title: The risk of Bipolar Disorders in Multiple Sclerosis.
abstract: BACKGROUND
  The aim was to determine the risk of Mood Disorders (MD), particularly Bipolar Disorders (BD), in Multiple Sclerosis (MS) using standardized psychiatric diagnostic tools.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  201 consecutive-patients with MS.
  
  
  METHODS
  804 sex- and age-matched subjects without MS, randomly selected from a database concurrently used for an epidemiological study on the MD prevalence in the community. Psychiatric diagnoses according to DSM-IV were determined by physicians using structured interview tools (ANTAS-SCID).
  
  
  RESULTS
  Compared to controls, MS patients had a higher lifetime prevalence of DSM-IV Major Depressive Disorders (MDD; P<0.0001), BD I (P=0.05), BD II (P<0.0001) and Cyclothymia (P=0.0001). As people with MS had a higher risk of depressive and bipolar spectrum disorders, ratio MDD/bipolar spectrum disorders was lower among cases (P<0.005) indicating a higher association with Bipolar Spectrum Disorders and MS.
  
  
  CONCLUSIONS
  MS diagnosis was differently collected in cases and controls. Even if this might have produced false negatives in controls, it would have reinforced the null hypothesis of no increased risk for MD in MS; therefore, it does not invalidate the results of the study.
  
  
  CONCLUSIONS
  This study was the first to show an association between BD and MS using standardized diagnostic tools and a case-control design. The results suggest a risk of under-diagnosis of BD (particularly type II) in MS and caution in prescribing ADs to people with depressive episodes in MS without prior excluding BD. The association between auto-immune degenerative diseases (like MS) and BD may be an interesting field for the study of the pathogenic hypothesis.
authors.affiliation: Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Consultation Liaison Psychiatric Unit at the University Hospital of Cagliari, University of Cagliari and AOU Cagliari, Italy. Electronic address: mgcarta@tiscali.it.
authors.forename: M G
authors.initials: MG
authors.lastname: Carta
authors.affiliation: Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Consultation Liaison Psychiatric Unit at the University Hospital of Cagliari, University of Cagliari and AOU Cagliari, Italy. Electronic address: mfmoro@gmail.com.
authors.forename: M F
authors.initials: MF
authors.lastname: Moro
authors.affiliation: Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Centro Sclerosi Multipla, Cagliari, Italy. Electronic address: lorena.lorefice@hotmail.it.
authors.forename: L
authors.initials: L
authors.lastname: Lorefice
authors.affiliation: Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Consultation Liaison Psychiatric Unit at the University Hospital of Cagliari, University of Cagliari and AOU Cagliari, Italy. Electronic address: giutri@email.it.
authors.forename: G
authors.initials: G
authors.lastname: Trincas
authors.affiliation: Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Centro Sclerosi Multipla, Cagliari, Italy. Electronic address: ecocco@unica.it.
authors.forename: E
authors.initials: E
authors.lastname: Cocco
authors.affiliation: Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Consultation Liaison Psychiatric Unit at the University Hospital of Cagliari, University of Cagliari and AOU Cagliari, Italy. Electronic address: emilio.delgiudice@gmail.com.
authors.forename: E
authors.initials: E
authors.lastname: Del Giudice
authors.affiliation: Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Centro Sclerosi Multipla, Cagliari, Italy. Electronic address: giusefenu.med@tiscali.it.
authors.forename: G
authors.initials: G
authors.lastname: Fenu
authors.affiliation: Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Bipolar Disorders Programme, Institute of Clinical Neuroscience, Hospital Clínic, Universitat de Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalunya, Spain. Electronic address: FCOLOM@clinic.ub.es.
authors.forename: F
authors.initials: F
authors.lastname: Colom
authors.affiliation: Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy; Centro Sclerosi Multipla, Cagliari, Italy. Electronic address: gmarrosu@unica.it.
authors.forename: M G
authors.initials: MG
authors.lastname: Marrosu
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000453:epidemiology*; D016022:Case-Control Studies; D015897:Comorbidity; D003527:Cyclothymic Disorder / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000453:epidemiology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000453:epidemiology*; D015995:Prevalence; D012306:Risk
keywords: Bipolar Disorders; Comorbidity; Life-time prevalence; MDQ; Mood Disorders; Multiple Sclerosis