Hostname: page-component-76fb5796d-vvkck Total loading time: 0 Render date: 2024-04-26T03:25:10.046Z Has data issue: false hasContentIssue false
  • English
  • Français

The impact of stressful life events on risk of relapse in women with multiple sclerosis: A prospective study

Published online by Cambridge University Press:  07 September 2008

Charalampos I. Mitsonis ,
Iannis M. Zervas ,
Panagiotis A. Mitropoulos ,
Nikolaos P. Dimopoulos ,
Constantin R. Soldatos ,
Constantin M. Potagas  and
Constantin A. Sfagos
Charalampos I. Mitsonis*
Affiliation:
1st Department of Psychiatry, Athens University Medical School, Eginition Hospital, 7, Metamorfoseos Street, GR-15234 Halandri, Athens, Greece
Iannis M. Zervas
Affiliation:
1st Department of Psychiatry, Athens University Medical School, Eginition Hospital, 72, Vas. Sofias Avenue, GR-11528Athens, Greece
Panagiotis A. Mitropoulos
Affiliation:
Department of Business Administration, University of Patras, 145 Theofrastou, GR-23335Patras, Greece
Nikolaos P. Dimopoulos
Affiliation:
Dromokaition Psychiatric Hospital, 343, Iera Odos, GR-12461Athens, Greece
Constantin R. Soldatos
Affiliation:
1st Department of Psychiatry, Athens University Medical School, Eginition Hospital, 72, Vas. Sofias Avenue, GR-11528Athens, Greece
Constantin M. Potagas
Affiliation:
Department of Neurology, Athens University Medical School, Eginition Hospital, 72, Vas. Sofias Avenue, GR-11528Athens, Greece
Constantin A. Sfagos
Affiliation:
Department of Neurology, Athens University Medical School, Eginition Hospital, 72, Vas. Sofias Avenue, GR-11528Athens, Greece
*
*Corresponding author. Tel.: +30 210 807 2483; fax: +30 210 514 5824; mobile: +30 6945 371 700. E-mail address: ectorcenter@yahoo.gr (C.I. Mitsonis), izervas@med.uoa.gr (I.M. Zervas), pmitro@upatras.gr (P.A. Mitropoulos), dmpnikos@yahoo.gr (C.R. Dimopoulos), egslelabath@hol.gr (C.R. Soldatos), cpotagas@ath.forthnet.gr (C.M. Potagas), ectorcenter@yahoo.gr (C.A. Sfagos).
Get access

Abstract

Purpose

The aims of this study were first, to examine the general relation between stressful life events (SLEs) and clinical relapses in women with multiple sclerosis (MS) and second, to investigate the relations of the specific stressor attributes of duration, type, and severity on MS exacerbations.

Methods

Twenty six ambulating women with relapsing-remitting MS were followed-up for a mean of 56.3 weeks. Patients documented SLEs weekly in self report diaries which were then collected at regular pre-scheduled clinic visits every 4 weeks. SLEs were classified as short-term if they had subjectively no lasting effect and long-term if they had a subjectively felt psychological impact that lasted at least 10–14 days after the event. The severity of SLEs was determined using the Recent Life Change Questionnaire.

Results

Experiencing three or more SLEs, during a 4-week period, was associated with a 5-fold increase of MS relapse rate (95% CI 1.7–16.4, p = 0.003). The presence of at least one long-term SLE was associated with three times (95% CI 1.01–9.13, p < 0.05) the rate of MS exacerbation during the following 4 weeks. There was no significant association between the severity (95% CI 0.99–1.01, p > 0.05) or the type (χ2 = 7.29, df = 5, p > 0.05) of stressor and the risk for relapse.

Conclusion

Ambulatory women with relapsing-remitting MS who experience cumulative SLEs may be at a greater risk for relapse. Duration is the only stress attribute that seems to increase the risk for relapsing in contrast to stress type and stress severity that were not found to interact with MS exacerbation.

