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llms.txt·psychiatry LLM catalog · sitemap

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Clinical Atlas Prestige · Evidence-first

Psych VivasConsultation-liaison psychiatry

Psych Vivas · Consultation-liaison psychiatry

Multiple sclerosis psychiatry — structured clinical viva

Fellowship viva on MS depression, PBA, suicide, cognition, and DMT interface.

clinical
On this page & tools

Target exams

FRANZCPMRCPsychABPNMD-DNB

Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
You are the CL psychiatry registrar. Neurology asks you to review a 38-year-old man with MS who has major depression with passive suicidal ideation, episodes of brief involuntary crying without sadness, cognitive complaints threatening his job, and a request to stop interferon because of mood. Discuss classification of MS psychiatric syndromes, differentials including PBA versus depression, suicide risk, stepwise psychological and pharmacological management including DM/Q where available, steroid-related risks, and shared-care disposition with neurology.

Interpretation

Reveal interpretation

Leading diagnoses: MS-associated major depression with suicide risk plus probable PBA (brief involuntary crying without sadness) plus cognitive complaints with vocational threat; interferon–mood link is possible contributor but usually multifactorial.[1][5]

Differentials to voice: demoralisation only; bipolar spectrum; steroid effects if recent pulses; delirium; pure fatigue mislabelled as depression; primary anxiety; cognitive impairment independent of mood (Rao patterns).[2][6]

Plan: explicit suicide assessment; CBT (telephone-capable); SSRI with monitoring; PBA education and DM/Q if available (QT/interactions) or pragmatic SSRI; cognitive screening/neuropsychology; do not stop DMT unilaterally — joint neurology decision.[2][3][4][7]

Close: shared MS–psychiatry follow-up, partner education, work supports, crisis plan.[1][5]

Key points

Goldman lens

Treat MS depression as core disease care, not optional soft psychology.[1]

PBA ≠ mood episode

Involuntary brief laughing/crying — consider DM/Q evidence pathway.[3]

Suicide literacy

Elevated risk — assess explicitly every time.[5]

References

  1. [1]Goldman Consensus Group The Goldman Consensus statement on depression in multiple sclerosis Mult Scler, 2005.PMID 15957516
  2. [2]Minden SL, Feinstein A, Kalb RC, et al. Evidence-based guideline: assessment and management of psychiatric disorders in individuals with MS Neurology, 2014.PMID 24376275
  3. [3]Pioro EP, Brooks BR, Cummings J, et al. Dextromethorphan plus ultra low-dose quinidine reduces pseudobulbar affect Ann Neurol, 2010.PMID 20839238
  4. [4]Mohr DC, Hart SL, Julian L, et al. Telephone-administered psychotherapy for depression Arch Gen Psychiatry, 2005.PMID 16143732
  5. [5]Feinstein A, Pavisian B Multiple sclerosis and suicide Mult Scler, 2017.PMID 28327056
  6. [6]Rao SM, Leo GJ, Bernardin L, Unverzagt F Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction Neurology, 1991.PMID 2027484
  7. [7]Patten SB, Williams JV, Metz LM Anti-depressant use in association with interferon and glatiramer acetate treatment in multiple sclerosis Mult Scler, 2008.PMID 17986504