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01-12-2020 | Myasthenia Gravis | Research article

Prospective study of stress, depression and personality in myasthenia gravis relapses

Authors: Anca Bogdan, Carolina Barnett, Abdulrahman Ali, Mohammed AlQwaifly, Alon Abraham, Shabber Mannan, Eduardo Ng, Vera Bril

Published in: BMC Neurology | Issue 1/2020

Abstract

Background

Psychopathology and personality traits may influence the course of autoimmune disorders. With this prospective longitudinal cohort study, we aimed to assess personality, stress and depression in myasthenia patients who relapse and those who remain stable or improve (non-relapsers).

Method

We collected data from 155 consecutive adult patients with confirmed MG attending the Neuromuscular Clinic, Toronto General Hospital, between March 2017 and July 2018, for this study. Patients were assessed at baseline and 6 months, or at the time of MG relapse. At both visits, the patients were assessed clinically and were asked to complete self-administered questionnaires for disease severity, chronic stress and depression. Personality type was assessed at baseline only. Relapsing patients were defined as those patients with MGII score increasing by more than 5.5 points from visit 1 to visit 2.

Results

Relapsers had higher baseline scores for depression (p = 0.01) and the change in disease severity correlated with the change in depression score (r = 0.2534, p = 0.0015, 95% CI: 0.098 0.3961). Higher levels of stress at baseline and neuroticism predicted higher relapse rates (p = 0.01 and p < .0001, respectively). In the linear regression model, with change of the MGII score as the dependent variable, change in depression scores (p = 0.0004) and age (p = 0.03) predicted change in disease severity.

Conclusions

Since emotional factors and personality type may influence MG, attention to these factors might improve care in MG patients.

Keesey JC. Clinical evaluation and management of myasthenia gravis. Muscle Nerve. 2004;29:484–505. https://doi.org/10.1002/mus.20030.CrossRefPubMed

Breiner A, Widdifield J, Katzberg HD, et al. Epidemiology of myasthenia gravis in Ontario, Canada. Neuromuscul Disord. 2015;26:41–6. https://doi.org/10.1016/j.nmd.2015.10.009.CrossRefPubMed

Doering S, Henze T, Schüssler G. Coping with myasthenia gravis and implications for psychotherapy. Arch Neurol. 1993;50:617–20. https://doi.org/10.1001/archneur.1993.00540060055018.CrossRefPubMed

Afshar H, Roohafza HR, Keshteli AH, et al. The association of personality traits and coping styles according to stress level. J Res Med Sci. 2015;20:353–8.CrossRefPubMedPubMedCentral

Blum S, Lee D, Gillis D, et al. Clinical features and impact of myasthenia gravis disease in Australian patients. J Clin Neurosci. 2015;22:1164–9. https://doi.org/10.1016/j.jocn.2015.01.022.CrossRefPubMed

Hoffmann S, Ramm J, Grittner U, et al. Fatigue in myasthenia gravis: risk factors and impact on quality of life. Brain Behav. 2016;6:e00538. https://doi.org/10.1002/brb3.538.CrossRefPubMedPubMedCentral

Braz NFT, Rocha NP, Vieira ÉLM, et al. Muscle strength and psychiatric symptoms influence health-related quality of life in patients with myasthenia gravis. J Clin Neurosci. 2018;50:41–4. https://doi.org/10.1016/j.jocn.2018.01.011.CrossRefPubMed

Jeong A, Min J-H, Kang YK, et al. Factors associated with quality of life of people with myasthenia gravis. PLoS One. 2018;13:e0206754. https://doi.org/10.1371/journal.pone.0206754.CrossRefPubMedPubMedCentral

Kulaksizoglu IB. Mood and anxiety disorders in patients with myasthenia gravis: aetiology, diagnosis and treatment. CNS Drugs. 2007;21:473–81. https://doi.org/10.2165/00023210-200721060-00004.CrossRefPubMed

10.

Bogdan A, Barnett C, Ali A, et al. Chronic stress, depression and personality type in patients with myasthenia gravis. Eur J Neurol. 2020;27:204–9. https://doi.org/10.1111/ene.14057.CrossRefPubMed

11.

Fisher J, Parkinson K, Kothari MJ. Self-reported depressive symptoms in myasthenia gravis. J Clin Neuromuscul Dis. 2003;4:105–8.CrossRefPubMed

12.

Suzuki Y, Utsugisawa K, Suzuki S, et al. Factors associated with depressive state in patients with myasthenia gravis: a multicentre cross-sectional study. BMJ Open. 2011;1:e000313. https://doi.org/10.1136/bmjopen-2011-000313.CrossRefPubMedPubMedCentral

13.

Magni G, Micaglio GF, Lalli R, et al. Psychiatric disturbances associated with myasthenia gravis. Acta Psychiatr Scand. 1988;77:443–5.CrossRefPubMed

14.

Aysal F, Karamustafalioğlu O, Özçelik B, et al. The relationship of symptoms of anxiety and depression with disease severity and treatment modality in myasthenia gravis: a cross-sectional study. Noro Psikiyatr Ars. 2013;50:295–300. https://doi.org/10.4274/npa.y5611.CrossRefPubMedPubMedCentral

15.

Paul RH, Cohen RA, Goldstein JM, Gilchrist JM. Severity of mood, self-evaluative, and vegetative symptoms of depression in myasthenia gravis. J Neuropsychiatry Clin Neurosci. 2000;12:499–501. https://doi.org/10.1176/jnp.12.4.499.CrossRefPubMed

16.

Sitek EJ, Bilińska MM, Wieczorek D, Nyka WM. Neuropsychological assessment in myasthenia gravis. Neurol Sci. 2009;30:9–14. https://doi.org/10.1007/s10072-008-0001-y.CrossRefPubMed

17.