Keywords

Multiple sclerosisRelapseRiskStress attributesStressful life events
Type
Original article
Information
European Psychiatry , Volume 23 , Issue 7 , October 2008 , pp. 497 - 504
Copyright
Copyright © Elsevier Masson SAS 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ackerman, K.D.Martino, M.Heyman, R.Moyna, N.M.Rabin, B.S.Immunologic response to acute psychological stress in MS patients and controls J Neuroimmunol. 68 1996 85–94CrossRefGoogle ScholarPubMed
Ackerman, K.D.Heyman, R.Rabin, B.S.Anderson, B.P.Houck, P.R.Frank, E.et al.Stressful life events precede exacerbations of multiple sclerosis Psychosom Med. 64 2002 916–920Google ScholarPubMed
Ackerman, K.D.Stover, A.Heyman, R.Anderson, B.P.Houck, P.R.Frank, E.et al.2002 Robert Ader New Investigator award. Relationship of cardiovascular reactivity, stressful life events, and multiple sclerosis disease activity Brain Behav Immun. 17 2003 141–151CrossRefGoogle Scholar
American Psychiatric Association: Diagnostic and Statistical Manual of Mental disorders 4th ed. 2000 American Psychiatric Association Washington, DC Text revision (DSM-IV-TR)Google Scholar
Avitsur, R.Stark, J.L.Sheridan, J.F.Social stress induces glucocorticoid resistance in subordinate animals Horm Behav. 39 2001 247–257CrossRefGoogle ScholarPubMed
Bitsch, A.Schuchardt, J.Bunkowski, S.Kuhlmann, T.Brueck, W.Acute axonal injury in multiple sclerosis. Correlation with demyelination and inflammation Brain. 123 2000 1174–1183CrossRefGoogle ScholarPubMed
Brown, G.W.Life events and measurementBrown, G.W.Harris, T.O.Life events and illness. 1989 Guildford New York3–45Google ScholarPubMed
Brown, R.F.Tennant, C.C.Dunn, S.M.Pollard, J.D.A review of stress-relapse interactions in multiple sclerosis: important features and stress-mediating and -moderating variables Mult Scler. 11 2005 477–484CrossRefGoogle ScholarPubMed
Brown, R.F.Tennant, C.C.Sharrock, M.Hodgkinson, S.Dunn, S.M.Pollard, J.D.Relationship between stress and relapse in multiple sclerosis: Part I. Important features Mult Scler. 12 2006 453–464CrossRefGoogle ScholarPubMed
Brown, R.F.Tennant, C.C.Sharrock, M.Hodgkinson, S.Dunn, S.M.Pollard, J.D.Relationship between stress and relapse in multiple sclerosis: Part II. Direct and indirect relationships Mult Scler. 12 2006 465–475CrossRefGoogle ScholarPubMed
Buljevac, D.Flach, H.Z.Hop, W.C.Hijdra, D.Laman, J.D.Savelkoul, H.F.et al.Prospective study on the relationship between infections and multiple sclerosis exacerbations Brain. 125 2002 952–960CrossRefGoogle ScholarPubMed
Buljevac, D.Hop, W.C.Reedeker, W.Janssens, A.C.van der Meche, F.G.van Doorn, P.A.et al.Self reported stressful life events and exacerbation in multiple sclerosis: prospective study BMJ. 9 2003 307–310Google Scholar
Caplan, B.Gibson, C.J.Weiss, R.Stressful sequelae of disabling illness Int Rehabil Med. 6 1984 58–62CrossRefGoogle ScholarPubMed
Confavreux, C.Hutchinson, M.Hours, M.M.Cortinovis-Tourniaire, P.Moreau, T.Rate of pregnancy-related relapse in multiple sclerosis. Pregnancy in Multiple Sclerosis Group N Engl J Med. 339 1998 285–291CrossRefGoogle ScholarPubMed
Correa, S.G.Rodriguez-Galan, M.C.Rivero, V.E.Riera, C.M.Chronic varied stress modulates experimental autoimmune encephalomyelitis in Wistar rats Brain Behav Immun. 12 1998 134–148CrossRefGoogle ScholarPubMed
Foley, F.W.Miller, A.H.Traugott, U.LaRocca, N.G.Scheinberg, L.C.Bedell, J.R.et al.Psychoimmunological dysregulation in multiple sclerosis Psychosomatics. 29 1988 398–403CrossRefGoogle ScholarPubMed
Franklin, G.M.Nelson, L.M.Heaton, R.K.Burkes, J.S.Thompson, D.S.Stress and its relationship to acute exacerbations in multiple sclerosis J Neurol Rehabil. 2 1988 7–11Google Scholar
Gasperini, C.Grasso, M.G.Fiorelli, M.Millefiorini, E.Morino, S.Anzini, A.et al.A controlled study of potential risk factors preceding exacerbation in multiple sclerosis J Neurol Neurosurg Psychiatry. 59 1995 303–305CrossRefGoogle ScholarPubMed
Goeb, J.L.Even, C.Nicolas, G.Gohier, B.Dubas, F.Garré, J.B.Psychiatric side effects of interferon-beta in multiple sclerosis Eur Psychiatry. 21 2006 186–193CrossRefGoogle ScholarPubMed
Goodkin, D.E.Rooney, W.D.Sloan, R.Bacchetti, P.Gee, L.Vermathen, M.et al.A serial study of new MS lesions and the white matter from which they arise Neurology. 51 1998 1689–1697CrossRefGoogle ScholarPubMed
