Psychiatric comorbidities are quite common in patients with myasthenia gravis, particularly mood and anxiety disorders ( 4). Psychiatric Comorbidities in Myasthenia Gravis She was able to be discharged on this regimen after medical stabilization and reported continued adherence at the time of outpatient follow up per records. The following morning, she reported significant improvement in sleep and mood.
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Because there was no clear benzodiazepine withdrawal presentation and the patient had a history of positive response to doxazosin, she was started on a trial of prazosin 1 mg at bedtime. She had no tremors, hallucinations, or cognitive dysfunction.įrom the initial assessment, it was difficult to determine whether the patient’s symptoms of anxiety and insomnia were secondary to benzodiazepine withdrawal, a primary anxiety disorder, or PTSD. There was no evidence of psychomotor agitation on exam, and vital signs demonstrated only mild, intermittent elevations in heart rate and blood pressure. Despite this, she described symptoms consistent with prior episodes of withdrawal, including restlessness and heart palpitations.
She had been detoxed with lorazepam before transfer to our facility. She reported that she had been taking alprazolam for anxiety for 11 years, and felt that her symptoms were well controlled on this before hospitalization. She otherwise denied any history of sleep problems or sleep medications.
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She reported that she had briefly taken doxazosin for difficulty sleeping while at an inpatient drug rehab facility in the past this had provided full relief of symptoms at the time. She denied experiencing nightmares or flashbacks. She reported that while her current mood was “terrible” from lack of sleep, she felt that her depression was well controlled as an outpatient on bupropion 300 mg. She described feeling exhausted, irritable, and extremely anxious as a result. On interview, the patient reported that while she typically slept about 10 hours per night outside of the hospital, she had been unable to sleep at all since admission to the outside hospital one week ago. The psychiatric consultation liaison service was consulted to provide medication recommendations.
They had attempted to treat these symptoms with trazodone and zolpidem, without success. Her initial presenting symptoms of weakness, shortness of breath, dysphagia, and muscle spasms had improved significantly with intravenous immunoglobulin and solumedrol however, the primary team was concerned that persistent anxiety and insomnia were preventing a full recovery. The patient is a 31-year-old woman with a history of myasthenia gravis and reported anxiety, depression, attention deficit hyperactivity disorder, posttraumatic stress disorder (PTSD), and polysubstance abuse who presented to the neurology service as a transfer from an outside hospital in myasthenic crisis, likely precipitated by drug use and sleep deprivation.
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