b'Suicidal ThoughtsThe risk of suicide among the MS population is at least twice that of the generalpopulation. You may assume the people most at risk are those who are increasinglydisabled and who have a progressive disease course, and those are indeed riskfactors. However, other risk factors associated with suicidal thoughts include beingyounger and earlier disease course. In fact, the risk of suicide is highest in the rstfew years after diagnosis. This indicates that anxiety about a future life with MS cancontribute to suicidal thinking.Gender also plays a role. While women with MS are more likely to suer fromdepression and/or anxiety, men with MS are more likely to commit suicide. Thismay reect another risk factor that was identiedlack of social supportwhichmay disproportionately aect men.Whatever the cause, suicidal thinking is a symptom that can be treated. Withmedication or counseling, you can begin to want to live. If you are experiencingsuicidal thoughts, seek immediate assistance from a mental health provider or callthe National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255). Pseudobulbar aect As early as 1840, Jean-Martin Charcot, an early multiple sclerosis researcher,observed that some MS patients exhibited foolish laughter for no cause and some-times, on the contrary, to melt into tears for no reason. This disconnect betweenfeelings and emotional expression is known as pseudobulbar aect. It is estimatedthe condition aects at least 10 percent of people with MS. Pseudobulbar affect is a nervous system disorder that is characterized byuncontrolled crying or laughing that is disproportionate or inappropriate in the socialcontext, or is not linked to the correct emotion. For example, a person with PBA maynd themselves crying during a comedy show or laughing at a tragedy on the news,or something mildly funny or mildly sad may unleash an uncontrollable torrentof laughter or tears. While the disease mechanisms are poorly understood, it isaccepted that the source of the condition is injury to the neurological pathways thatcontrol emotional expression. Because these episodes are so unpredictable and disconnected from actual feelings,they can be particularly unnerving for the person with the condition, as well as family,friends, and caregivers. The symptoms of this condition can be a source of embarrassment,social isolation, anxiety, and depression, and can take a toll on your quality of life.Studies suggests that as many as 40 percent of people experiencing symptomsdo not discuss the problem with their physician. Recording crying and laughingepisodes in a journal can help you in discussions with your healthcare provider.Early and accurate diagnosis is imperative so that appropriate treatment can begiven. 5'