A patient with multiple sclerosis may experience a “perfect storm” of physical disability, fatigue and depression.


When working with a patient with multiple sclerosis it is important to inquire about:

(1) physical disability

(2) fatigue

(3) depression

(4) bothersome side effects of medications


If any one of these features is present, then there is a good chance that the other factors can be identified as well.


Psychological disability may be present especially during an exacerbation:

(1) anxiety

(2) uncertainty

(3) poor coping

(4) loss of hope

(5) catastrophizing


If these factors go unchecked then the patient may develop negative behaviors (such as avoidance) and nonadherence, which may contribute to deterioration.


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