Multiple sclerosis psychiatry — structured clinical viva

Leading diagnoses: MS-associated major depression with suicide risk plus probable PBA (brief involuntary crying without sadness) plus cognitive complaints with vocational threat; interferon–mood link is possible contributor but usually multifactorial.^[1][5]

Differentials to voice: demoralisation only; bipolar spectrum; steroid effects if recent pulses; delirium; pure fatigue mislabelled as depression; primary anxiety; cognitive impairment independent of mood (Rao patterns).^[2][6]

Plan: explicit suicide assessment; CBT (telephone-capable); SSRI with monitoring; PBA education and DM/Q if available (QT/interactions) or pragmatic SSRI; cognitive screening/neuropsychology; do not stop DMT unilaterally — joint neurology decision.^[2][3][4][7]

Close: shared MS–psychiatry follow-up, partner education, work supports, crisis plan.^[1][5]