Introduction

Locked-in syndrome (LIS) is a neurological condition as a result from injury to the brainstem. People with LIS have quadriplegia, which is the partial or total loss of function in the limbs and torso. However, they retain their ability to understand the world around them and are still able to move their eyes.¹ Causes of this condition include traumatic brain injuries, CNS tumours, strokes, and in some cases, infections. 

Although the physical deficits of LIS are often highlighted, it is also important to be aware of the psychiatric comorbidities of LIS. Depression, anxiety, and adjustment disorders are common mental health issues that can affect people with LIS.

In this article, we will explore LIS in detail and how conditions like depression, anxiety, and adjustment disorders are interlinked with this syndrome. 

Understanding locked-in syndrome

Locked-in syndrome is a neurological condition that causes almost complete paralysis, but eye movement remains intact. This is because the area of the brain responsible for controlling the upper eyelid and vertical eye movement is not damaged.² Additionally, people with this syndrome tend to be fully conscious, and this is because the reticular activating system, which is responsible for wakefulness, is not damaged.¹

Although consciousness and eye movements remain intact, full-body paralysis is still a difficult pill to swallow. Overnight, people with LIS lose their autonomy and require 24-hour assistance from caregivers. People with LIS lose their ability to communicate verbally or through physical movements. The sudden diagnosis not only has physical implications but also psychological ones, like depression, anxiety, and adjustment disorders. In attempting to treat LIS, a holistic approach is essential.

Depression in LIS patients

Depression is a condition that can affect patients with LIS, and it is important to be able to identify it.

Risk factors

People with LIS have certain risk factors that can increase their chances of developing depression. The sudden loss of mobility is a huge risk factor, and it can also lead to social isolation. The inability to move and interact with others can take a toll on one's mental health. Another major risk factor is the communication difficulties that all LIS patients suffer from. Being unable to express yourself is detrimental to one's mental well-being.

Diagnostic challenges

In order to accurately diagnose depression, clinicians would engage in a conversation with the patient regarding thoughts, emotions, and general well-being. However, for individuals with LIS, this is significantly impeded by their inability to communicate. This communication challenge impacts an accurate diagnosis. In addition, a study has shown that caregivers tend to overestimate depression in people with LIS, possibly leading to a misdiagnosis.³

Intervention options

It can be difficult to accurately diagnose LIS, but it is not impossible. To overcome communication barriers, tools like eye-tracking communication devices enable people with LIS to communicate and express their emotions. In mild cases of depression, psychotherapy can be tailored to people with LIS. In more severe cases, medications like antidepressants can be considered.

Anxiety disorders in LIS

Anxiety disorders are one of the most common psychiatric conditions globally. Anxiety disorders cause one to experience intense fear and worry.⁴ It is not uncommon for people with LIS to have an anxiety disorder, and some of the manifestations can include panic attacks and health-related anxiety.

Various factors could trigger an anxiety disorder. In patients with LIS, being uncertain about one's future and having to be suddenly dependent on a caregiver could be a likely trigger. Being able to identify these triggers and provide treatment is key. Some treatments for anxiety disorders can be adapted for those with LIS and include:

• Support groups: Being around others with LIS can help relieve anxiety and help one adjust to their condition
• Professional support: Talking with psychologists and therapists can be beneficial
• Pharmacological measures: In cases of severe anxiety disorders, medications can be used to ease symptoms

Adjustment disorders

An adjustment disorder is a reaction, whether behavioural or emotional, to a stressful event in one's life. This reaction often occurs suddenly, typically within 3 months of the stressful event. Symptoms of an adjustment disorder include low mood, tearfulness, worry, and nervousness. Although adjustment disorders primarily affect children and teenagers, they can also affect adults.⁵ Injuries that result in LIS are usually traumatic and sudden, possibly leading to an adjustment disorder.

Although the symptoms of an adjustment disorder may resemble those of depression, they are not the same. One of the differences is that some of the symptoms of an adjustment disorder can overlap with anxiety symptoms. Additionally, people with adjustment disorders are less likely to have as many depressive episodes as those with depression.⁶

The treatment of adjustment disorders is similar to that of anxiety disorders. Support from qualified mental health professionals and participating in support groups can be beneficial. One thing that can be understated is the role that support from family and friends can play. 

Importance of early psychological screening and support

It is important to have multidisciplinary teams that include doctors, mental health practitioners, nurses, speech and language therapists, and other healthcare providers. This will help ensure that patients not only get treatment for their physical symptoms but also for their psychological ones.

Early psychological screening is crucial to ensure that those with LIS receive the appropriate treatment before their symptoms worsen. To apply early screening, screening materials should be adapted for use in those with LIS. Without this, important symptoms might be missed, which could delay diagnosis and treatment.

Not only will early psychological screening aid in early diagnosis and treatment, but it can also help increase the quality of life of those with LIS suffering from psychological conditions.  

Conclusion

LIS is a condition caused by damage to the brain, where one is paralysed in all four limbs. However, people with LIS are fully conscious and retain their ability to move their eyes. Psychological conditions like depression, anxiety, and adjustment disorders can affect those with locked-in syndrome, and it is important to look out for the signs. Risk factors for these conditions include the sudden loss of mobility, dependence on caregivers and traumatic events that lead to LIS. It can be difficult to diagnose these conditions in people with LIS, and this is why it is important to use non-traditional methods. Tools like eye-tracking communication devices can be used to help those with LIS answer psychological screening questions. Early detection of these particular mental health conditions is crucial to ensure prompt diagnosis and treatment. Treatment can include participating in support groups, receiving support from friends and family, and therapy. Pharmacological measures like antidepressant medications might also be used.

FAQs

How long can someone survive with locked-in syndrome?

With the correct treatment, one can live a long, healthy life with this condition. 

Can you recover from LIS?

If the cause of LIS is reversible, then a full recovery is possible

Can people with LIS speak?

People with LIS are unable to speak; however, they are conscious.