Disinhibition And Poor Impulse Control
PERHAPS THE RAREST but most dramatic of the emotional changes seen in MS involves loss of normal behavioral inhibitions and control over impulses. People who experience this problem may be socially or sexually inappropriate, have uncontrollable rages, and may even be assaultive or self-destructive. Such behavior is almost impossible to live with and can lead to criminal charges or involuntary psychiatric hospitalization. For some people, this behavior follows a waxing and waning pattern associated with exacerbations.
 |
| Characteristics Of Multiple Sclerosis |
For others, it is simply part of their day-to-day behavior. There is no evidence to suggest that such behavior is under voluntary control or has anything to do with the person's moral character or values. Instead, it is almost surely a direct result of demyelination in those parts of the brain responsible for inhibition. Disinhibition and poor impulse control may at times be successfully controlled with one of the moodstabilizing drugs such as divalproex sodium, carbamazepine (Tegretol), or lithium. However, in extreme cases, hospitalization and/or the use of a major tranquilizer such as haloperidol (Haldol) may be necessary.
Medication Side Effects
A NUMBER OF MEDICATIONS are used in the management of MS and its symptoms, and many of them can affect mood. These include steroids for exacerbations, baclofen (Lioresal) for spasticity, pemoline (Cylert) for fatigue, and the interferon-beta medications (Avonex, Rebif, Betaseron). In the past, little attention has been devoted to the effects of these drugs on mood.
Perhaps the most dramatic effects can be seen with steroids. Many people get a "high" while on steroids and actually become manic. In addition, the cessation of steroid treatment often produces transient depression. People who have a history of extreme reactions to steroids, especially if they become "high," may be treated in advance with a mood-stabilizing drug such as divalproex sodium (Depakote). The depressive reaction at the end of treatment can be treated with an antidepressant, but often it is helped sufficiently by an awareness of its cause and emotional support until it passes on its own.
There has been much discussion in recent years about the possibility that interferon-beta precipitates depression. It is well known that the interferons have the potential to alter mood when they are used in very high doses. However, research concerning the effects of interferon on mood in people who have MS has been inconclusive. Every person reacts differently to drugs. Given the variety of drugs used in MS, and the even greater variety of possible combinations, it is probably wise to be alert to the potential for significant emotional side effects. In MS, there are many forces at work to stir up emotional reactions and changes of all sorts. Careful attention to the potential side effects of treatments can help reduce one source of intrusion into the emotional lives of people with MS.
Impact Of Cognitive Changes
IN AN IMPORTANT study of cognition and employment, it was found that 16% of people with MS-related cognitive impairment were working compared with 44% of an identical sample of people with MS who were not cognitively impaired. In other words, cognitive changes are more predictive of a person's ability to remain employed than is physical disability.
Cognitive impairment can have a similarly negative impact on the fulfillment of family roles and responsibilities, especially if memory loss leads to unreliability. Unfortunately, family members are often unaware that MS can cause cognitive problems or they do not connect the changes in behavior they see with the person's MS. Failure to remember things that have been discussed or tasks that were supposed to have been done can cause much family strain. Family members often see these lapses as evidence of an "attitude" problem, insensitivity, lack of concern, or laziness.
Teenagers may be quick to recognize and capitalize on a weak memory. ("You told me I could go to that party. Don't you remember anything?") Anger and confusion often accompany cognitive changes because of these misunderstandings and miscommunications. In many instances, the most helpful strategy for the family is to clarify exactly what is going on, and why, and come up with some simple strategies for dealing with the problems brought on by cognitive changes. To find out more, you can check out Characteristics Of Multiple Sclerosis.