title: Psychological stress and the subsequent appearance of new brain MRI lesions in MS.
abstract: OBJECTIVE
  To examine the relationship between stressful life events and psychological distress, and the subsequent development of gadolinium-enhancing (Gd+) brain lesions.
  
  
  BACKGROUND
  It has long been speculated that stressful life events and psychological distress are associated with disease exacerbation in MS. This is the first prospective longitudinal study of the relationship between stressful life events, psychological distress, and disease activity as measured by Gd+ brain MRI.
  
  
  METHODS
  Thirty-six patients (mean age, 44.4 years; 22 women, 14 men) with relapsing forms of MS were assessed once every 4 weeks for 28 to 100 weeks. Assessments included Gd+ MRI, the Social Readjustment Rating Scale (SRRS), the Hassles Scale, and the Profile of Mood States. The SRRS was altered in the following manner: 1) three items that confounded with MS were eliminated, 2) endorsed items were rated for intensity, and 3) the scale was divided into three subscales: major negative events, conflict and disruption in routine, and positive life events. Data were analyzed using mixed-effects logistic regression to account for intrasubject correlations. Stress and distress measures were used to predict concurrent and future MRI activity.
  
  
  RESULTS
  For the total sample of patients, increased conflict and disruption in routine was followed by increased odds of developing new Gd+ brain lesions 8 weeks later (odds ratio, 1.64; p = 0.00083). There was no strong evidence of a relationship between psychological stress or distress and clinical exacerbation.
  
  
  CONCLUSIONS
  These data provide support for the notion that conflict and disruption in routine are related to subsequent disease activity in MS. However, this relationship is not sufficiently robust to predict clinical exacerbations reliably in individual patients.
authors.affiliation: University of California at San Francisco, CA 94115-1642, USA.
authors.forename: D C
authors.initials: DC
authors.lastname: Mohr
authors.forename: D E
authors.initials: DE
authors.lastname: Goodkin
authors.forename: P
authors.initials: P
authors.lastname: Bacchetti
authors.forename: A C
authors.initials: AC
authors.lastname: Boudewyn
authors.forename: L
authors.initials: L
authors.lastname: Huang
authors.forename: P
authors.initials: P
authors.lastname: Marrietta
authors.forename: W
authors.initials: W
authors.lastname: Cheuk
authors.forename: B
authors.initials: B
authors.lastname: Dee
mesh_terms: D000328:Adult; D001921:Brain / Q000473:pathology* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D009103:Multiple Sclerosis / Q000150:complications* / Q000473:pathology* / Q000503:physiopathology; D011446:Prospective Studies; D013315:Stress, Psychological / Q000150:complications* / Q000473:pathology* / Q000503:physiopathology; D013997:Time Factors