Neuropsychiatric Symptoms of Guillain-Barré Syndrome

It starts in your feet—the numbness and tingling reverberating throughout your extremities. Eventually, you cannot move. You are paralyzed. Guillain-Barré syndrome (GBS) is a serious autoimmune condition in which the immune system attacks the nerves causing widespread pain, paralysis, a loss of coordination, difficulty breathing, and along with the physical manifestations, a host of neuropsychiatric symptoms. Read further to learn what the neuropsychiatric symptoms of Guillain-Barré syndrome are, how a physician arrives at that diagnosis, and which treatments are implemented when Guillain-Barré syndrome occurs with mental illness.

What is Guillain-Barré Syndrome?

Guillain-Barré syndrome (GBS) is an autoimmune neurological disorder in which the body’s immune system attacks the peripheral nervous system. The peripheral nervous system includes the nerves outside of the brain and spinal cord. The nerves are covered by a protective myelin sheath and connect the central nervous system to the brain and organs by relaying messages to control muscle movement and other bodily functions.

In a healthy immune system, cells called lymphocytes recognize viruses and bacteria as foreign invaders. They produce antibodies and activate the production of proteins to rid of them. This mechanism is disrupted in Guillain-Barré syndrome. Nearly half of Guillain-Barré syndrome cases follow a viral illness or bacterial infection. After sensing an infection like the flu, diarrhea, or respiratory illness, the immune response remains stimulated. The body creates antibodies and mistakenly responds to the nerves as if they are harmful—damaging the protective sheath or the nerves beneath the sheath. As the nerves die off, full-body paralysis is known to occur.

Causes of Guillain-Barré Syndrome

The causes of Guillain-Barré syndrome are unknown. Experts have noted that over half of Guillain-Barré syndrome cases are triggered by a virus, infection, or any stressor on the body. Males are more likely to develop the condition than females with risk increasing with age.

• Campylobacter—a bacterial infection characterized by diarrhea and found in undercooked poultry
• Epstein-Barr virus—the virus that causes infectious mononucleosis
• Hepatitis A, B, C, and E—a group of viral illness that affects the liver
• Influenza—this is the common flu
• Cytomegalovirus—a strain of the herpes virus
• Zika virus—a virus spread through mosquito bites and includes symptoms such as joint pain, red eyes, fever, and a rash
• Mycoplasma pneumonia—also called “walking pneumonia” mycoplasma pneumonia is a highly contagious atypical respiratory illness
• HIV/AIDS—a virus that prevents the body from fighting infections
• Trauma—examples of events that can cause Guillain-Barré syndrome are traffic accidents, falls, or abuse
• Surgery—Surgery initiates the inflammatory process to cause Guillain-Barré syndrome in those who are susceptible

Neurological Symptoms of Guillain-Barré Syndrome

Aside from weakness and paralysis, Guillain-Barré syndrome causes symptoms throughout the entire body. These include severe pain, respiratory distress, constipation, difficulty urinating, visual disturbances, and cardiac problems such as blood pressure irregularities. However, Guillain-Barré syndrome is a neurological disorder, so many of the symptoms are neurological in nature.

Motor Control and Sensory Control

The first symptoms of Guillain-Barre syndrome involve motor and sensory control, as the condition damages motor neurons. Guillain-Barre syndrome begins as weakness that progresses to full-body paralysis. On average, the rate of progression ranges from one day to over four weeks depending on the severity. The motor and sensory symptoms appear on both sides of the body.

As the condition progresses, it causes the below motor and sensory symptoms:

• Paresthesia—This is a tingling sensation that begins in the toes and fingertips and progresses upward.
• Pain—Widespread pain occurs in the muscles, from tingling sensations, and muscle cramping that worsens at night.
• Numbness—Numbness results in a loss of vibration and touch.
• Loss of proprioception—Someone with Guillain-Barre syndrome typically struggles with perception and awareness of the body.
• Imbalance—With a loss of perception, balancing issues, an unsteady gait, and trouble navigating stairs precede full-body paralysis.
• Difficulty swallowing—Choking on saliva is a sign of swallowing difficulties, as coordination of the muscles are disrupted and weak.  

Sleep Disorders

Sleep disturbances are frequently reported in those with Guillain-Barre syndrome. The primary factors contributing to the development of sleep disorders are anxiety over the disease and sensory manifestations like pain, paresthesia, and immobility.

