Nöropsikiyatri Arşivi; 2013;50(4):295-300
Miyastenia Graviste Anksiyete ve Depresif Belirtilerin, Hastalık Şiddeti ve Tedavi Biçimiyle İlişkisi: Kesitsel Bir Çalışma
Faysal, O Karamustafalıoğlu, B Özçelik, M Yılmaz, N Karamustafalıoğlu,H Yumrukça, O Tankaya
Bakırköy Training and Research Hospital for Psychiatry, İstanbul
Introduction: 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.
Methods: 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).
Results: 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.
Conclusion: 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.
The Relationship of Symptoms of Anxiety and Depression with Disease Severity and Treatment Modality in Myasthenia Gravis: A Cross-sectional Study
Amaç: Psikopatolojiyle miyastenia gravis (MG) siddeti arasindaki iliskiye dair bulgular az ve çeliskili görünmektedir. Bu çalismanin amaci, MG hastalarindan olusan küçük bir kohortta, depresyon ve anksiyete ile hastalik siddeti ve tedavi biçimi arasindaki iliskiyi anlamaktir.
Yöntem: Iki aylik bir süre boyunca, Istanbul’daki bir nöromüsküler hastaliklar poliklinigine ardisik olarak basvuran MG tanisi alan 67 hasta çalismaya davet edildi ve toplam 42 hasta çalismaya alindi. Hastalarin tümü çalismaya katilmayi kabul etti. MG siddeti Osserman ve Genkins siniflandirmasina göre belirlendi. Katilimcilarin durumu, sosyodemografik form, Beck Depresyon Envanteri (BDE), Beck Anksiyete Envanteri (BAE), Hamilton Depresyon Derecelendirme Ölçegi’nin 17 maddeli uyarlamasi (HDDÖ) ve Hamilton Anksiyete Derecelendirme Ölçegi (HADÖ) kullanilarak degerlendirildi.
Bulgular: Evre IIB olan MG hastalarinin BAE, HDDÖ ile HADÖ toplam ve bedensel anksiyete puanlari, evre I ve evre IIA olan MG hastalarinin puanlarina göre önemli ölçüde yüksekti (p<0,05). Benzer olarak, prednizolon-piridostigmin/azatioprin alan hastalarin BAE, HDDÖ ile HADÖ toplam ve bedensel anksiyete puanlari, yalniz prednizolon alan hastalarin puanlarina göre önemli ölçüde yüksekti (p<0,05). Lineer regresyon analizi, hastalik siddeti ve stresli yasam olaylarinin HDDÖ puaniyla iliskili etmenler oldugunu ortaya koyuyordu. Hastalik siddeti, tedavi biçimi ve cinsiyet ise HADÖ puanlariyla iliskili etmenlerdi.
Sonuç: Bu çalismadan, görece siddetli MG’si olan hastalarin veya antikolinesteraz-immunosupresif kombinasyonu kullanan hastalarin psikiyatrik/psikolojik açidan dikkatle degerlendirilmelerinin gerekebilecegi sonucu çikarilabilir.