Myasthenia gravis and psychiatric comorbidities

Abstract

BackgroundMyasthenia gravis (MG) is a chronic, autoimmune disease involving neuromuscular junctions frequently associated with psychiatric morbidity in terms of depression and anxiety. The interaction between MG and psychiatric disorders needs to be appreciated, especially in the primary care setting, as the symptoms may overlap. The main objective of this study was to recognize the rate of occurrence of psychiatric morbidity among MG patients and to assess the demographic variations of patients and its relevance. Participants and methodsA descriptive cross-sectional study was conducted during the period between June 2011 and December 2013 at the Neurology Department, Nasser Institute Hospital. Thirty MG patients from outpatients' clinics/inpatients' wards of Nasser Institute Hospital between 18 and 50 years of age and both sexes were included. The patients were subjected to clinical interview according to the protocol followed at the neuropsychiatry department of Ain Shams Faculty of Medicine, the quantitative myasthenia gravis test, and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th ed. ResultsThe results showed that 27 (90%) patients had psychiatric comorbidity. Major depressive disorder (MDD) was found in 13 (43.3%) patients and dysthymic disorder was seen in only 7 (23.3%) patients. Anxiety disorders were found in 10 (33.3%) patients; adjustment disorders were found in two patients and mixed anxiety depressive disorder was found in two patients (6.7% for each). The most frequent anxiety disorder was generalized anxiety disorder (16.7%), followed by obsessive-compulsive disorder and social phobia (10% each), and panic disorder (PD) and agoraphobia (6.7% each). There was a significant correlation between the myasthenia severity index of the patient and his chance to have MDD of moderate severity. In addition, there was a significant association between MDD of mild severity and number of hospitalizations (P = 0.047), number of ICU admissions (P = 0.034), and number of myasthenic crisis (P = 0.038). There was a statistically significant association between severe MDD and number of plasmapharesis settings (P = 0.04). Moreover, there was also a statistically significant association between PD and number of myasthenic crisis (P = 0.042) and between agoraphobia without history of PD and number of hospitalizations (P = 0.048). Conclusion A high association of psychiatric comorbidities with MG of up to 90% was seen in the current study. The most common psychiatric comorbidities are depressive disorders and anxiety disorders. The disease characteristics for MG are the most common variables to have a significant correlation with the rate of psychiatric comorbidities, especially disease duration and severity.

Depression: A Contributing Factor to the Clinical Course in Myasthenia Gravis Patients

“…The study demonstrated a statistically significant correlation between the prevalence of depression and the severity of the disease. This result corresponds with the results of other studies [35,47,48,50]. At the baseline of our evaluation, in the group of MG patients with depression and antidepressive treatment, the MG-ADL score was 7.73 (SD = 5.05), while in the group of MG patients without the diagnosis of depression, the MG-ADL score was 4.30 (SD = 4.84, p < 0.001), a statistically significant difference.…”

“…The findings of our study suggest that individuals with myasthenia gravis who received treatment with antidepressants tend to be younger, with a mean age of 42.27 years (SD = 14.88), than patients without depression, 58.97 years (SD = 14.67, p < 0.001), and with a shorter duration of illness, the first group had a mean duration of illness of 59.55 months (SD = 66.98) compared to 95.03 months (SD = 102.64, p = 0.023) in the group of MG patients without depression. This statement supports the underlying premise that the etiology of psychiatric morbidity can be attributed to MG's persistent and debilitating nature, resulting in limitations across several domains of life [35], diminished quality of life, and significant psychological distress [44]. Additionally, the fluctuating symptoms of myasthenia gravis and the possibility of a myasthenia crisis contribute to increased irritability, tension, and anxiety in patients, increasing their susceptibility to depressive and anxiety disorders [45].…”

“…Shifting our focus to anxiety, the Americas have the highest prevalence, with 53% of individuals experiencing anxiety-related issues; in contrast, Asia reports the lowest prevalence of anxiety, with just 25% of individuals affected [25]. The prevalence rate is even higher in studies where the selection was made from a tertiary hospital with severe and complicated cases; a study reported that 90% of patients with MG had a psychiatric comorbidity [35].…”