Myasthenia Gravis presenting as a Dissociative Disorder: a case report of a differential diagnosis
Bibliographic record
Abstract
Introduction Conversion disorder is characterised by symptoms that can impact sensory or motor function. The average incidence of conversion disorder is between 4 -12 per 100,000 per year. Conversion disorder has a wide variety of somatic and neurological differential diagnoses. Objectives A 22-year-old woman was admitted to the hospital due to COVID-19 pneumonia. During the hospitalisation period, she developed progressive weakness, due to which she couldn’t move, eat or take care of herself. In terms of history, she is healthy, married and gave birth to her first child almost 9 months ago. Two days postpartum, the patient experienced an inability to connect with the child and provide care, as well as a decline in her mood. The husband reports episodes in which the patient had difficulties holding the child while being able to perform house chores, which required more physical strength. Two years prior to hospitalization, during stressful situations she experienced similar episodes and difficulty swallowing. While hospitalized, extensive testing was done, including an acetylcholine receptor antibody test, which was negative at first. Because of of the initially negative testing results a psychiatrist was called. On the first visit, the patient remained in a supine position and reported a lack of strength in both arms and legs, occasionally experiencing difficulty raising her head, however managed to stand up from the bed, walk independently for 5–6 meters, turn around, and, as soon as she reached the bed, descend into it. The staff reported her inability to walk earlier in the day. On the second visit, she notes that she feels tired but now can feed and take care of herself; however, some weakness persists in the proximal muscle groups. In between visits she received treatment with corticosteroids because of the COVID infection. After repeating the acetylcholine receptor antibody test, there was a positive result, and a diagnosis was established. Methods This case report demonstrates how a somatic disorder can mimic a psychiatric one because of the overlapping symptoms and initial negative test results. While receiving symptomatic therapy with glucocorticoids due to the COVID infection, the patient’s condition improved; she began to eat and walk on her own. Results From the psychiatric aspect, it was associated with separation from the child— a relieving of the stress factor, due to which dissociative symptoms decreased. Conclusions Before considering a diagnosis of a dissociative disorder, a patient should be examined by other specialists according to their symptoms. A thorough neurologic and physical examination, as well as diagnostic tests, should be performed to exclude a physical pathology. Myasthenia gravis has a comorbidity with a number of psychiatric conditions and can also be very similar to a dissociative disorder, especially due to stress aggravating the symptoms of myasthenia gravis. Disclosure of Interest None Declared
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.005 | 0.003 |
| Science and technology studies | 0.004 | 0.003 |
| Scholarly communication | 0.003 | 0.004 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.006 | 0.005 |
| Insufficient payload (model declined to judge) | 0.004 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".