title: Prospective examination of anxiety and depression before and during confirmed and pseudoexacerbations in patients with multiple sclerosis.
abstract: OBJECTIVE
  This study was designed to determine whether pseudoexacerbations and confirmed MS exacerbations are preceded by or concurrent with increased anxiety or depressive symptoms.
  
  
  METHODS
  This was a secondary analysis of 121 patients with MS who were observed for 48 weeks during a randomized controlled trial. Participants completed monthly self-reports on depressive and anxiety symptoms. Patient-reported exacerbations were assessed through a telephone-administered symptom checklist and neurologic examination.
  
  
  RESULTS
  Both pseudoexacerbations and confirmed exacerbations were associated with concurrent somatic depressive (β = .16 and β = .33, respectively; p values < .05), affective depressive (β = .17 [p = .02] and β = .12 [p = .06]), and anxiety symptoms (β = .24 and β = .20, p values < .01), controlling for baseline symptoms. Preexisting somatic and affective depressive symptoms predicted amplified relationships between concurrent confirmed exacerbations and these symptoms (β = .19 and β = .20, respectively; p values < .01). A standard deviation increase in anxiety symptoms relative to baseline predicted subsequent onset of pseudoexacerbations (odds ratio = 1.54, p = .02), whereas increased somatic depressive symptoms predicted confirmed exacerbations (odds ratio = 1.59, p = .01).
  
  
  CONCLUSIONS
  Patients with MS experiencing pseudoexacerbations or confirmed exacerbations should be assessed and monitored for depressive and anxiety symptoms, and confirmed exacerbations are particularly concerning in patients with a history of depression. The psychological or psychiatric antecedents of MS exacerbations generate new hypotheses on etiologies of confirmed exacerbations and pseudoexacerbations.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00147446.
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
authors.forename: Michelle Nicole
authors.initials: MN
authors.lastname: Burns
authors.forename: Ewa
authors.initials: E
authors.lastname: Nawacki
authors.forename: Juned
authors.initials: J
authors.lastname: Siddique
authors.forename: Daniel
authors.initials: D
authors.lastname: Pelletier
authors.forename: David C
authors.initials: DC
authors.lastname: Mohr
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology*; D001008:Anxiety Disorders / Q000523:psychology; D003863:Depression / Q000523:psychology*; D003866:Depressive Disorder / Q000523:psychology; D018450:Disease Progression; D005260:Female; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000523:psychology*; D016017:Odds Ratio; D011446:Prospective Studies; D011795:Surveys and Questionnaires