Clinical Sleep studies (Karkare et al., 2013) reveal patients with Guillain-Barre syndrome displaying insomnia, the inability to fall or stay asleep, REM behavioral disorder in which someone acts out their dreams and abnormal eye movements in NREM sleep. The loss of muscle control during sleep stems from the muscle weakness from the damaged nerves.

Autonomic Dysfunction

The autonomic nervous system is comprised of the sympathetic and parasympathetic divisions of the nervous system. It controls bodily functions that occur “automatically.” This includes the regulation of heart rate, blood pressure, respirations, bowel and bladder control, pupillary reflexes, and more.

In Guillain-Barre syndrome, autonomic dysfunction is the failure and overactivity of the autonomic nervous system. A study at the Mayo Clinic investigated 187 patients with  Guillain-Barre syndrome and marked autonomic dysfunction. The findings proved the main symptoms of autonomic dysfunction manifest as gastrointestinal ileus, as well as tachycardia with hypotension and/or hypertension (Kondziella, 2019). Symptoms of autonomic dysfunction correlate with the severity of Guillain-Barre syndrome.

Psychiatric Disorders Related To Guillain-Barré Syndrome

Guillain-Barre syndrome is not a psychiatric condition, but in many instances, it does cause psychiatric symptoms. Approximately 24 collective studies conclude Guillain-Barre syndrome has an onset of psychiatric symptoms such as stress, anxiety, depression, fatigue, sleep abnormalities, visual hallucinations, paranoid delusions, disorientation, terror, and psychosis within one to four weeks after the diagnosis (Hillyae et al., 2020).

Anxiety and Depression

Anxiety is a common psychiatric manifestation of Guillain-Barre syndrome. Generalized anxiety, excessive worry out of proportion to the situation is associated with the severity of acute illness. 82 percent of patients suffer from anxiety (Hillyar et al., 2020) and depression—a mood disorder characterized by persistent sadness and apathy. These patients develop anxiety and depression after experiencing intense paralysis, enduring admissions to the intensive care unit, requiring ventilation, or worries over their prognosis (i.e. length of paralysis, possible respiratory failure, etc.). They may become depressed over their loss of abilities. Further, anxiety is especially prominent in the recovery phase.   

Psychosis

Psychosis is a mental disorder causing someone to become out of touch with reality. Key features of psychosis are hallucinations and delusions. During episodes of hallucinations and delusions, those with psychosis see, hear, and believe things that are not real, and their behavior is eccentric to the norm. Up to 70 percent of patients diagnosed with Guillain-Barre syndrome experience short term psychosis that lasts about nine days. Hallucinations are mainly visual and they have paranoid delusions—thinking someone is “out to get them.”

Forms of Guillain-Barré Syndrome

Guillain-Barré syndrome is not a lone disorder. It consists of multiple types. Experts distinguish one type from another by the onset of presentation. Each type has symptoms that begin at various locations in the body and the eventual paralysis progresses in a specific order.

Acute inflammatory Demyelinating Polyradiculoneuropathy (AIDP)

Acute inflammatory Demyelinating Polyradiculoneuropathy (AIDP) is the most common form of Guillain-Barré syndrome. The first sign is persistent weakness with sensory changes in the lower extremities. The weakness moves upward and can rapidly lead to paralysis without intervention. Approximately 15% suffer from respiratory failure requiring mechanical ventilation as weakness encompasses the entire body.

Acute Motor Axonal Neuropathy (AMAN)

Acute motor axonal neuropathy (AMAN) is seen less in the United States and Europe. Acute paralysis is the primary manifestation. It is easy to identify this type of Guillain-Barré syndrome because there is no sensory loss with the paralysis. Unlike the other types, the damage from acute motor axonal neuropathy does not cause a loss of myelin. Antibodies only damage the coating of motor neurons.

Acute Motor-Sensory Axonal Neuropathy (AMSAN)

Acute Motor-Sensory Axonal Neuropathy (AMSAN) is the most rare, severe form of Guillain-Barré syndrome because it leads to degeneration of both motor and sensory nerve fibers. It is similar to acute motor axonal neuropathy, but has sensory changes occurring with acute paralysis and recovery time is prolonged.

Miller Fisher Syndrome (MFS)

Although more prevalent in Asia, Miller Fisher syndrome (MFS) is a type of Guillain-Barré syndrome in which weakness originates in the eyes with blurred vision and weakness of the facial muscles that is evident by drooping eyelids. Someone with miller fisher syndrome also lacks tendon reflexes. This type is associated with very poor motor control of the muscles causing an unsteady gait.

