Aysal Fikret, Karamustafalioğlu Oğuz, Özçelik Başak, Yilmaz Meltem, Karamustafalioğlu Nesrin, Yumrukçal Hüseyin, Tankaya Onur
Bakırköy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Department of Neurology, İstanbul, Turkey.
Şişli Etfal Teaching and Research Hospital, Department of Psychiatry, İstanbul, Turkey.
Noro Psikiyatr Ars. 2013 Dec;50(4):295-300. doi: 10.4274/npa.y5611. Epub 2013 Dec 1.
Findings about the relationship between psychopathology and severity of myasthenia gravis (MG) seem scarce and conflicting. The aim of this study was to investigate the relationship of depressive and anxiety symptoms with disease severity and treatment modalities among a cohort of patients with MG.
Sixty-seven patients, who presented to the neuromuscular outpatient clinic, at a neuropsychiatry hospital in Istanbul, Turkey in a two-month period, were recruited consecutively. A total of 42 patients with MG were invited to participate in the study. None of the patients refused to participate. Severity of MG was assessed according to the Osserman and Genkins classification. The participants were evaluated by a sociodemographic form, the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Hamilton Depression Rating Scale 17-item version (HAM-D), and the Hamilton Anxiety Rating Scale (HAM-A).
The patients with stage IIB MG had significantly higher scores on the BAI, HAM-D, HAM-A total and somatic anxiety than those with stage I and IIA MG (p<0.05). Likewise, the patients taking a combination of prednisolone+pyridostigmine/azathioprine had significantly higher scores on the BAI, HAM-D, HAM-A total and somatic anxiety than those taking only prednisolone (p<0.05). Linear regression analysis revealed that disease severity and stressful life events were the factors associated with the HAM-D scores. Disease severity, treatment modalities, and gender were the factors associated with the HAM-A scores.
The results of the present study may suggest that patients with relatively more severe MG or those taking a combination of immunosupressive and anticholinesterase medications need psychiatric/psychological evaluation.
关于精神病理学与重症肌无力（MG）严重程度之间关系的研究结果似乎很少且相互矛盾。本研究的目的是调查一组MG患者中抑郁和焦虑症状与疾病严重程度及治疗方式之间的关系。
连续招募了在土耳其伊斯坦布尔一家神经精神病医院神经肌肉门诊就诊的67例患者，为期两个月。共邀请了42例MG患者参与研究，无一例患者拒绝参与。根据奥斯erman和Genkins分类法评估MG的严重程度。通过社会人口学表格、贝克抑郁量表（BDI）、贝克焦虑量表（BAI）、汉密尔顿抑郁评定量表17项版本（HAM-D）和汉密尔顿焦虑评定量表（HAM-A）对参与者进行评估。
IIB期MG患者在BAI、HAM-D、HAM-A总分和躯体焦虑方面的得分显著高于I期和IIA期MG患者（p<0.05）。同样，服用泼尼松龙+吡啶斯的明/硫唑嘌呤组合的患者在BAI、HAM-D、HAM-A总分和躯体焦虑方面的得分显著高于仅服用泼尼松龙的患者（p<0.05）。线性回归分析显示，疾病严重程度和应激性生活事件是与HAM-D得分相关的因素。疾病严重程度、治疗方式和性别是与HAM-A得分相关的因素。
本研究结果可能表明，MG相对更严重的患者或服用免疫抑制和抗胆碱酯酶药物组合的患者需要进行精神科/心理评估。
