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Psychosis in Multiple Sclerosis

Written by Risa Nguyen, Edited by Rushlenne Pascual

What is multiple sclerosis?

Multiple sclerosis (MS) is an incurable autoimmune disorder that affects the brain and spinal cord. In multiple sclerosis, the body mistakenly attacks myelin, a fatty protective substance that surrounds nerve cells.1 When the myelin is damaged, the nerve cell is exposed and electric signal communication between nerve cells slows down.2 The weakened communication caused by degraded myelin can impair neurological function that is needed to carry out everyday activities.


Features of multiple sclerosis

The appearance of multiple sclerosis often occurs between the ages of 20 to 40, and this disorder  is two to three times more common in women. The symptoms of multiple sclerosis are numbness, electric shock sensations, loss of coordination and balance, weakness, vision issues, and memory loss.1, 2 There are three ways that multiple sclerosis appears in its patients.


The most common type of multiple sclerosis is relapsing-remitting, which is when the patient experiences new or existing symptoms over days or weeks at a time (relapse) with long periods of recovery in between (remission). There is also secondary-progressive MS, which is similar to relapsing-remission; however, the symptoms also worsen within 10 to 40 years from the beginning of onset. In the last type of MS, primary-progressive, symptoms gradually appear and worsen without alternating between relapse and remission.


Multiple sclerosis is diagnosed with a combination of mirror resonance imaging (MRI) and spinal taps. Using an MRI allows doctors to visualize and detect brain damage in MS patients. Doctors use spinal taps to detect abnormal levels of immune system activity in a patient’s spinal fluid. Although there is no cure for MS, it can be treated to make the symptoms more manageable for patients. Corticosteroids and plasma exchange suppress the patient’s overactive immune system from attacking its own nerve cells.1


Linking multiple sclerosis and mental health disorders, such as psychosis

Multiple sclerosis is understood as a neurological disorder because of how it directly damages the structure of the nerve cells. However, it is also related to psychiatry, as MS can cause mood changes. Psychosis is a severe mental health condition that may occur in MS patients.


Psychosis is a mental health condition characterized by a struggle to distinguish between reality and false thoughts.3 The symptoms of psychosis include paranoia, delusions, and hallucinations. The quality of life for patients with multiple sclerosis is more strongly affected with the onset of psychosis.


Although psychosis is only reported in 2-4% of MS cases, it is more common in MS patients than it is in the general population.4 According to a study conducted by Anthony Feinstein, MS patients with psychosis had more brain tissue damage than the MS patients who did not have psychosis. Additionally, the patients’ psychosis symptoms appeared after their neurological symptoms of MS.5 The data from Feinstein’s study shows the correlation between multiple sclerosis and the appearance of psychosis.


Limitations to understanding psychosis in multiple sclerosis

While there is an association between psychosis and multiple sclerosis, it is unclear whether mental health issues can be used to determine the severity of MS.4 There is a possibility that psychological disorders manifest separately from MS in some patients instead of being a symptom of MS. Factors unrelated to the neurological effects of MS can explain the development of psychosis, making it more difficult to establish a causative relationship between the two disorders. One explanation is that the negative symptoms of MS and the complicated treatment plan that comes with it can impact mental health, leading to psychosis in severe cases. Another explanation is that the use of corticosteroids in multiple sclerosis treatment induces psychosis in some patients.6  There are few studies on this subject, which makes it difficult to establish a clear relationship between the two conditions.4 Additional studies that account for patients’ genetic predispositions, environmental surroundings, and MS treatments are needed to illustrate a clearer connection between MS and psychosis.


Treatment of psychosis in patients with multiple sclerosis

People with multiple sclerosis can experience long, healthy lives with proper treatment. It is important to treat psychosis in patients with multiple sclerosis because the presence of social withdrawal and emotional detachment may make MS patients less likely to seek or follow treatment.7 The treatment for psychosis for patients with MS is similar to those without MS.4 Psychosis is treated with antipsychotic medications and psychotherapy. By regularly talking with a behavioral therapist, patients can develop healthy coping mechanisms for psychosis symptoms.3

References


  1. Mayo Clinic. Multiple Sclerosis. Mayo Clinic. Published November 1, 2024. https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/symptoms-causes/syc-20350269

  2. Cleveland Clinic. Myelin Sheath: What It Is, Purpose & Function. Cleveland Clinic. Published May 9, 2022. https://my.clevelandclinic.org/health/body/22974-myelin-sheath

  3. National Institute of Mental Health. Understanding psychosis. National Institute of Mental Health. Published 2023. https://www.nimh.nih.gov/health/publications/understanding-psychosis

  4. Murphy R, O'Donoghue S, Counihan T, et al. Neuropsychiatric syndromes of multiple sclerosis. Journal of Neurology, Neurosurgery, and Psychiatry. 2017;88(8):697-708. doi:10.1136/jnnp-2016-315367

  5. Feinstein A, Boulay GD, Ron MA. Psychotic Illness in Multiple Sclerosis: A Clinical and Magnetic Resonance Imaging Study. British Journal of Psychiatry. 1992;161(5):680-685. doi:10.1192/bjp.161.5.680

  6. Buckley P, Hutchinson M. Psychosis and multiple sclerosis. British Journal of Psychiatry. 1993 Mar;162:422-3. doi: 10.1192/bjp.162.3.422b. PMID: 8453443.

  7. Gilberthorpe TG, O'Connell KE, Carolan A, et al. The spectrum of psychosis in multiple sclerosis: a clinical case series. Neuropsychiatric Disease and Treatment. 2017;13:303-318. Published 2017 Feb 1. doi:10.2147/NDT.S116772

This post is not a substitute for professional advice. If you believe that you may be experiencing a medical emergency, please contact your primary care physician, or go to the nearest Emergency Room. Results from ongoing research are constantly evolving. This post contains information that was last updated in December 2025.


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