title: Relevance of anxiety in clinical practice of Guillain-Barre syndrome: a cohort study.
abstract: OBJECTIVE
  Illness is often associated with anxiety, but few data exist about the prognostic significance of this phenomenon. To address this issue, we assessed whether patient anxiety is associated with subsequent need for intubation in Guillain-Barré syndrome (GBS).
  
  
  METHODS
  Incident case-cohort study.
  
  
  METHODS
  Acute secondary care in a teaching hospital (France) from 2006 to 2010.
  
  
  METHODS
  110 adult GBS patients. Either language barrier or cognitive decline that precluded understanding was considered as exclusion criteria.
  
  
  METHODS
  Acute respiratory failure.
  
  
  METHODS
  At admission, anxiety and clinical factors (including known predictors of respiratory failure: delay between GBS onset and admission, inability to lift head, vital capacity (VC)) were assessed and related to subsequent need for mechanical ventilation (MV). Anxiety was assessed using a Visual Analogical Scale (VAS), the State Anxiety Inventory form Y1 (STAI-Y1) score and a novel-specific questionnaire, evaluating fears potentially triggered by GBS. Patients were asked to choose which they found most stressful from weakness, pain, breathlessness and uncertainty.
  
  
  RESULTS
  23 (22%) were subsequently ventilated. Mean STAI-Y1 was 47.2 (range 22-77) and anxiety VAS 5.2 (range 0-10). STAI was above 60/80 in 22 (21%) patients and anxiety VAS above 7/10 in 28 (27%) patients. Fear of remaining paralysed, uncertainty as to how the disease would progress and fear of intubation were the most stressful. Factors significantly associated with anxiety were weakness and bulbar dysfunction. STAI-Y1 was higher and uncertainty more frequent in subsequently ventilated patients, who had shorter onset-admission delay and greater weakness but not a lower VC. Uncertainty was independently associated with subsequent MV.
  
  
  CONCLUSIONS
  Early management of patients with GBS should evaluate anxiety and assess its causes both to adjust psychological support and to anticipate subsequent deterioration.
authors.affiliation: Medical Intensive Care Unit, Raymond Poincaré Teaching Hospital, Garches, France.
authors.forename: Tarek
authors.initials: T
authors.lastname: Sharshar
authors.forename: Andrea
authors.initials: A
authors.lastname: Polito
authors.forename: Raphaël
authors.initials: R
authors.lastname: Porcher
authors.forename: Takoua
authors.initials: T
authors.lastname: Merhbene
authors.forename: Morgane
authors.initials: M
authors.lastname: Blanc
authors.forename: Marion
authors.initials: M
authors.lastname: Antona
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Durand
authors.forename: Diane
authors.initials: D
authors.lastname: Friedman
authors.forename: David
authors.initials: D
authors.lastname: Orlikowski
authors.forename: Djillali
authors.initials: D
authors.lastname: Annane
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Marcadet