University of Groningen PSYCHOSOCIAL DYSFUNCTION IN THE FIRST YEAR AFTER GUILLAIN-BARRE SYNDROME

In this investigation we study the impact of Guillain–Barré syndrome (GBS) on psychological distress, depressive symptoms, and health status of patients during the first year after GBS. At 3, 6, and 12 months, patients were given the General Health Questionnaire, the Sickness Impact Profile, and the Center for Epidemiologic Studies Depression Scale. Eighty-five patients participated. Psychological distress and depressive symptoms were present but improved between 3 and 6 months. At 12 months the psychosocial health status was still impaired. Patients who perceived their physical residua to be moderately to seriously disruptive and patients with muscle ache and cramps had worse scores on all scales. It can be concluded that most of the improvement occurred in the first 6 months. Psychosocial health status, however, was still impaired at 1 year, but depressive symptoms played no role. Treatment of muscle ache and cramps, and the disruptive effect of physical residua should be seriously considered. Muscle Nerve 41: 533–539, 2010 Guillain–Barré syndrome (GBS) is an acute autoimmune disease of the peripheral nervous system. The main feature is a rapidly evolving motor weakness that is combined, in many patients, with sensory loss. Approximately 20% of GBS patients develop respiratory problems. After a plateau phase, spontaneous recovery starts, but it is not always complete. Several studies have described the residual physical signs, but little is known about the psychosocial impact of GBS. The acute paresis and its consequences may be very threatening for the patient, and psychological distress may be expected. Anxiety and hallucinations, forced dependency, inability to communicate, pain, and lack of information (in patient and family) were found to be the main psychosocial problems in an intensive care unit (ICU) among patients with GBS. In a study of 10 ICU patients, Weiss found that states of anxiety were especially evident during the initial phase of the disease, during dissemination and maximum intensity of paralysis. On the other hand, depressive symptoms were primarily noticeable during the phase of remission when the nadir had passed, but recovery had not yet begun. Our hypothesis is that psychological distress and depression are not only restricted to patients who were admitted to an ICU and, furthermore, are also present after the acute phase. Previous reports have scarcely addressed this topic. A recent study of 42 patients showed decreased health status during the first 2 years but it did not cover psychological distress and depression. Some personal reports did show how individuals perceived their physical condition and experienced psychological distress and depressive feelings during the acute phase of GBS and during the process of rehabilitation. In one study (n 1⁄4 10), anxiety and depression were reasons for persistent disability. To test our hypothesis, our study was not confined to patients admitted to an ICU, but we systematically studied a larger group of GBS patients for the presence and course of psychological distress, depressive symptoms, and health status during the first year after GBS. Further, the perceived physical condition and its effects were also studied.