Heesen, C.Mohr, D.C.Huitinga, I.Bergh, F.T.Gaab, J.Otte, C.et al.Stress regulation in multiple sclerosis: current issues and concepts Mult Scler. 13 2007 143–148CrossRefGoogle ScholarPubMed
Janssens, A.C.Buljevac, D.van Doorn, P.A.van der Meché, F.G.Polman, C.H.Passchier, J.et al.Prediction of anxiety and distress following diagnosis of multiple sclerosis: two-year longitudinal study Mult Scler. 12 2006 794–801CrossRefGoogle ScholarPubMed
Kurtzke, J.F.Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS) Neurology. 33 1983 1444–1452CrossRefGoogle Scholar
McDonald, W.I.Compston, A.Edan, G.Goodkin, D.Hartung, H.P.Lublin, F.D.et al.Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis Ann Neurol. 50 2001 121–127CrossRefGoogle Scholar
Miller, M.A.Rahe, R.H.Life changes scaling for the 1990s J Psychosom Res. 43 1997 279–292CrossRefGoogle ScholarPubMed
Mohr, D.C.Dick, L.P.Russo, D.Pinn, J.Boudewyn, A.C.Likosky, W.et al.The psychosocial impact of multiple sclerosis: exploring the patient's perspective Health Psychol. 18 1999 376–382CrossRefGoogle ScholarPubMed
Mohr, D.C.Goodkin, D.E.Bacchetti, P.Boudewyn, A.C.Huang, L.Marrietta, P.et al.Psychological stress and the subsequent appearance of new brain MRI lesions in MS Neurology. 55 2000 55–61CrossRefGoogle ScholarPubMed
Mohr, D.C.Hart, S.L.Julian, L.Cox, D.Pelletier, D.Association between stressful life events and exacerbation in multiple sclerosis: a meta-analysis BMJ. 328 2004 731CrossRefGoogle ScholarPubMed
Mohr, D.C.Pelletier, D.A temporal framework for understanding the effects of stressful life events on inflammation in patients with multiple sclerosis Brain Behav Immun. 20 2006 27–36CrossRefGoogle ScholarPubMed
Mohr, D.C.Stress and multiple sclerosis J Neurol. 254 Suppl 2 2007 65–68CrossRefGoogle ScholarPubMed
Munck, A.Náray-Fejes-Tóth, A.Glucocorticoids and stress: permissive and suppressive actions Ann N Y Acad Sci. 746 1994 115–130CrossRefGoogle ScholarPubMed
Nisipeanu, P.Korczyn, A.D.Psychological stress as risk factor for exacerbations in multiple sclerosis Neurology. 43 1993 1311–1312CrossRefGoogle ScholarPubMed
Pearce, J.M.Historical descriptions of multiple sclerosis Eur Neurol. 54 2005 49–53CrossRefGoogle ScholarPubMed
Pendleton, V.R.Willems, E.Swank, P.Poston, W.S.Goodrick, G.K.Reeves, R.S.et al.Negative stress and the outcome of treatment for binge eating Eat Disord. 9 2001 351–360CrossRefGoogle ScholarPubMed
Schwartz, C.E.Foley, F.W.Rao, S.M.Bernardin, L.J.Lee, H.Genderson, M.W.Stress and course of disease in multiple sclerosis Behav Med. 25 1999 110–116CrossRefGoogle ScholarPubMed
Serlupi Crescenzi, G.Risk factors in multiple sclerosis: implications for pathogenesisSerlupi Crescenzi, G.A multidisciplinary approach to myelin disease. 1987 Plenum Press New York227–232CrossRefGoogle Scholar
Sharrack, B.Hughes, R.A.Clinical scales for multiple sclerosis J Neurol Sci. 135 1996 1–9CrossRefGoogle ScholarPubMed
Sibley, W.A.Risk factors in multiple sclerosisRaine, C.S.McFarland, H.F.Tourtelotte, W.W.Multiple sclerosis: clinical and pathogenetic basis. 1997 Chapman & Hall London141–148Google Scholar
Silver, N.C.Good, C.D.Barker, G.J.MacManus, D.G.Thompson, A.J.Moseley, I.F.et al.Sensitivity of contrast enhanced MRI in multiple sclerosis. Effects of gadolinium dose, magnetization transfer contrast and delayed imaging Brain. 120 1997 1149–1161CrossRefGoogle ScholarPubMed
Stip, E.Truelle, J.L.Organic personality syndrome in multiple sclerosis and effect of stress on recurrent attacks Can J Psychiatry. 39 1994 27–33CrossRefGoogle ScholarPubMed
van Winsen, L.M.Muris, D.F.Polman, C.H.Dijkstra, C.D.van den Berg, T.K.Uitdehaag, B.M.Sensitivity to glucocorticoids is decreased in relapsing remitting multiple sclerosis J Clin Endocrinol Metab. 90 2005 734–740CrossRefGoogle ScholarPubMed
Vollmer, T.The natural history of relapses in multiple sclerosis J Neurol Sci. 256 Suppl 1 2007 5–13CrossRefGoogle ScholarPubMed
Warren, S.Warren, K.G.Cockerill, R.Emotional stress and coping in multiple sclerosis (MS) exacerbations J Psychosom Res. 35 1991 37–47CrossRefGoogle ScholarPubMed
Weinshenker, B.G.Epidemiology of multiple sclerosis Neurol Clin. 14 1996 291–308CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.