1Sondes Bader, 1Emna Ellouz, 2Wafa Abbes

1Neurology Department, Gabes Hospital, gabes, Tunisia; 2Psychiatry Department, Gabes Hospital, Gabes, Tunisia


Multiple sclerosis (MS) is a demyelinating disease that shows variable clinical presentation.The presence of psychotic disorders in MS patients is rare and occurs in 2-3% of cases. Some studies reported that 95% of adult patients with MS experience psychiatric symptoms and up to 1% of MS has psychiatric onset. Little data has been reported on psychotic symptoms occurring during the MS course or preceding the onset of MS population.

Material(s) and Method(s):

We report a case of a male adult patient with psychotic trouble as first recognized manifestation of MS.


A 19- year-old patient who does not have a clinical history was followed in the psychiatry department for psychotic disorder for 2 years. Clinical manifestation include intrapsychic hallucination, imposed ideas, ideas of influence and reference, ideic and affective ambivalence.Hewas treated by several neuroleptic, anxiolytic drugs without improvement. The brain scan did not show any abnormalities.Due to treatment resistance the patient was referred to the neurology department. Neurological examination revealed only lower limbs brisk reflexes. The brain MRI revealed multifocal demyelinating lesions separated in space and analysis of Cerebral spinal fluid (CSF) showed oligoclonal bands and high IgG index. Immunological assessment for systemic diseases was negative.Patient was treated with corticosteroids, Interferon beta on which he showed a significant improvement of psychiatric symptoms.


The diagnosis of MS should be considered in patients with psychotic troubles especially if there is a lack of response to standard treatments