Diagnosing Guillain-Barré Syndrome

When diagnosing Guillain-Barré syndrome, a physician looks for the presence of progressive numbness, tingling, weakness, and paralysis occurring on both sides of the body. It is important they note the rate of sensory changes. Guillain-Barré syndrome tends to progress quickly, while other neurological conditions take months to progress. Next, deep tendon reflexes are tested during the evaluation because reflexes are absent in many cases. The doctor also questions the patient’s infection history. If the patient has recently had diarrhea or a respiratory infection, the chance of Guillain-Barré syndrome is higher.

To confirm Guillain-Barré syndrome, the physician orders specific testing indicative of the diagnosis:

• Spinal tap—A spinal tap, also called a lumbar puncture, is a procedure in which a needle is placed into the spine to remove a sample of cerebrospinal fluid (CSF) to test for infection or high levels of protein. The spinal fluid in patients with Guillain-Barré syndrome has elevated protein levels with a normal white blood cell count.
• Electromyography—An electromyography measures the levels of muscle activity through small electrodes inserted into the muscle. The muscle activity in someone with Guillain-Barré syndrome is weak.
• Nerve conduction studies—Electrodes placed on the skin deliver shocks to the nerve to measure nerve signals. The speed of nerve signals is slowed in Guillain-Barré syndrome.

Treating the Neuropsychiatric Symptoms of Guillain-Barré Syndrome

Guillain-Barré syndrome does not have a cure. However, the progression can be slowed or reversed with intravenous immunoglobulin (IVIG) or plasma exchange. IVIG is an infusion of healthy antibodies administered directly into the vein. The goal of IVIG is to prevent the damage to the nerves inflicted by the unhealthy antibodies. When IVIG is ineffective, plasma exchange (plasmapheresis) uses a machine to remove blood from the body and filter out the harmful antibodies.

There are other treatments that manage the symptoms of those with Guillain-Barré syndrome. Therapies that specifically treat the psychiatric symptoms of Guillain-Barré syndrome are:

• Serotonin reuptake inhibitors (SSRIs)—SSRIs are an antidepressant medication that increases the amount of serotonin, a neurotransmitter in the brain that is important for regulating mood, by preventing it from being reabsorbed once released to communicate between nerve cells. As published in Neuropsychiatric Disease and Treatment, patients prescribed low doses of SSRIs show significant improvement in anxiety within 3-7 days.  
• Psychotherapy—Psychotherapy, also known as “talk therapy,” is an important component of recovering from Guillain-Barré syndrome. In psychotherapy, the patient discusses their emotions with a professional counselor. The therapist uses techniques to identify unproductive thoughts, feelings, and beliefs contributing to unwanted behaviors. This is crucial to overcome any fears or residual anxiety preventing a full recovery during and after treatment.
• Physical therapy—Physical therapy focuses on rehabilitating the body, but because much of the anxiety and depression stems from the loss of abilities and lifestyle changes from the condition, slowly regaining movement through a personalized exercise plan with a physical therapist is beneficial to the patient’s mental health.

The neurological and psychiatric symptoms of Guillain-Barré syndrome are life-altering, but with support and medical therapies, many make a full recovery.

References

Brousseau, K., Arciniegas, D., & Harris, S. (2005). Pharmacologic management of anxiety and affective lability during recovery from Guillain-Barré syndrome: some preliminary observations. Neuropsychiatric disease and treatment, 1(2), 145–149. https://doi.org/10.2147/nedt.1.2.145.61047

Hillyar, C., & Nibber, A. (2020). Psychiatric Sequelae of Guillain-Barré Syndrome: Towards a Multidisciplinary Team Approach. Cureus, 12(2), e7051. https://doi.org/10.7759/cureus.7051

Karkare, K., Sinha, S., Taly, A.B., & Rao, S. (2013). Sleep Abnormalities in Guillain Barre Syndrome: A Clinical and Polysomnographic Study. J Sleep Disorders Ther, (2):1, DOI: 10.4172/2167-0277.1000109

Kondziella, D. (2019). Autonomic Dysfunction in Guillain–Barré Syndrome Puts Patients at Risk. Neurocrit Care, 32:86–87.

Cheyanne Perry

Cheyanne is currently studying psychology at North Greenville University. As an avid patient advocate living with Ehlers Danlos Syndrome, she is interested in the biological processes that connect physical illness and mental health. In her spare time, she enjoys immersing herself in a good book, creating for her Etsy shop, or writing for her own blog.