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P01-293 - Psychiatric mis-diagnoses and escitolopram treatment of mood and anxiety disorders in myasthenia gravis: a case report

Published online by Cambridge University Press:  17 April 2020

E. Pan
Affiliation:
Department of Psychiatry, GATA Haydarpasha Training Hospital, Istanbul, Turkey
A. Algul
Affiliation:
Department of Psychiatry, GATA Haydarpasha Training Hospital, Istanbul, Turkey
S. Ebrinc
Affiliation:
Department of Psychiatry, GATA Haydarpasha Training Hospital, Istanbul, Turkey
C. Basoglu
Affiliation:
Department of Psychiatry, GATA Haydarpasha Training Hospital, Istanbul, Turkey
U.B. Semiz
Affiliation:
Department of Psychiatry, GATA Haydarpasha Training Hospital, Istanbul, Turkey
M.A. Ates
Affiliation:
Department of Psychiatry, GATA Haydarpasha Training Hospital, Istanbul, Turkey
M.G. Senol
Affiliation:
Department of Neurology, GATA Haydarpasha Training Hospital, Istanbul, Turkey
M. Cetin
Affiliation:
Department of Psychiatry, GATA Haydarpasha Training Hospital, Istanbul, Turkey

Abstract

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Myasthenia gravis (MG), is a chronic, autoimmune disease involving neuromuscular junctions [1]. Psychopathological disturbances and misdiagnosed as a psychiatric disorder are frequently reported in patients with MG because of variable and fluctuating course of disease [2]. However, during the course of the disease, mainly depression and anxiety disorders can be added to the clinics [1].

Case

The complaints such as weakness, difficulty swallowing and speaking that worsening at evening, may be easily supposed neurotic disorders, in a twenty-two year old male patient, has started about two months ago. In neurology clinic, in requested psychiatric consultation; there were complaints like inability to breathe, sweating, palpitations, reluctance, pessimism and unhappiness.

The patient has diagnosed according to DSM IV-TR as “Agoraphobia without panic disorder” and “Major Depression, Single Episod”. Escitolopram titrated by 20 mg/day has started. Depressive and agoraphobic symptoms have disappeared at the end of four weeks (HAM-A-D:24;11-21;9).

Discussion

MG patients, especially during the beginning of disease symptoms in almost all patients with the appeal was referred to the psychiatric services and 1/3 of it has been reported as psychiatric mis-diagnosis [1,2]. Choice of psychotropic drugs is important that do not affect the respiratory center and neuromuscular transmission. Agents, used in the treatment of MG, can inflame psychopathology and can create resistance to psychotropic treatment. Therefore, cooperation of neurologist and psychiatrist is important.

Type
Consultation liaison psychiatry
Copyright
Copyright © European Psychiatric Association 2010

References

Magni, G., Micaglio, G., Lalli, R., Bejato, L., Cadeago, Mr., Mersky, H., Angelini, C. Psychiatric disturbances associated with myasthenia gravis. Acta Psyc Scand 1988; 77: 443445Google Scholar
Santy, P.A. Undiagnosed myasthenia gravis in emergency psychiatric referrals. Ann Emerg Med 1983; 12: 397398Google Scholar
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