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Distinct psychological profiles in multiple sclerosis : relations to site of lesion and neuropsychological function Boyle, Eleanor A.


An important question in multiple sclerosis (MS) is whether personality changes result from the neuropathological process or, alternatively, are normal psychological responses to the stress of living with the disease. The purpose of this study was to determine (1) if empirical support could be found for personality profiles described in the literature and (2) if these profiles were related to neuropathology. The subjects for this study were 99 MS patients with mild physical disease, and 56 well matched normal controls. In addition, a validation study was done on positive results, using 43 MS patients and 20 controls. A review of the literature suggested four common profiles in MS patients, namely denial, exaggeration of symptoms, ‘Depression’ (distinct from psychiatrically— defined major depression), and distress concordant with physical disability. These profiles were operationally defined by three variables measuring (i) objective clinical disability (Kurtzke Expanded Disability Status Scale); (ii) the patient’s perception of symptoms; and (iii) the patient’s level of psychological distress. These three variables were analyzed using Ward’s method of cluster analysis, which yielded four groups consistent with the hypothesized profiles. Subsequently, identical results were obtained on the validation study. To determine if profile membership was related to neuropathological processes, membership in a psychological profile was correlated with lesion site and cognitive function. Site—by—site lesion analyses revealed that ‘Depressed’ patients had more pathology in one right parietal lobe site than did members of other groups. In the validation study there was a non—significant trend (p < 0.09) supporting this relation. The remaining sites (26/27) showed no differences, therefore, with the exception of the ‘Depressed’ group, no support was found for a pathological basis for psychological profiles. Hence, one would infer that in the mild stages of MS, profiles are reactive responses. The profile groups were also compared on number of lesion sites and did not differ, suggesting that profile does not reflect stage of biological disease. Analyses of neuropsychological test results indicated that only the ‘Depressed’ group with the right parietal lesion had cognitive impairment in comparison to the other groups. This finding was not replicated on validation. The current study provided empirical support for distinct psychological responses in MS, but for denial and somatic exaggeration no evidence was found for a pathological basis. These data will be useful to professionals working with MS patients, and may have therapeutic implications.

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