Spotlight on Migraine: psychiatric comorbidities

Psychiatric conditions, especially mood, anxiety, and personality disorders, are common in persons suffering from migraine. These psychiatric comorbidities can alter the clinical course of migraine, its prognosis, and the quality of life of the sufferers. Therefore, diagnosis and treatment of these coexisting conditions are crucial parts of managing persons with migraine. In this article, the authors review the recent findings as well as summarize the key concept of the association between migraine and these psychiatric conditions.

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Spotlight on Sleep and mental disorders

In this article, Dr. Rebekah Jakel of Duke University reviews the role of sleep symptomatology in psychiatric disorders and sleep conditions that are associated with psychiatric disorders, including affective, anxiety, and psychotic disorders. Sleep disturbances are common in individuals who are experiencing psychiatric illness and are included in the diagnostic criteria of many of the affective and anxiety disorders. Sleep symptoms may hinder response to treatment and frequently persist after treatment of psychiatric conditions, increasing the risk of relapse. Thus, clinical attention to sleep disturbances during acute and maintenance treatment of psychiatric conditions is important.

The author discusses general treatments for the management of sleep disturbances experienced in the context of psychiatric illness, including cognitive behavioral therapy for insomnia and its effects on insomnia comorbid with psychiatric conditions.

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Spotlight on Multiple sclerosis: neurobehavioral aspects

Multiple sclerosis is a chronic autoimmune, inflammatory neurologic disease that leads to varying degrees of myelin and axonal injury and destruction in the central nervous system. Although the course of multiple sclerosis is varied and unpredictable, most people with multiple sclerosis initially experience reversible neurologic deficits that are followed by progressive deterioration over time. In addition to debilitating motor symptoms, neurologic deficits such as spasticity, ataxia, and dysesthesia may accompany changes in cognitive and psychiatric status.

In this article, Dr. Adam Gerstenecker of the University of Alabama at Birmingham discusses the neurobehavioral aspects of multiple sclerosis. Cognitive impairment is common in multiple sclerosis, with prevalence rates ranging from 45% to 65% at both the earlier and later stages of the disease. Although cognitive decline is more common in the progressive form of multiple sclerosis, evidence suggests that cognitive impairment is a central feature of multiple sclerosis regardless of phenotype. Cognitive impairment in multiple sclerosis affects most cognitive domains, but processing speed, visual learning, and short-term memory deficits are most common. Cognitive slowing has been observed to be significantly associated with brain volume loss and global gray matter atrophy, and evidence suggests that cognitive decline in multiple sclerosis leads to functional impairments in instrumental activities of daily living. In terms of psychiatric features, mood disorders dominate the clinical picture, with up to 80% of people with multiple sclerosis endorsing some level of depressive symptomology.

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