Falsos negativos en el diagnóstico de la miastenia gravis

Pérez-Nellar, Jesús; Rodríguez, Ana

doi:10.33588/rn.3008.99532

Cited by 6 publications

(5 citation statements)

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“…Depression has been documented to be under-treated and under-recognized since the obscure and mild symptoms of medical diseases may overlap with the somatic symptoms of depression (2,5,7,8). Only three studies focused on Axis I comorbidities of MG; and the most common comorbidities found were mood and anxiety disorders (6,9,10).…”

Section: Introductionmentioning

confidence: 99%

Miyastenia Graviste Anksiyete ve Depresif Belirtilerin, Hastalık Şiddeti ve Tedavi Biçimiyle İlişkisi: Kesitsel Bir Çalışma

Aysal¹,

Karamustafalıoğlu²,

Özçelik³

et al. 2013

Npa

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Section: Introductionmentioning

confidence: 99%

Miyastenia Graviste Anksiyete ve Depresif Belirtilerin, Hastalık Şiddeti ve Tedavi Biçimiyle İlişkisi: Kesitsel Bir Çalışma

Aysal¹,

Karamustafalıoğlu²,

Özçelik³

et al. 2013

Npa

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“…It is intriguing to analyze this coexistence as merely coincidental, particularly since somatic symptoms associated with MG might obscure the accurate assessment of the severity of depression. In other words, the physical symptoms experienced by MG patients may sometimes be mistaken for signs of depression [52,53]. It is essential to consider this intricate relationship carefully and not jump to conclusions about the severity of depression in MG patients, as these individuals may be grappling with complex symptoms that are not immediately evident through traditional diagnostic criteria.…”

Section: Discussionmentioning

confidence: 99%

“…Fikret Aysal and colleagues [53], in their research regarding the treatment of patients with myasthenia gravis about symptoms of anxiety and depression, suggested that individuals who received a combination of anticholinesterase and immunosuppressive therapies experienced a higher prevalence of depression and anxiety symptoms than those who were solely prescribed prednisolone. Our study did not show a statistical difference between the patients treated only with corticosteroids and those with an immunosuppressant associated with the treatment.…”

Section: Discussionmentioning

confidence: 99%

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

Mihalache,

Vilciu,

Petrescu

et al. 2023

Medicina

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Background and Objectives: The association between myasthenia gravis (MG) and depression is intricate and characterized by bidirectional causality. In this regard, MG can be a contributing factor to depression and, conversely, depression may worsen the symptoms of MG. This study aimed to identify any differences in the progression of the disease among patients with MG who were also diagnosed with depression as compared to those without depression. Our hypothesis focused on the theory that patients with more severe MG symptoms may have a higher likelihood of suffering depression at the same time. Materials and Methods: One hundred twenty-two male and female patients (N = 122) aged over 18 with a confirmed diagnosis of autoimmune MG who were admitted to the Neurology II department of Myasthenia Gravis, Clinical Institute Fundeni in Bucharest between January 2019 and December 2020, were included in the study. Patients were assessed at baseline and after six months. The psychiatric assessment of the patients included the Hamilton Depression Rating Scale-17 items (HAM-D), and neurological status was determined with two outcome measures: Quantitative Myasthenia Gravis (QMG) and Myasthenia Gravis Activities of Daily Life (MG-ADL). The patients were divided into two distinct groups as follows: group MG w/dep, which comprised 49 MG patients diagnosed with depressive disorder who were also currently receiving antidepressant medication, and group MG w/o dep, which consisted of 73 patients who did not have depression. Results: In our study, 40.16% of the myasthenia gravis (MG) patients exhibited a comorbid diagnosis of depression. Among the MG patients receiving antidepressant treatment, baseline assessments revealed a mean MG-ADL score of 7.73 (SD = 5.05), an average QMG score of 18.40 (SD = 8.61), and a mean Ham-D score of 21.53 (SD = 7.49). After a six-month period, a statistically significant decrease was observed in the MG-ADL (2.92, SD = 1.82), QMG (7.15, SD = 4.46), and Ham-D scores (11.16, SD = 7.49) (p < 0.0001). These results suggest a significant correlation between MG severity and elevated HAM-D depression scores. Regarding the MG treatment in the group with depression, at baseline, the mean dose of oral corticosteroids was 45.10 mg (SD = 16.60). Regarding the treatment with pyridostigmine, patients with depression and undergoing antidepressant treatment remained with an increased need for pyridostigmine, 144.49 mg (SD = 51.84), compared to those in the group without depression, 107.67 mg (SD = 55.64, p < 0.001). Conclusions: Our investigation confirms that the occurrence of depressive symptoms is significantly widespread among individuals diagnosed with MG. Disease severity, along with younger age and higher doses of cortisone, is a significant factor associated with depression in patients with MG. Substantial reductions in MG-ADL and QMG scores were observed within each group after six months, highlighting the effectiveness of MG management. The findings suggest that addressing depressive symptoms in MG patients, in addition to standard MG management, can lead to improved clinical outcomes.

