[Neuropsychiatric symptoms as a manifestation of multiple sclerosis after 2-year follow-up period].

Multiple sclerosis (MS) is a chronic inflammatory disease of the CNS. Its most frequent and typical initial forms of presentation are neuritis optica or arrays of sensory-motor symptoms. Nevertheless, a small minority of patients (about 1%) experience changes in mood, behaviour, personality, or cognition as initial manifestations of MS. This may result in an erroneous diagnosis of a primarily psychiatric condition. In contrast, as cases of MS progress, neuropsychiatric symptoms are very likely to appear; estimates indicate that they will affect two-thirds of all patients at some point. Depression is by far the most frequent symptom, and occurs independently of the degree of neurological disability. Psychotic symptoms have the same incidence in the general population as in patients with MS. Psychiatric comorbidities in MS are probably underdiagnosed, and therefore also undertreated. A depressive syndrome is frequently interpreted as a secondary effect of certain drugs or mistaken for MS-associated fatigue. It should be noted that psychiatric symptoms are not included in Kurtzke’s Expanded Disability Status Scale (EDSS), and that cognitive function is represented in a very limited way (as 1 of 8 functional systems). However, both factors have a large impact on the quality of life of MS patients and their families, and they are also associated with an increased risk of suicide. We present here the clinical case of a patient who was eventually diagnosed with MS after an onset characterised by neuropsychiatric symptoms. After 2 years of follow-up, the patient continues to have exclusively psychiatric and cognitive symptoms.