Improvement of quality of life and its relationship with neuropsychiatric outcomes in patients with multiple sclerosis starting treatment with natalizumab: A 3-year follow-up multicentric study.

BACKGROUND: Health-related quality of life (HRQoL) is impaired in multiple sclerosis (MS) but can be improved by disease-modifying therapies such as natalizumab. However, the predictive factors and neuropsychiatric correlates of HRQoL improvement are unknown. METHODS: In this study, 48 patients with relapsing-remitting MS were included in a 3-year open-label, single group, multicenter, clinical trial (NCT01392872). HRQoL was measured by the disease-specific MusiQoL questionnaire, together with physical disability, cognition, fatigue, anxiety and depression scores at baseline, 6months, 12months, 18months and 36months after starting natalizumab therapy. RESULTS: Compared to baseline, global HRQoL, as measured with the index of the MusiQoL, was significantly increased 6months after the beginning of natalizumab therapy, with medium effect-size (58.6±16.2 vs 69.8±18.9, p<0.001, Cohen's d=0.63). This improvement was maintained over time for up to 3years and mainly concerned activity of daily living, psychological well-being, symptoms and coping (p<0.001 for every dimensions). The variation of global HRQoL after 3years was negatively correlated with the variation of fatigue score (r=-0.44, p=0.015). Furthermore, a higher fatigue score at baseline was correlated with improvement in global HRQoL 3years afterwards (r=0.34, p=0.041), independently of age, educational level, disease duration and disability at baseline (ß=2.45, p=0.020). Disability at baseline, cognitive impairment, anxiety and depression failed to predict or correlate with global HRQoL improvement in multivariate analyses. CONCLUSION: Natalizumab improved HRQoL quickly and sustainably in patients with relapsing-remitting MS. In terms of HRQoL, natalizumab seems to benefit mostly patients with more marked fatigue at baseline.

Measuring happiness: from fluctuating happiness to authentic-durable happiness.

On the basis of the theoretical distinction between self-centeredness and selflessness (Dambrun and Ricard, 2011), the main goal of this research was to develop two new scales assessing distinct dimensions of happiness. By trying to maximize pleasures and to avoid displeasures, we propose that a self-centered functioning induces a fluctuating happiness in which phases of pleasure and displeasure alternate repeatedly (i.e., Fluctuating Happiness). In contrast, a selfless psychological functioning postulates the existence of a state of durable plenitude that is less dependent upon circumstances but rather is related to a person's inner resources and abilities to deal with whatever comes his way in life (i.e., Authentic-Durable Happiness). Using various samples (n = 735), we developed a 10-item Scale measuring Subjective Fluctuating Happiness (SFHS) and a 13-item scale assessing Subjective Authentic-Durable Happiness (SA-DHS). Results indicated high internal consistencies, satisfactory test-retest validities, and adequate convergent and discriminant validities with various constructs including a biological marker of stress (salivary cortisol). Consistent with our theoretical framework, while self-enhancement values were related only to fluctuating happiness, self-transcendence values were related only to authentic-durable happiness. Support for the distinction between contentment and inner-peace, two related markers of authentic happiness, also was found.