Ybarra MI, Kummer A, Frota ERC, et al. Psychiatric disorders in myasthenia gravis. Arq Neuropsiquiatr. 2011;69:176–9.CrossRefPubMed

18.

Barnett C, Bril V, Kapral M, et al. A conceptual framework for evaluating impairments in myasthenia gravis. PLoS One. 2014;9:e98089. https://doi.org/10.1371/journal.pone.0098089.CrossRefPubMedPubMedCentral

19.

Barnett C, Bril V, Kapral M, et al. Development and validation of the myasthenia gravis impairment index. Neurology. 2016;87:879–86. https://doi.org/10.1212/WNL.0000000000002971.CrossRefPubMedPubMedCentral

20.

Barnett C, Bril V, Kapral M, et al. Myasthenia gravis impairment index: responsiveness, meaningful change, and relative efficiency. Neurology. 2017;89:2357–64. https://doi.org/10.1212/WNL.0000000000004676.CrossRefPubMedPubMedCentral

21.

Allen AP, Kennedy PJ, Dockray S, et al. The Trier social stress test: principles and practice. Neurobiol Stress. 2017;6:113–26. https://doi.org/10.1016/j.ynstr.2016.11.001.CrossRefPubMed

22.

Kirschbaum C, Pirke KM, Hellhammer DH. The “Trier social stress test”--a tool for investigating psychobiological stress responses in a laboratory setting. Neuropsychobiology. 1993;28:76–81. https://doi.org/10.1159/000119004.CrossRefPubMed

23.

Beck AT, Steer RA, Brown GK. Manual for the Beck Depression Inventory-II. 1996. San Antonio, TX: Psychological Corporation.

24.

Costa PT. Jr, McCrae RR. The Revised NEO Personality Inventory (NEO-PI-R). 2008. In G. J. Boyle, G. Matthews, & D. H. Saklofske (Eds.), The SAGE handbook of personality theory and assessment, Vol. 2. Personality measurement and testing (p. 179–198). Sage Publications, Inc. https://doi.org/10.4135/9781849200479.n9.

25.

Pearson FS, Cleland CM, Chaple M, et al. Substance use, mental health problems, and behavior at risk for HIV: evidence from CJDATS. J Psychoactive Drugs. 2008;40:459–69. https://doi.org/10.1080/02791072.2008.10400652.CrossRefPubMed

26.

World Health Organization Depression and Other Common Mental Disorders. Global Health estimates. In: httpsapps.who.intirisbitstreamhandleWHO-MSD-MER-.-eng.pdf;sequence. Accessed 18 Jul 2019.

27.

Beydoun SR, Wang J, Levine RL, Farvid A. Emotional stress as a trigger of myasthenic crisis and concomitant takotsubo cardiomyopathy: a case report. J Med Case Rep. 2010;4:393. https://doi.org/10.1186/1752-1947-4-393.CrossRefPubMedPubMedCentral

28.

Stojanovich L. Stress and autoimmunity. Autoimmun Rev. 2010;9:A271–6. https://doi.org/10.1016/j.autrev.2009.11.014.CrossRefPubMed

29.

Stojanovich L, Marisavljevich D. Stress as a trigger of autoimmune disease. Autoimmun Rev. 2008;7:209–13. https://doi.org/10.1016/j.autrev.2007.11.007.CrossRefPubMed

30.

Wang L, Zhang Y, He M. Clinical predictors for the prognosis of myasthenia gravis. BMC Neurol. 2017;17:77. https://doi.org/10.1186/s12883-017-0857-7.CrossRefPubMedPubMedCentral

31.

Juel VC. Myasthenia gravis: management of myasthenic crisis and perioperative care. Semin Neurol. 2004;24:75–81. https://doi.org/10.1055/s-2004-829595.CrossRefPubMed

32.

Lacomis D. Myasthenic crisis. Neurocrit Care. 2005;3:189–94. https://doi.org/10.1385/NCC:3:3:189.CrossRefPubMed

33.

Ramos-Fransi A, Rojas-Garcia R, Segovia S, et al. Myasthenia gravis: descriptive analysis of life-threatening events in a recent nationwide registry. Eur J Neurol. 2015;22:1056–61. https://doi.org/10.1111/ene.12703.CrossRefPubMed

34.

Kelly MM, Tyrka AR, Price LH, Carpenter LL. Sex differences in the use of coping strategies: predictors of anxiety and depressive symptoms. Depress Anxiety. 2008;25:839–46. https://doi.org/10.1002/da.20341.CrossRefPubMedPubMedCentral

35.

Matud MP, Bethencourt JM, Ibáñez I. Gender differences in psychological distress in Spain. Int J Soc Psychiatry. 2015;61:560–8. https://doi.org/10.1177/0020764014564801.CrossRefPubMed

36.

Penley JA, Tomaka J, Wiebe JS. The association of coping to physical and psychological health outcomes: a meta-analytic review. J Behav Med. 2002;25:551–603.CrossRefPubMed

37.

Ayache D, da Costa IP. Personality traits and associated changes in women with lupus. Rev Bras Rheumatol. 2009;49:643–57.CrossRef

Title: Prospective study of stress, depression and personality in myasthenia gravis relapses
Authors: Anca Bogdan
Carolina Barnett
Abdulrahman Ali
Mohammed AlQwaifly
Alon Abraham
Shabber Mannan
Eduardo Ng
Vera Bril
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Myasthenia Gravis
Mood Disorders
Affective Disorder
Published in: BMC Neurology / Issue 1/2020
Electronic ISSN: 1471-2377
DOI: https://doi.org/10.1186/s12883-020-01802-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prospective study of stress, depression and personality in myasthenia gravis relapses

Abstract

Background

Method

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Results

Conclusions

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