Psychopathology in myasthenia gravis: Results from a multicenter Italian study

Introduction: Myasthenia gravis (MG) is a chronic autoimmune disorder characterized by neuromuscular impairment. While its motor symptoms are well-documented, its neuropsychological impact remains underexplored. This multicenter retrospective case-control study explores the prevalence of psychopathology in MG patients compared to healthy controls (HCs), analyzing correlations between disease severity and psychiatric disorders. Methods: We retrospectively analyzed 116 MG patients and 119 HCs from three Italian MG centers. Neuropsychological assessment included the Frontal Assessment Battery (FAB) for executive functions, the Beck Depression Inventory (BDI-II) for depression, the 12-Item Short-Form Health Survey (SF-12) for quality of life, the Insomnia Severity Index (ISI) for sleep disturbances, and the Symptom Checklist-90 Revised (SCL-90-R) for psychological distress. Group differences were assessed using ANOVA. In MG patients, correlations between clinical and neuropsychological measures were explored through Pearson's coefficient, while multivariate logistic regression identified predictors of psychiatric involvement. Results: MG patients exhibited significantly higher SCL-90 total scores and all subdomains (p <= 0.001), more frequent sleep disturbances (p = 0.028), and higher BDI-II scores (p <= 0.001) than HCs. Increased steroid dosage correlated with anxiety (r = 0.39, p = 0.04), psychoticism (p = 0.021), and depression (p = 0.015). Regression analysis identified disease severity (OR = 2.14, 95 % CI: 1.30-3.51, p = 0.002) and corticosteroid dosage (OR = 1.78, 95 % CI: 1.12-2.83, p = 0.015) as independent predictors of psychiatric symptoms. Conclusions: MG patients show a significantly higher psychiatric burden, with disease severity and corticosteroid exposure as key contributors. These findings highlight the need for integrated neuropsychiatric monitoring in MG care.