engleski

Challenges in the treatment of corticosteroid induced bipolar disorder in a patient with myasthenia gravis

Objectives: To discuss potential difficulties in choosing adequate treatment in the case of a patient with corticosteroids induced bipolar disorder and myasthenia gravis (MG). Background and aims: MG is a chronic, autoimmune disorder of the neuromuscular junctions. As it is frequently accompanied by psychiatric comorbidities including affective disorders, diagnosis and treatment can be complicated in several ways. First, symptoms of MG and psychiatric disorders can be similar and mimic one another. Second, MG-treatment includes corticosteroids which can lead to worsening of psychiatric symptoms. Third, due to the complexity of MG, patients are more susceptible to different adverse effects of medications, especially the ones used in the treatment of psychiatric symptoms, e.g. benzodiazepines, antipsychotics and antidepressants. Our aim was to present treatment possibilities in MG with bipolar disorder. Materials and methods: A case report and a review of literature. Results: We report a case of a 48-year-old female patient with MG, threated with corticosteroids and antagonist of acetylcholinesterase was admitted to the psychiatric hospital. During the last couple of months her mood oscillated from euphoria to depression, while her behaviour was disorganised, ranging from excessive money spending to complete neglect of care for herself and household, both leading to complete dysfunctionality. Multidisciplinary treatment plan including reduction of their doses and prescription of antipsychotic, antidepressant and anxiolytic was made. Conclusions In complex clinical presentation like this, multidisciplinary approach and literature review are essential for adequate treatment. Correction of corticosteroids and appropriate psychopharmacotherapy (aripiprazole, duloxetine, oxazepam) led to clinical improvement in our patient.

myasthenia gravis ; corticosteroids ; bipolar disorder

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