Sarah L. Minden

Memory impairment in multiple sclerosis.

We compared the performance of 50 multiple sclerosis (MS) patients and 35 normal controls on a variety of memory tasks to determine the nature and severity of memory deficits in the MS patients and the proportion of patients affected. We also determined the relationship between memory and other cognitive functions, demographic factors, disease characteristics, depression, and psychoactive medication. We found significant differences between patients and controls on almost all memory tests. Patterns of learning, effects of interference, and improvement with cuing were similar for both groups. Thirty percent of patients showed severe memory impairment, 30% were moderately impaired, and 40% were mildly or not impaired. Memory dysfunction was related to impairment of other cognitive functions, lower socioeconomic status, chronic progressive type of MS, and use of antianxiety medication, but not to severity of disability, duration of MS symptoms or depression.

Hypomanic reactions to ACTH and prednisone treatment for multiple sclerosis

Nine of 50 MS patients became hypomanic or manic during treatment with ACTH or prednisone. Symptoms did not occur with every drug exposure and were more common with ACTH. Patients at risk were identified by episodes of major depression before and after the onset of MS and by family histories of depression or alcoholism.

Improving the quality of mental health care in Multiple Sclerosis

OBJECTIVE An exploratory study of mental health treatment of people with multiple sclerosis (MS) to identify hypotheses for future testing. METHODS We mailed surveys to 8750 MS patients in four geographically distributed MS Centers; 3384 completed the survey. We used a modified version of the Experience of Care and Health Outcome Survey™ to assess mental health problems and experiences with mental health treatment and the Kessler 6 scale to identify serious mental illness. RESULTS In the year before the survey, sixty percent of patients reported mental health problems. Less than one half of these individuals received mental health treatment, either from their MS care provider or a mental health professional in the MS Center or the community. Patients generally had good mental health treatment experiences, and felt helped by their treatment, but gave less positive reports about how long it took to be seen, receiving information about treatment options and managing their condition, and phone contact. Care experiences were more positive among those who received care from mental health professionals (compared to medical care providers) and among those receiving mental health treatment in the MS Center (compared to in the community). CONCLUSIONS The unmet need for mental health treatment for people with MS is high. Options for MS care providers to help meet this need include hiring mental health professionals to provide on-site treatment; providing mental health treatment themselves; and referring patients to mental health professionals in the community and collaborating in integrated care. This study provided preliminary data for two related hypotheses that warrant further testing: MS patients will receive better mental health care if their mental health treatment is co-located with their MS care and if it is provided by mental health professionals.

A pilot study of young adults with multiple sclerosis: demographic, disease, treatment, and psychosocial characteristics.

BACKGROUND Although multiple sclerosis (MS) is the most common neurologic disease disabling younger adults, very little is known about the characteristics of young adults with MS and the impact of MS on their lives. OBJECTIVES To conduct a pilot study of the demographic, disease, treatment, and psychosocial characteristics of young adults with MS (aged 18 and 31 years). METHODS We solicited participation from all 452 members of the Registry of the North American Research Committee On Multiple Sclerosis (NARCOMS) Project aged 18 to 31 years, collecting data from 100 of these young adults (22%) by computer-assisted telephone interviews. Data included basic demographic, disease, and treatment characteristics, ratings of satisfaction with access to and quality of MS and mental health care, and beliefs about the impact of MS on their current and future lives. RESULTS Participants were 93% female and averaged 28.6 years of age, and 88% had relapsing-remitting MS. Forty-three percent received the majority of their MS-focused care at an MS clinic and 94% had seen a neurologist in the previous 12 months. More than 40% reported depressive symptoms at the time of the survey. These young adults with MS had relatively low rates of concern about the impact of MS in the present but higher rates of worry about their future. CONCLUSIONS These findings suggest the need for a study with a larger, representative sample of young adults with MS to guide development of programs, interventions, and services tailored to meet their needs.

Assessments of Nursing Home Guidelines for Quality of Care Provided to Residents With Multiple Sclerosis

This study assessed the opinions of nursing directors about quality guidelines developed by the National Multiple Sclerosis Society (NMSS) to assist with the care of nursing home residents with multiple sclerosis (MS). Data were collected in a survey of nursing directors at 800 nursing facilities, with 64 nursing directors participating (8.2% response rate). Participating nursing facilities are similar to other nursing homes for facility characteristics and the number of MS residents receiving care. Large majorities of participants thought these NMSS guidelines were important to the development of care plans and staff training. However, most nursing directors were unaware of these guidelines.

Decision Support 2000+: A New Information System for Public Mental Health Care

The federal government has been very involved in supporting the data standards and infrastructure development processes that are driving the e-healthcare boom today. Historically, the federal government has supported efforts to develop common data standards in the mental health arena through efforts at the Center for Mental Health Services within the Substance Abuse and Mental Health Services Administration and the National Institute of Mental Health within the Alcohol, Drug Abuse, and Mental Health Administration. This chapter provides insight into the government’s efforts in the United States as we enter the new millennium. Current efforts, however, would not have been possible without the groundbreaking efforts of the 1970s and 1980s.