Multiple Sclerosis

Pearl B. Werfel, PhD, is a clinical psychologist inprivate practice, who specializes in wellness andchronic illness and pain. She has been inductedinto the National MS Society Hall of Fame forHealthcare Professionals and is a member of theClinical Advisory Committee of the NorthernCalifornia Chapter of the Society. Dr. Werfelteaches courses at CSPP/Alliant on how to workwith clients with chronic illness and she developedan online program for pain and stressmanagement for those living with MS.Ron E. Franco Duran, PhD, is presently AssociateProfessor and Associate Provost for Research andScholarship at Alliant International University.His research interests are in how identityinfluences health behaviors, the effectiveness ofgroup-based interventions for persons living withchronic illness, and how health care organizationsadopt and evaluate evidence-informed behavioralinterventions.Linda J. Trettin, PhD, is a clinical neuropsychologistwith Mercy General Hospital Dignity Healthand the MS Achievement Center. She receivedcertification as a Multiple Sclerosis CertifiedSpecialist with the Consortium of MultipleSclerosis Centers. She also leads National MSSociety - sponsored behavioral health programs.Dr. Trettin's research interests focus on the neuropsychiatricand cognitive difficulties faced byindividuals living with chronic medical andpsychiatric conditions.

Table of Contents1 Description1.1 Terminology1.1.1 Psychiatric Disorders and PsychosocialProblems Associated With MS1.1.2 Psychiatric Diagnoses Associated With MS1.1.3 Psychosocial Problems Associated With MS1.2 Definition1.3 Epidemiology1.3.1 Incidence and Prevalence and1.3.2 Underdiagnosis of MS1.3.3 Psychiatric Diagnoses in MS1.4 Course and Prognosis1.4.1 Course1.4.2 Prognosis1.4.3 Treatment Effects on Course and Prognosis1.4.4 Course and Prognosis of MS Signs andSymptoms1.5 Differential Diagnosis1.5.1 Symptoms of MS Versus Other Etiologies1.5.2 Psychiatric Diagnoses1.5.3 Neuropsychological Diagnosis1.5.4 Types of Cognitive Dysfunction in MS1.5.5 Neuropsychological Evaluation1.5.6 Personality Disorders1.6 Comorbidities1.6.1 Medical and Biobehavioral Comorbiditiesin MS1.6.2 Comorbidity Among Psychiatric Disorders1.6.3 Comorbidity Among Cognitive Disorders1.7 Diagnostic Procedures and Documentation1.7.1 Diagnostic Process1.7.2 Medical Diagnostic Procedures1.7.3 Common Client Responses to Diagnosis1.7.4 Psychiatric Diagnostic Procedures andDocumentation2 Theories and Models2.1 Models of Illness and Disability2.1.1 Moral Model2.1.2 Medical Model .2.1.3 Minority Model2.1.4 Biopsychosocial Model2.2 Minority Stress Model2.3 Depression2.3.1 Depression and Psychosocial Factors2.3.2 Depression and Neurologic Integrity2.4 Anxiety Disorders2.5 Cognitive Impairment2.5.1 Primary Contributors to Cognitive Impairment2.5.2 Secondary Contributors to CognitiveImpairment3 Diagnosis and Treatment Indications3.1 Common Points of Entry Into Psychotherapy3.2 Psychological Evaluation3.2.1 Mood3.2.2 Suicide Risk3.3 Emotional Components of Living With MS3.4 Cognitive and Psychiatric Disorders ImpedingPsychotherapy and Medical Treatment3.4.1 Cognitive Difficulties3.4.2 Cognitive Dysfunction and NeurobehavioralProblems3.4.3 Depression and Pain3.4.4 Sleep Disturbance and Psychiatric Comorbidity3.5 Medication Issues3.6 Psychological Difficulties of Learned Helplessnessand Secondary Gain3.6.1 Learned Helplessness3.6.2 Secondary Gain3.7 Prioritizing Problems and Needs3.8 Focus of Psychotherapy3.8.1 Health and Wellness3.8.2 Clinical Focus3.9 Psychosocial Adaptation3.10 Coping3.11 Social Support3.12 Referral Issues4 Treatment4.1 Methods of Treatment4.1.1 Integrative Health Care4.1.2 Medical Treatment for MS4.1.3 Complementary and Alternative Medicine4.1.4 Neuropsychiatric Treatment (Psychopharmacology)4.1.5 Interdisciplinary Rehabilitation in MS4.1.6 Cognitive Rehabilitation4.1.7 Psychological Interventions4.1.8 Stress Management4.1.9 Pain Management4.1.10 Fatigue Management4.1.11 Mind-Body Interventions4.1.12 Group-Based Interventions .4.2 Working With Physicians and Other HealthcareProviders4.3 Efficacy and Prognosis .4.3.1 Neuropsychological Prognosis4.4 Variations and Combinations of Methods4.5 Problems in Carrying Out the Treatments .4.5.1 Managing Ambivalence, Conflicts, andAmbiguity4.5.2 Medical Interventions4.5.3 Noncompliance/Resistance4.6 Multicultural Issues5 Case Vignettes6 Further Reading7 References8 Appendix: Tools and Resources