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World J Psychiatry. Apr 19, 2023; 13(4): 161-170
Published online Apr 19, 2023. doi: 10.5498/wjp.v13.i4.161
Neuroimmune, clinical and treatment challenges in multiple sclerosis-related psychoses
Katarina Vesic, Aleksandar Gavrilovic, Nataša R Mijailović, Milica M Borovcanin
Katarina Vesic, Aleksandar Gavrilovic, Department of Neurology, University of Kragujevac, Faculty of Medical Sciences, Kragujevac 34000, Sumadija, Serbia
Nataša R Mijailović, Department of Pharmacy, University of Kragujevac, Faculty of Medical Sciences, Kragujevac 34000, Sumadija, Serbia
Milica M Borovcanin, Department of Psychiatry, University of Kragujevac, Faculty of Medical Sciences, Kragujevac 34000, Sumadija, Serbia
Author contributions: Vesic K has presented the idea; Vesic K and Borovcanin M structured the manuscript; All authors searched the literature in their scope of interest and competencies; Vesic K incorporated all parts of the manuscript and drew a figure; The authors gave final suggestions and approval for the final version of the manuscript.
Supported by Ministry of Science and Technological Development of the Republic of Serbia, No. 175069.
Conflict-of-interest statement: Vesic K, Gavrilovic A, Mijailović RN declare no conflict of interest. Borovcanin MM has received research funding from Ministry of Science and Technological Development of the Republic of Serbia (No. 175069).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Katarina Vesic, PhD, Assistant Professor, Department of Neurology, University of Kragujevac, Faculty of Medical Sciences, 69 Svetozara Markovica, Kragujevac 34000, Sumadija, Serbia. stojanovick@yahoo.com
Received: December 27, 2022
Peer-review started: December 27, 2022
First decision: January 9, 2023
Revised: February 16, 2023
Accepted: March 23, 2023
Article in press: March 23, 2023
Published online: April 19, 2023
Abstract

In recent years, epidemiological and genetic studies have shown an association between autoimmune diseases and psychosis. The question arises whether patients with schizophrenia are more likely to develop multiple sclerosis (MS) later in life. It is well known that the immune system plays an important role in the etiopathogenesis of both disorders. Immune disturbances may be similar or very different in terms of different types of immune responses, disturbed myelination, and/or immunogenetic predispositions. A psychotic symptom may be a consequence of the MS diagnosis itself or a separate entity. In this review article, we discussed the timing of onset of psychotic symptoms and MS and whether the use of corticosteroids as therapy for acute relapses in MS is unfairly neglected in patients with psychiatric comorbidities. In addition, we discussed that the anti-inflammatory potential of antipsychotics could be useful and should be considered, especially in the treatment of psychosis that coexists with MS. Autoimmune disorders could precipitate psychotic symptoms, and in this context, autoimmune psychosis must be considered as a persistent symptomatology that requires continuous and specific treatment.

Keywords: Multiple sclerosis, Psychosis, Schizophrenia, Corticosteroids, Antipsychotics

Core Tip: Immunological perturbations in multiple sclerosis (MS) can lead to the development of psychotic symptoms. The use of corticosteroids and antipsychotics might prove beneficial and in patients with MS-related psychosis and outweigh their adverse effects.