Necla KESKİN, Soner ÇAKMAK, Lut TAMAM, Ahmet Turan EVLİCE

Bipolar Bozukluk-Multiple Skleroz Birlikteliği: Bir Olgu Sunumu

Multiple skleroz santral sinir sisteminin kronik demiyelinizan bir hastalığıdır. Nöropsikiyatrik belirtiler multiple sklerozda sıklıkla görülür ve bipolar bozukluk multiple skleroz ile birlikte en sık görülen ruhsal bozukluklardandır. Multiple sklerozda bipolar bozukluk atakları hastalığın ilk belirtisi, eşzamanlı bir tanı olabileceği gibi tedavi amaçlı kullanılan bir ilacın yan etkisi de olabilir. Multiple skleroz -bipolar bozukluk birlikteliği iyi bilinen ancak etyolojisi aydınlatılmamış ve yeterince araştırılmamış bir durumdur. Son çalışmalar ortak genetik zemin üzerinde durmaktadır. Multiple sklerozda bipolar bozukluk tedavisi ile ilgili veriler olgu bildirimlerine dayanmaktadır ve tedavi bireye özgü olmalıdır. Bu yazıda multiple skleroz ektanılı, bipolar bozukluk manik atak geçiren bir olgu üzerinden bipolar bozukluk multiple skleroz birlikteliği, epidemiyolojisi, etyolojisi ve tedavisi tartışılmıştır.

Anahtar Kelimeler:

Bipolar bozukluk, multiple skleroz, nöropsikiyatrik belirtiler

Comorbidity of Bipolar Disorder and Multiple Sclerosis: A Case Report

Multiple sclerosis is a chronic demyelinating disease of a central nervous system. Neuropsychiatric symptoms are common in multiple sclerosis and bipolar disorder is one of the most common psychiatric disorders that coexist with multiple sclerosis. Manic episodes may be the first presenting symptom of multiple sclerosis as comorbid pathology or as an adverse effect of pharmacotherapies used in multiple sclerosis. The comorbidity of bipolar disorder and multiple sclerosis is well-proven but its etiology is not known and investigated accurately. Recent studies support a common genetic susceptibility. Management of bipolar disorder in multiple sclerosis is based on evidence provided by case reports and treatment should be individualized. In this report, the association between bipolar disorder and multiple sclerosis, epidemiology, ethiology and treatment is discussed through a case had diagnosed as multiple sclerosis and had a manic episode with psychotic features.

Keywords:

Bipolar disorder, multiple sclerosis, neuropsychiatric symptoms,

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Chwastiak LA, Ehde DM. Psychiatric issues in multiple sclerosis. Psychiatr Clin North Am. 2007; 30:803–17.
Joffe RT, Lippert GP, Gray TA, Sawa G, Horvath Z. Mood disorders and multiple sclerosis. Arch Neurol. 1987; 44:376-8.
Edwards LJ, Constantinescu CS. A prospective study of conditions associated with multiple sclerosis in a cohort of 658 consecutive outpatients attending a multiple sclerosis clinic. Mult Scler. 2004; 10:575–81.
Oral ET, Yalçıner B, Karadağ F, Sarı H, Verimli A. Monopolar Mania and/or Multiple Sclerosis: A case report Düşünen Adam. 1994; 7:30-3.
Heila H, Turpeinen P, Erkinjuntti T. Case study: mania associated with multiple sclerosis. J Am Acad Child Adolesc Psychiatry. 1995; 34:1591–5.
Ybarra MI, Moreira MA, Araşjo CR, Lana-Peixoto MA, Teixeira AL. Bipolar disorder and multiple sclerosis. Arq Neuropsiquiatr. 2007; 65:1177-80.
Lyoo IK, Seol HY, Byun HS, Renshaw PF. Unsuspected multiple sclerosis in patients with psychiatric disorders: a magnetic resonance imaging study. J Neuropsychiatry Clin Neurosci. 1996; 8:54-9.
Marrie RA, Fisk JD, Yu BN, Leung S, Elliott L, Caetano P, et al. CIHR Team in the Epidemiology and Impact of Comorbidity on Multiple Sclerosis. Mental comorbidity and multiple sclerosis: validating administrative data to support population-based surveillance. BMC Neurol. 2013; 13:16.
Konradi C, Sillivan SE, Clay HB. Mitochondria, oligodendrocytes and inflammation in bipolar disorder: evidence from transcriptome studies points to intriguing parallels with multiple sclerosis. Neurobiol Dis. 2012; 45:37-47.
Schiffer RB, Weitkamp LR, Wineman NM, Guttornsem S. Multiple sclerosis and affective disorder: family history, sex, and HLA-DR antigens. Arch Neurol. 1988; 45:1345-8.
Kellner CH, Davenport Y, Post RM, Ross RJ: Rapidly cycling bipolar disorder and multiple sclerosis. Am J Psychiatry. 1984; 141:112–3.
Asghar-Ali AA, Taber KH, Hurley RA, Hayman LA. Pure neuropsychiatric presentation of multiple sclerosis. Am J Psychiatry. 2004; 161:226-31.
Minden SL. Mood disorders in multiple sclerosis: diagnosis and treatment. J Neurovirol. 2000; 6:160–
Pine DS, Douglas CJ, Charles E, et al. Patients with multiple sclerosis presenting to psychiatric hospitals. J Clin Psychiatry. 1995; 56:297–306.
Fisk JD, Morehouse SA, Brown MG, Skedgel C, Murray TJ. Hospital-based psychiatric service utilization and morbidity in multiple sclerosis. Can J Neurol Sci. 1998; 25:230–5.
Kemp K, Lion JR, Magram G. Lithium in the treatment of a manic patient with multiple sclerosis: a case report. Dis Nerv Syst. 1977; 38:210-1.
Solomon JG. Multiple sclerosis masquerading as lithium toxicity. J Nerv Ment Dis. 1978; 166:663-5.
Kahn D, Stevenson E, Douglas CJ. Effect of sodium valproate in three patients with organic brain syndromes. Am J Psychiatry. 1988; 145:1010-1.
Davids E, Hartwig U, Gastpar M. Antipsychotic treatment of psychosis associated with multiple sclerosis. Prog Neuropsychopharmacol Biol Psychiatry. 2004; 28:743-4.
Heckers S, Anick D, Boverman JF, Stern TA. Priapism following olanzapine administration in a patient with multiple sclerosis. Psychosomatics. 1998; 39:288-90.
Yadav R, Zigmond AS. Temporal lobe lesions and psychosis in multiple sclerosis. BMJ Case Rep. 2010; 2010: bcr0120102651.
Muzyk AJ, Christopher EJ, Gagliardi JP, Kahn DA. Use of aripiprazole in a patient with multiple sclerosis presenting with paranoid psychosis. J Psychiatr Pract. 2010; 16:420-4.
Pontikes TK, Dinwiddie SH. Electroconvulsive therapy in a patient with multiple sclerosis and recurrent catatonia. J ECT. 2010; 26:270-1.
Yazışma Adresi / Address for Correspondence: Dr. Necla Keskin Çukurova Üniversitesi Tıp Fakültesi, Ruh Sağlığı ve Hastalıkları Anabilim Dalı 01330 Balcalı-ADANA e-mail: neclakeskin@yahoo.com geliş tarihi/received :01.06.2013 kabul tarihi/accepted:17.06.2013