Psychoses onset in multiple sclerosis: A systematic review and meta-analysis - 16/04/25

Doi : 10.1016/j.neurol.2025.03.012

I. Ketata ^a,^b,⁎ , E. Ellouz ^a,^b, A. Ketata ^c,^d
^a Neurology Department, University Hospital of Gabes, 6014 Gabes, Tunisia
^b Sfax University, Faculty of Medicine, Sfax, Tunisia
^c Laboratory of Electromechanical Systems, National Engineering School of Sfax, University of Sfax, Sfax, Tunisia
^d Higher Institute of Applied Sciences and Technology of Gabes, University of Gabes, Gabes, Tunisia

^⁎Corresponding author. Neurology Department, University Hospital of Gabes, 6014 Gabes, Tunisia.Neurology Department, University Hospital of GabesGabes6014Tunisia

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Highlights

•	Bipolar disorder and schizophrenia are the most commonly reported psychoses in cases of MS.
•	Psychosis frequently occurred either prior to or at the time of an MS diagnosis.
•	Individuals with schizophrenia were less likely to exhibit neurological symptoms compared to those with other types of psychosis.
•	Polymorphic delusions were strongly linked to the onset of psychosis occurring either after or simultaneously with MS.
•	Treatment-resistant psychosis is commonly observed in MS cases.
•	Some brain lesions detected on MRI may contribute to the onset of psychosis in MS cases.

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Abstract

Background

Psychotic symptoms in multiple sclerosis (MS) have been infrequently studied, despite the existence of numerous case reports showing inconsistent findings. Our aim was to assess the timing of psychosis onset and examine its characteristics in MS cases.

Material and methods

We conducted a systematic review and meta-analysis according to PRISMA 2020. We searched for case reports and case series of psychosis in MS on MEDLINE through PubMed, Google Scholar, Web of Science, and Cochrane. SPSS 26 was used to perform the data analysis.

Results

Overall, 43 cases were reviewed. Bipolar disorder and schizophrenia (SCZ) were the most frequently observed types. Psychosis was often present before or at the time of MS diagnosis. For patients with prior psychosis before MS diagnosis, those with SCZ were less likely to develop neurologic symptoms compared to those with other psychosis types. Polymorphic delusions were significantly associated with psychosis onset either after or concurrently with MS. Extensive periventricular white matter lesions, cerebellar peduncles, and cerebellar lesions were significantly associated with the onset of psychosis following MS diagnosis. Resistant-treatment psychosis occurred in 59.4% of cases. A favorable outcome was significantly more common in patients with relapsing-remitting MS compared to those with other forms of MS.

Conclusion

Our study highlights the importance of considering MS in patients with psychoses, especially those with SCZ or treatment-resistant psychosis. Some white matter lesions may trigger psychosis after MS diagnosis. While managing psychosis in MS can be challenging, MS-specific treatments have proven effective.

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Keywords : Multiple sclerosis, Psychoses, Schizophrenia, Bipolar disorder, Mood disorder, Psychotic disorder