Psychological Health Important Consideration for Myasthenia Gravis Space

Findings of pronounced personality traits among individuals who have myasthenia gravis (MG) have led investigators to conclude that clinicians should consider psychological and behavioral interventions beyond the prescribed pharmacotherapy patients receive to optimize outcomes among this population.

“The influence of personality factors has been investigated in many diseases, including autoimmune disorders like autoimmune diabetes or Sjogren’s syndrome,” the study authors wrote. “No systematic, controlled data on personality traits in MG patients are available. It has been postulated, however, that personality type might influence stress perception and relapse rate.”

Publishing their study findings in Brain and Behavior,¹ the authors noted that their rationale for this study stemmed from a lack of data on personality characteristics among patients with MG compared with frequent reports of depression and anxiety among these same patients. The study population had a mean (SD) age of 63.98 (15.5) years and an age at primary diagnosis of 55.3 (16.7) years. Almost 71% were considered to have late-onset MG, or diagnosis at older than 50 years, and 86.36% were seropositive for acetylcholine receptor antibodies.

Neuroticism, extraversion, openness, agreeableness, and conscientiousness were evaluated via the NEO Five-Factor Inventory (NEO-FFI), which contains 12 statements on each personality trait, among a cohort of 44 German patients receiving care in University of Halle/Saale’s Department of Neurology and 44 controls. This inventory was filled out twice, with answers from patients and their caregivers/relatives corresponding to the present time and before MG symptoms started. Higher scores (range, 0-48) for each trait indicated a higher potential expression of that personality dimension, the authors noted. Patients also completed the MG-Quality of Life (MG QoL 15; score range, 0-60) Index, the MG-Activity of Daily Living (MG-ADL; score range, 0-24) questionnaire, the German version of the Hospital Anxiety and Depression Scale (HADS-D), the Beck Anxiety Inventory (BAI), and the short version of the General Depression Scale (CES-D: Center for Epidemiologic Studies Depression Scale).

At baseline, the mean (SD) MG QoL 15 score among the MG cohort was 13.88 (12.65); mean (SD) MG-ADL score was 3.24 (2.76); 66% were receiving a pension, of whom 7% were receiving disability; and 7% could not work for medical reasons.

Findings from the NEO-FFI evaluation show neuroticism to be significantly elevated among the patients with MG compared with controls, both before MG and at present:

• Controls: 15.62 (8.36)
• Pre-MG: 18.18 (6.18) (P = .010)
• Present with MG: 20.53 (6.76) (P = .004)

Further, a subanalysis conducted among the male patients showed neuroticism to be significantly elevated in those with MG vs the control population: 18.47 (6.72) vs 11.62 (7.23).

Extraversion and openness, however, were significantly lower in the patients with MG:

• Extraversion:
  • Controls: 28.36 (6.03)
  • Pre-MG: 29.12 (6.29) (P = .010)
  • Present with MG: 24.90 (5.75) (P = .008)
• Openness:
  • Controls: 28.87 (5.8)
  • Pre-MG: 24.53 (5.6) (ns)
  • Present with MG: 25.90 (5.66) (P = .019)

Results on agreeableness and conscientiousness did not reach statistical significance.

In addition, following individual personality trait comparison using matched-paired t-testing on the premorbid vs present MG assessments, neuroticism again was significantly elevated (P < .05) in the presence of MG, while the lower scores for conscientiousness (P < .005) and extraversion (P < .05) both reached statistical significance.

The investigators highlighted that a potential indicator for increased neuroticism among the patients with MG compared with the control population was bulbar involvement. Bulbar muscles are the group of muscles in the head and neck that affect speaking, swallowing, chewing, and holding the jaw in place, and the bulbar brain region (in the brainstem) holds the nerves that control these muscles.

For anxiety and depression, findings from the CES-D (r = 0.474), HADS-D (r = 0.408), BAI (r = 0.519), and MG QoL 15 (r = 0.491) showed significant correlations (all P <.001) with neuroticism among the MG cohort.

“Findings of higher rates of neuroticism and lower extraversion and openness in MG patients, compared to controls, should raise awareness for individual personality characteristics in the long-term management of this chronic disease,” the authors concluded. “These findings should signify rehabilitative psychological interventions such as neurotic-reducing strategies and behavioral management strategies (conscientious-promoting behavior; preventive coping strategies of stress and anxiety) in addition to standard medical treatment.”

References

1. Jordan B, Förster L, Buchholz T, Sperfeld AD, Zierz S. Personality factors in patients with myasthenia gravis: a prospective study. Brain Behav. 2023;e3228. doi:10.1002/brb3.3228

2. Is there such a thing as bulbar myasthenia gravis? Myasthnia-gravis.com. May 25, 2021. Updated April 2023. Accessed August 30, 2023. https://myasthenia-gravis.com/clinical/bulbar-symptoms