerosis

Multiple sclerosis (MS) challenges the individual, the family, and society because (1) it can produce wide-ranging functional losses; (2) it is generally progressive with functional losses increasing over time; and (3) its course is unpredictable. Persons affected by MS respond by (1) experiencing changes in their perception of themselves and their world; (2) altering their social roles; and (3) undergoing a variety of emotional responses, especially depression and grief over the losses caused by the illness. Psychosocial interventions that address MS challenges include (1) educational interventions such as lectures, workshops, and books; (2) supportive interventions such as counseling and support groups; (3) psychoeducational interventions such as communication skills training; and (4) somatic therapies such as antidepressants. The unpredictable and progressive course of MS means that affected individuals face a lifetime of periodic challenge. Comprehensive care in MS must address the psychosocial challenges of the illness on a long-term basis. In this way MS care can address the whole patient.

Stress, Multiple Sclerosis, and Everyday Functioning

Numerous studies have described an association between stress and the onset or exacerbation of multiple sclerosis (MS). Most of the studies that have been conducted to date, however, have had methodological flaws including: (1) retrospective designs, (2) inadequate or absent control groups, (3) small sample sizes, (4) clinical measures that are insensitive to underlying disease activity, and (5) wide variation in the measurement of stress. Animal models of MS have enabled researchers to examine the effects of stress directly in the central nervous system. Stress affects three biological systems that may be dysregulated in MS: the neuroendocrine system, the sympathetic nervous system, and the serotonergic neurotransmitter system. Future stress-MS research should evaluate the relationship between stress and these systems.

Recommendations for cognitive screening and management in multiple sclerosis care

Purpose: To promote understanding of cognitive impairment in multiple sclerosis (MS), recommend optimal screening, monitoring, and treatment strategies, and address barriers to optimal management. Methods: The National MS Society (“Society”) convened experts in cognitive dysfunction (clinicians, researchers, and lay people with MS) to review the published literature, reach consensus on optimal strategies for screening, monitoring, and treating cognitive changes, and propose strategies to address barriers to optimal care. Recommendations: Based on current evidence, the Society makes the following recommendations, endorsed by the Consortium of Multiple Sclerosis Centers and the International Multiple Sclerosis Cognition Society: Increased professional and patient awareness/education about the prevalence, impact, and appropriate management of cognitive symptoms. For adults and children (8+ years of age) with clinical or magnetic resonance imaging (MRI) evidence of neurologic damage consistent with MS: As a minimum, early baseline screening with the Symbol Digit Modalities Test (SDMT) or similarly validated test, when the patient is clinically stable; Annual re-assessment with the same instrument, or more often as needed to (1) detect acute disease activity; (2) assess for treatment effects (e.g. starting/changing a disease-modifying therapy) or for relapse recovery; (3) evaluate progression of cognitive impairment; and/or (4) screen for new-onset cognitive problems. For adults (18+ years): more comprehensive assessment for anyone who tests positive on initial cognitive screening or demonstrates significant cognitive decline, especially if there are concerns about comorbidities or the individual is applying for disability due to cognitive impairment. For children (<18 years): neuropsychological evaluation for any unexplained change in school functioning (academic or behavioral). Remedial interventions/accommodations for adults and children to improve functioning at home, work, or school.