Multiple Sclerosis associated neuropsychiatric disorders include major depression (MD), obsessive-compulsive disorder (OCD), bipolar affective disorder, euphoria, pseudobulbar affect, psychosis, and personality change. Magnetic Resonance Imaging (MRI) studies focused mainly on identifying morphostructural correlates of MD; only a few anecdotal cases on OCD associated to MS (OCD-MS), euphoria, pseudobulbar affect, psychosis, personality change, and one research article on MRI abnormalities in OCD-MS have been published. Therefore, in the present review we will report mainly on neuroimaging abnormalities found in MS patients with MD and OCD. All together, the studies on MD associated to MS suggest that, in this disease, depression is linked to a damage involving mainly frontotemporal regions either with discrete lesions (with those visible in T1 weighted images playing a more significant role) or subtle normal appearing white matter abnormalities. Hippocampal atrophy, as well, seems to be involved in MS related depression. It is conceivable that grey matter pathology (i.e., global and regional atrophy, cortical lesions), which occurs early in the course of disease, may involve several areas including the dorsolateral prefrontal cortex, the orbitofrontal cortex, and the anterior cingulate cortex whose disruption is currently thought to explain late-life depression. Further MRI studies are necessary to better elucidate OCD pathogenesis in MS. 1. Introduction Neuropsychiatric disorders associated to Multiple Sclerosis (MS) may be divided into two categories: mood disorders (including behavioural disturbances) [1] and cognitive impairment. The high preponderance of psychiatric symptoms in patients with MS has led to the suggestion that this disease should be routinely included in the differential diagnosis of patients being seen for psychiatric complaints [2–4]. Diaz-Olavarrieta et al. [5], by administering the Neuropsychiatric Inventory [6] to 44 patients with MS who were not under steroid treatment or were not under relapse, found that 95% of the patients were experiencing neuropsychiatric symptoms; in particular, dysphoria or depressive symptoms were most common (79%), followed by agitation (40%), anxiety (37%), irritability (35%), apathy (20%), euphoria (13%), disinhibition (13%), hallucinations (10%), and delusions (7%). In this review we will focus on MS associated mood and behavioural disorders and, in particular, on their neuroimaging aspects. MS associated neuropsychiatric disorders include major depression (MD), obsessive-compulsive disorder
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