ARTICLE W R I T T E N B Y: R U T H A N N M A R R I E , J E F F R E Y C O H E N , O L A F S T U V E , M A R I A T R O J A N O , P E R S O E L B R E G S O R E N S E N , S T E P H E N R E I N G O L D , G A RY C U T T E R , & N A D I A R E I D E R

P R E S E N TAT I O N B Y: N AT H A N T. G R I S W O L D

F E R R I S S TAT E U N I V E R S I T Y

N U R S 4 4 1

MULTIPLE SCLEROSIS

THE INCIDICENCE AND PREVELNACE OF PSYCHATRIC DISORDERS IN MULTIPLE SCLEROSIS : A SYSTAMATIC REVIEW

INTRODUCTION

Multiple Sclerosis- MS is an Immune- mediated progressive demyelization disease of the central nervous system (CNS).

Precipitating factors: include pregnancy, fatigue, stress, Infection, trauma and geographical location , geographical location.

MS: affects nearly 400,000 people in the United States

MS: Can occur at any age peak onset is between 25 and 35; affects women more frequently then men. MS consists of periods of remission and exacerbations

Warning signs of MS: Vision problems, memory problems.

Symptoms of MS: Lhermitte’s sign, fatigue, tremors, ataxia, vertigo, nystagmus, emotional changes, and bladder and bowel disturbances.

Medications- Interferon’s, IVIG, Steroids, Glatiramer acetate, and Baclofen (Lioresal),

Source used: (Hinkle & Cheever, 2014, p. 2033-2036)

INTRODUCTION (CONT’D)

Known- The Psychiatric health issues is associated with drop in quality of life, more fatigue, and reduced adherence to disease-modifying therapy in multiple sclerosis MS

We know that MS can be self-limiting an lead to depression by, stress of illness, disease process, emotional changes, cognitive changes, immune neuroendocrine system changes, and disablement

Unknown- Occurrence and the type psychiatric disorders in MS patients.

Purpose: To assess the occurrence of chosen psychiatric disorders to understand the correlation between MS and mental illness. This study will also evaluate the quality of included studies.

Source used: (Marrie et al., 2014).

EVIDENCE FOR CARE

Nursing care Problem:

Their is little understanding on the occurrence of Psychological issues in patients who suffer form Multiple sclerosis.

Depression, may occur in response to immunological and inflammatory changes. Second, structural brain irregularity as measured by brain deterioration and lesions are linked with

depression in MS. Third, depression or anxiety may represent a general reaction to chronic illness. Fourth, disease-modifying therapies used to control MS may cause depression or anxiety. For instance, corticosteroids may cause temporary depression, mania or psychosis; while the pivotal

trials of interferon-beta for MS raised apprehension the therapy causing depression. psychosocial risk factors also play a part in psychiatric health issues in MS

This article goal is to understand the risk of developing chosen psychological conditions such as Bi-polar, Anxiety, psychosis, alcohol abuse, and substance abuse and their occurrence in established MS populations.

Source used (Marrie et al., 2014).

NURSING THEORY

Virginia Henderson Needs Theory Viewed humans as as whole a biological, psychological, spiritual,

and social being.

Sourced used: (Maville & Huerta, 2013, p. 32)

STUDY METHODS & RESULTS

118 studies included in systemic review.

Methods – Researchers search PubMed, PsychInfo, SCOPUS, and Web of Knowledge databases and reference lists of retrieved articles. Abstracts were screened for relevance by two independent reviewers, followed by full-text review. Data were abstracted by one reviewer, and verified by a second reviewer. Study quality was evaluated using a standardized tool.

Results- 118 studies were included in systematic review. Prevalence of psychiatric disorder Depression 23.7% Anxiety 21.9% Alcohol Abuse 14.8% Bi-polar 5.83% Psychosis 4.5% Substance Abuse 2.5%

Source used: (Marrie et al., 2014).

EVALUATION OF EVIDENCE

Critique & Creditability Systematic Review Written by 7 authors Scholarly & peer reviewed.

Study Limitations- lack of a population-based design Inability to illustrate non-responders in survey-based studies, Failure confirm the factors to assess the diagnosis of MS failure to report confidence intervals.

Future studies should develop a consistent approach to measuring psychiatric health issues, and reporting of age, sex, and ethnicity specific assessments would enhance future comparisons across studies.

Source used (Marrie et al., 2014).

PATIENT CARE DESIGN

Place the client, their beliefs, and their needs at the center of their care

Address patient as whole including MS health issues and mental health issues.

Shared/collaborative approach between their physicians psychologists and other healthcare professionals like ST, OT, and PT is important to address all patient needs that accompany MS patients

NURSING CARE PLAN

NURSING DIAGNOSIS

INTERVENTION

RATIONALE GOALS

Ineffective individual coping related to uncertainty of course of MS

1. Determine patient’s understanding of current situation and previous methods of dealing with life’s problems.

2. Refer to counseling, psychiatric clinical nurse specialist and/or psychiatrist, as indicated.

3. Maintain an honest, reality-oriented relationship.

1. Provides a clue as to how patient may deal with what is currently happening, and helps identify individual resources and need for assistance.

2. May need additional help to resolve issues of self-esteem and regain effective coping skills.

3. Lowers confusion minimizes painful, frustrating, struggle associated with adaptation to altered Health.

1. Maintain normal daily activities as best you can.

2. Stay connected with friends and family.

3. Continue to pursue hobbies that you enjoy and are able to do.

4. Get enough rest.

5. Exercise

ADVOCACY

Patient advocate Be Empathic:

Build trust with and rapport with patients

Effective, therapeutic communication verbally and non-verbally

Provide safe, comfortable, and healing environment

Be patient voice to petition for the quality care they disserve

This allows for quality care and best patient outcomes

SIGNIFICANCE OF RESEARCH

How does this help with patient care? This article points out that MS is a multifaceted disease an reconfirms that

psychiatric issues , particularly depression and anxiety, is common in MS.

The possibility of psychological issues in MS Patients this can being overwhelming in dealing with progression of disease, symptoms that accompany MS and bouts of remission & exacerbation periods that effect person as a whole.

This research brings to light the importance for nurses to assess the patient with MS as a whole.

Source used (Marrie et al., 2014).

SUMMARY & REFERENCES

Hinkle, J.L., & Cheever, K.H. (2014). Brunner & Suddarth’s Textbook of Medical- Surgical

Nursing (13th ed.). Philadelphia: Lippincott Williams & Wilkins, 2033-2039.

Marrie, R.A., Reingold, S., Cohen, J., Stuve, O., Trojano, M., Sorensen, P.S., Cutter, G.,

& Reider N. (2014). The incidence and prevalence of psychiatric disorders in multiple

sclerosis: a systematic review. Multiple Sclerosis Journal.1-13, DOI: 10.1177/

1352458514564487

Maville, J., & Huerta, C. (2013). Health promotion in nursing (3rd ed.). Clifton Park,

NY: Delmar, Cengage Learning, 31-33.