A program to facilitate retention of employment among persons with multiple sclerosis.

OBJECTIVES: The objective was to develop and evaluate the feasibility of a medical-community job-retention model in MS. STUDY DESIGN: 43 individuals with MS at risk for losing their jobs were randomized to one of two groups. Both received standard medical care. The experimental group received specialized services geared toward job-retention conducted by medical personnel and an employment specialist. The control group received only standard medical care. Both groups were followed for 1 year. RESULTS: The new program was feasible, however, participants made little use of its services. At the I-year follow-up there was no difference between the two groups in job retention. CONCLUSIONS: A combined medical-community job-retention program is feasible in MS. However, patients do not generally wish to take advantage of job-retention services until an employment crisis develops. Future programs should develop more effective approaches to early intervention to realize their maximum potential.

Psychosocial, Affective, and Behavioral Consequences of Multiple SclerosisTreatment of the "Whole" Patient.

Multiple sclerosis (MS) challenges the individual, the family, and society because (1) it can produce wide-ranging functional losses; (2) it is generally progressive with functional losses increasing over time; and (3) its course is unpredictable. Persons affected by MS respond by (1) experiencing changes in their perception of themselves and their world; (2) altering their social roles; and (3) undergoing a variety of emotional responses, especially depression and grief over the losses caused by the illness. Psychosocial interventions that address MS challenges include (1) educational interventions such as lectures, workshops, and books; (2) supportive interventions such as counseling and support groups; (3) psychoeducational interventions such as communication skills training; and (4) somatic therapies such as antidepressants. The unpredictable and progressive course of MS means that affected individuals face a lifetime of periodic challenge. Comprehensive care in MS must address the psychosocial challenges of the illness on a long-term basis. In this way MS care can address the whole patient.

Stress, Multiple Sclerosis, and Everyday FunctioningA Review of the Literature with Implications for Intervention.

Numerous studies have described an association between stress and the onset or exacerbation of multiple sclerosis (MS). Most of the studies that have been conducted to date, however, have had methodological flaws including: (1) retrospective designs, (2) inadequate or absent control groups, (3) small sample sizes, (4) clinical measures that are insensitive to underlying disease activity, and (5) wide variation in the measurement of stress. Animal models of MS have enabled researchers to examine the effects of stress directly in the central nervous system. Stress affects three biological systems that may be dysregulated in MS: the neuroendocrine system, the sympathetic nervous system, and the serotonergic neurotransmitter system. Future stress-MS research should evaluate the relationship between stress and these systems.