Panic attacks and psychiatric comorbidity in multiple sclerosis: reinterpreting a 2004–2006 Georgian case-control study in the context of contemporary evidence

Background Georgian evidence on psychiatric comorbidity in multiple sclerosis (MS) is sparse. A previously unpublished single-centre Batumi case-control dataset from 2004–2006 is reanalysed here and reinterpreted in the light of the 2026 clinical framework — current diagnostic criteria, disease-modifying therapies (DMTs), validated psychiatric instruments, and mechanistic neuroimaging — to establish a pre-DMT-era Georgian baseline against which contemporary MS care can be benchmarked. Methods In this single-centre, hospital-based case-control study conducted between 2004 and 2006 at the High Technology Hospital Medical Centre (Batumi, Georgia), 30 adults with clinically confirmed MS (16 women, 14 men; age range 20–75 years; disease duration 1–5 years) were compared with 30 age- and sex-matched healthy controls. Anxiety was assessed using the Sheehan Patient-Rated Anxiety Scale. Frequency of panic attacks, impairment in daily functioning, social behaviour, capability changes, suicidal ideation, and somato-vegetative symptoms were recorded through structured clinical interview. Between-group comparisons used Fisher’s exact test and chi-square tests; risk was expressed as odds ratios (ORs) with 95% confidence intervals (CIs). Results The overall distribution of panic-attack frequency differed significantly between groups (χ² = 8.83; df = 2; p = 0.012). Any panic attacks (≥5 per month) were reported by 26/30 (86.7%) patients and 17/30 (56.7%) controls (OR 4.97; 95% CI 1.39–17.82; p = 0.020). Compared with controls, patients had significantly higher odds of impaired daily functioning (OR 7.56; 95% CI 2.41–23.75; p = 0.001), capability changes (OR 4.67; 95% CI 1.57–13.87; p = 0.009), and social-behaviour disturbance (OR 3.76; 95% CI 1.24–11.39; p = 0.033). Suicidal ideation was more frequent in the MS group (36.7% vs 13.3%; OR 3.76; 95% CI 1.04–13.65; p = 0.072). Conclusions Georgian adults with MS in 2004–2006 showed strikingly elevated odds of panic attacks, functional impairment, and suicidal ideation compared with matched controls. The magnitude of this burden, reinterpreted against 2026 standards, plausibly reflects MS lived in the near-absence of modern care. These data establish a pre-DMT-era Georgian baseline and argue for urgent implementation of integrated psychiatric screening, expanded DMT access, and a contemporary multicentre Georgian MS registry. Keywords multiple sclerosis; panic disorder; anxiety; psychiatric comorbidity; case-control studies; Georgia (Republic)