Neuropsychological/-psychiatric deficits in immune-mediated neuropathies

Abstract

Albeit common, neuropsychological/psychiatric deficits in patients with autoimmune-mediated neuropathies have not received much attention; however, they can impose a considerable clinical problem. Especially in intensive-care treated Guillain Barré syndrome (GBS) severe psychosis may occur which may go unrecognised due to the severity of the neurological motor deficits. Fatigue may result in a major restriction of quality of life long after the acute phase of GBS and is also a major debilitating factor in chronic inflammatory neuropathies. Symptomatic treatment remains largely empirical.

Fatigue, pain and muscle weakness are frequent after Guillain-Barré syndrome and poliomyelitis

“…We also found that positive or negative affectivity score did not influence risk for perceived symptoms in the poliomyelitis and GBS patients. Therefore, fatigue cannot be explained only by concomitant cognitive disorders, as previously suggested [31][32][33]. Negative affectivity has been connected to physical complaints and may influence emotional and psychosocial adjustment in chronic nervous system disease such as epilepsy [34].…”

Neuropsychiatric manifestations in inflammatory neuropathies: A systematic review

“…Although exclusively a disease of the peripheral nervous system in its classical form, GBS appears to be accompanied by early changes in mental status, including hallucinations and delusions, in as many as one-third of patients, especially in association with severe weakness, mechanical ventilation, and autonomic dysfunction. 6,7 This may have a central mechanism, as suggested by the correlation with CSF protein levels found in 2 studies. 9,10 Loss of voluntary movement and ability to communicate may be contributors to the development of psychotic symptoms.…”

“…We identified a total of 20 original articles with data on neuropsychiatric assessments of patients diagnosed with inflammatory neuropathy, and 1 review article published in 2007. 6 Of these 20 original articles, 2 reported on the same group of patients in the setting of an interventional study. The original articles we reviewed, which are summarized in Table 1, showed considerable heterogeneity in focus.…”

“…Fatigue severity, as well as the mental component of the SF‐36 and pain symptoms, appeared to be closely associated with degree of functional recovery. Although exclusively a disease of the peripheral nervous system in its classical form, GBS appears to be accompanied by early changes in mental status, including hallucinations and delusions, in as many as one‐third of patients, especially in association with severe weakness, mechanical ventilation, and autonomic dysfunction . This may have a central mechanism, as suggested by the correlation with CSF protein levels found in 2 studies .…”

Chronic inflammatory demyelinating polyneuropathy associated with manic symptoms

“…To our knowledge, no cases of bipolar disorder associated with CIDP have been previously documented. In acute inflammatory demyelinating polyneuropathy (AIDP), brief reactive psychosis, anxiety, depressive episodes and rapid eye movement (REM) sleep abnormalities were observed (Chan and Gold, 2007). The possible mechanism includes potential central nervous system (CNS) targets of the disease shown by lower CSF hypocretin-1 levels, inflammation and microglial activation in CNS, and proinflammatory cytokine-induced neurotransmitter dysfunction (Chan and Gold, 2007).…”