3 All these psychiatric disturbances are usually associated with sleep problems. 2 PTSD is also observed after respiratory insufficiency in patients with MG. They usually consist of anxiety disorders such as panic disorder and generalized anxiety disorder and depressive disorders. Psychiatric comorbidities in patients with MG are rarely studied. After being discharged, the patient maintained regular follow-up with her neurologist. She was transferred to the neurology ward and stayed for 10 days and then left the hospital. After augmentation to 30 mg/d, the frequency and intensity of the panic attacks decreased, allowing for extubation, and mianserin was tapered and stopped at the request of the patient after she left the intensive care unit. She experienced no adverse effects and a partial response: only sleep was improved. Therefore, she was given mianserin at an initial dose of 15 mg/d. We concluded that she was experiencing panic attacks triggered by the worsening of the respiratory condition, with anticipatory anxiety about being short of breath. She did not meet DSM-5 criteria for posttraumatic stress disorder (PTSD), postpartum depression, or postpartum psychosis. Five days after the failure of the first extubation attempt, she exhibited insomnia, acute anxiety, sensation of imminent death, and recurrent tachycardia. The patient spent 29 days in the intensive care unit. She maintained spontaneous breathing after extubation 72 hours after the last session. She finally responded after 5 sessions of plasmapheresis. She subsequently underwent extubation and reintubation procedures 3 times. Her condition did not improve, and she could not maintain spontaneous breathing. Initial treatment consisted of intravenous immunoglobulins (2 g/kg over 5 days) with prednisone (20 mg/d) and pyridostigmine (30 mg 3 times/d). She was diagnosed with myasthenia crisis. She had her first episode of cardiorespiratory arrest during a computed tomography angiography procedure and was placed under endotracheal intubation and ventilation. Case ReportĪ 40-year-old woman, with no psychiatric history but previously diagnosed with generalized MG, presented to the emergency department 18 days after she delivered her first child with fatigue, diplopia, unilateral ptosis, progressive shortness of breath, and swallowing difficulties. 1 In the context of severe respiratory symptoms or respiratory failure, management of acute insomnia and anxiety is a therapeutic challenge with limited pharmacologic options. At the same time, anxiety and insomnia are frequently observed in severe forms of MG. Myasthenia gravis (MG) is one of the rare contraindications of anxiolytics and hypnotics.
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