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“…In contrast, the difficulty in clearly distinguishing symptoms of depression from fatigability and fatigue symptoms of MG might lead to delayed or misdiagnosis in MG patients 30 . It has been reported that only one patient out of ten with myasthenic symptoms gets an adequate MG diagnosis 31 . Young women are more likely to get a psychiatric diagnosis, whereas men are more often misdiagnosed with other somatic diseases 32 .…”

Section: Discussionmentioning

confidence: 99%

Mental health in myasthenia gravis patients and its impact on caregiver burden

Marbin

Piper

Lehnerer

et al. 2022

Sci Rep

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Psychiatric comorbidities are relevant in patients with Myasthenia gravis (MG). Also, MG patients experience a reduced health-related quality of life (HRQoL). We aimed to quantify the impact of depression as well as self-perceived MG severity on HRQoL and caregivers' burden. In this cross-sectional study, we used a survey encompassing demographic, disease-related information, and standardized questionnaires to assess symptoms of depression, anxiety, HRQoL (MG Quality of Life scale; MG-QoL15), and caregiver burden (Burden Scale for Family Caregivers; BSFC). Data from 1399 participating patients (96%) and 1042 caregivers (65%) were eligible for further analysis. Symptoms of depression and anxiety disorder were indicated by 31% and 36% of patients. Self-reported MG severity (MG severity) and MG-QoL15 scores were strongly associated (estimated marginal means for severe versus mild MG severity = 18 95% CI [16; 21]; p ≤ 0.001). Adjusting for symptoms of depression decreased the estimated strength of this association (estimated marginal means for severe versus mild MG severity = 15 [13; 17]; p ≤ 0.001). Caregiver burden was associated to MG disease severity (estimated marginal means for severe vs. mild MG severity = 0.16 [0.13; 0,19); p ≤ 0.001) and also negatively influenced by symptoms of depression (estimated marginal means = 0.12 [0.09; 0.15]). Symptoms of depression and anxiety disorder in MG are frequent. Beyond MG severity, symptoms of depression have negative effects on HRQoL as well as on caregivers’ burden. Diagnosis and treatment of psychiatric comorbidities should be considered an important element in MG care. Screening tools for mental health conditions should be implemented at least in specialized MG centers.

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Falsos negativos en el diagnóstico de la miastenia gravis

Cited by 6 publications

References 0 publications

Miyastenia Graviste Anksiyete ve Depresif Belirtilerin, Hastalık Şiddeti ve Tedavi Biçimiyle İlişkisi: Kesitsel Bir Çalışma

Miyastenia Graviste Anksiyete ve Depresif Belirtilerin, Hastalık Şiddeti ve Tedavi Biçimiyle İlişkisi: Kesitsel Bir Çalışma

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

Mental health in myasthenia gravis patients and its impact on caregiver burden

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