Psychotic Symptoms and Emotional Distress in Patients with Guillain-Barré Syndrome

Abstract

Psychological disturbances in 49 most severely compromised Guillain-Barré syndrome patients were prospectively studied by a semistructured interview and assessed by repeat psychiatric examination during the patients’ stay in the neuro-intensive care unit (ICU). Additional information was obtained from attending physicians, nurses and relatives. Anxiety (82%), acute stress disorder, depressive episodes (67%) and brief reactive psychosis (25%) were observed, with oneiroid psychosis (14%) among the latter. Psychotic episodes were strongly associated (p < 0.001) with severe tetraparesis, artificial ventilation and multiple cranial nerve dysfunction. CSF protein concentration was also correlated with the occurrence of psychotic symptoms. Patients themselves experienced loss of communication to be the most difficult condition to cope with. Fifty-five percent explicitly felt reassured by the environment of the ICU and 90% described contact with relatives to be most helpful. Our data suggest that motor deprivation and loss of communication are the conditions most closely connected with the occurrence of psychotic symptoms. Therapeutically, continuous psychosocial support and psychopharmacological measures may both be valuable tools to ameliorate distress.

Factors associated with long-term functional outcomes and psychological sequelae in Guillain–Barre syndrome

“…These are consistent with reports of participatory limitation (work, social and recreational activity, family life, caregiver stress, activities of daily life) in other GBS cohorts [13,15,16,22,25]. Previously anxiety, depression and brief episodes of reactive psychosis were reported in GBS in high dependency units, associated with severe GBS requiring ventilation, quadriparesis and cranial nerve involvement [27]. This has not been well studied over the long term in GBS survivors.…”

Neuropsychological/-psychiatric deficits in immune-mediated neuropathies

“…In a prospective study on 49 severely affected GBS patients, Weiss et al observed symptoms fulfilling diagnostic criteria for brief reactive psychosis including hallucinations and oneiric states in 25 % [22]; other symptoms included anxiety (82 %) and depressive episodes (67 %). Psychotic symptoms were associated with severe tetraparesis (MRC grade < 2), the need for artificial ventilation and multiple cranial nerve dysfunction.…”

“…In addition to psychodynamic explanations such as deprivation of movement and communication, other GBSspecific organic disease mechanisms may apply. Psychosocial support in conjunction with suitable medication is effective in reducing symptoms [22].…”

Akuttherapie des Guillain-Barré-Syndroms und der myasthenen Krise

“…Am funktionell denervierten Muskel ist eine mehrtägige Gabe depolarisierender Muskelrelaxanzien kontraindiziert (Hyperkaliämie). Bei langer Beatmung entwickeln GBS-Patienten regelmäßig Angst, Depressivität und psychosenahe Symptome[75]. Daher erhalten unsere Patienten eine symptomorientierte Mischung aus nieder-und hochpotenten Neuroleptika sowie Benzodiazepine oder gelegentlich Propofol zur Nacht (• " Tab.…”

“…Ein solches Vorgehen erfordert intensive Zuwendung zum Patienten, was zugleich den Bedarf an psychotropen Medikamenten reduziert. Der beste Schutz gegen psychotisches Erleben ist die Aufrechterhaltung der Kommunikation (auch mit Lesetafeln oder PC-Kommunikationshilfen)[75]. Die Kommunikation mit dem GBS-Patienten erlaubt auch eine Analyse evtl.…”