Monthly Archives:
December 2022

Neuropsychiatric Symptoms and Tick-Borne Diseases

Book: Microorganisms and Mental Health

Chapter: Neuropsychiatric Symptoms and Tick-Borne Diseases. Shannon L. Delaney, Lilly A. Murray & Brian A. Fallon. First Online:

In North America, Lyme disease (LD) is primarily caused by the spirochetal bacterium Borrelia burgdorferi, transmitted to humans by Ixodes species tick bites, at an estimated rate of 476,000 patients diagnosed per year. Acute LD often manifests with flu-like symptoms and an expanding rash known as erythema migrans (EM) and less often with neurologic, neuropsychiatric, arthritic, or cardiac features. Most acute cases of Lyme disease are effectively treated with antibiotics, but 10–20% of individuals may experience recurrent or persistent symptoms. This chapter focuses on the neuropsychiatric aspects of Lyme disease, as these are less widely recognized by physicians and often overlooked. Broader education about the potential complexity, severity, and diverse manifestations of tick-borne diseases is needed.

Group Psychotherapy for Parents of Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome

Ellerkamp H, Thienemann M, Tinero J, Shaw R, Dowtin LL, Frankovich J, Borkovi TC. Group Psychotherapy for Parents of Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome. J Clin Psychol Med Settings. 2022 Dec 8. doi: 10.1007/s10880-022-09926-0. Epub ahead of print. PMID: 36480109.

Parents of children with diagnoses of Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS) may experience significant psychological distress related to their child’s severe and relapsing illness and challenges with the traumatic nature of its treatment.

  • Assessed the feasibility, satisfaction, and treatment fidelity of a brief 9-session group therapy intervention for parents based on principles of trauma-focused cognitive behavior therapy (CBT). Ten parents participated in the study.
  • The 9-session intervention used a combination of techniques that included cognitive restructuring, coping skills, self-care, and a trauma narrative to address psychological stress, trust, grief, and unwanted emotions.
  • Outcome measures included parental symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD), as well as rating of parental satisfaction with the intervention.
  • The treatment was feasible and deliverable with high fidelity. The intervention was rated as useful and satisfactory by parents (overall average usefulness of 4.54 and satisfaction of 4.71 out of 5.0). Elevated symptoms of PTSD and depression decreased with large effect sizes (Cohen’s d = 1.42 and Cohen’s d = 1.38, respectively).
  • Participating parents demonstrated significantly more active coping and acceptance behaviors and stances.
  • A brief 9-session group therapy intervention based on principles of trauma-focused CBT was found to be effective in reducing symptoms of psychological distress in parents of children with PANS.
Psychiatric and neurological complications of long COVID

Zawilska JB, Kuczyńska K. Psychiatric and neurological complications of long COVID. J Psychiatr Res. 2022 Dec;156:349-360. doi: 10.1016/j.jpsychires.2022.10.045. Epub 2022 Oct 20. PMID: 36326545; PMCID: PMC9582925.

  • Apart from respiratory tract, COVID-19 affects nervous system.
  • Psychiatric and neurological symptoms of COVID-19 may persist for over 24 weeks.
  • Long COVID mostly affects adults but it may be observed in children and adolescents.
  • Chronic fatigue, depression, anxiety and cognitive deficits are the most common symptoms of long COVID.•Patients with long COVID may demonstrate brain hypometabolism.
A case of late onset obsessive-compulsive disorder following an upper respiratory infection

Michael Kandalaft, Edison Leung, Kristin Budd, Jordan Shull, Kendra Anderson,
A case of late onset obsessive-compulsive disorder following an upper respiratory infection,
Psychiatry Research Case Reports, Volume 1, Issue 2, 2022, 100078, ISSN 2773-0212, https://doi.org/10.1016/j.psycr.2022.100078.

This case demonstrates the potential for adult-onset obsessive-compulsive disorder following infection and the value of a complete medical history during psychiatric hospitalization. With the relative rarity of adult-onset obsessive-compulsive disorder, further studies are warranted to determine the treatment and mechanism of pathology.

Anti-inflammatory medications for the treatment of mental disorders: A scoping review
Fitton R, Sweetman J, Heseltine-Carp W, van der Feltz-Cornelis C. Anti-inflammatory medications for the treatment of mental disorders: A scoping review. Brain Behav Immun Health. 2022 Sep 19;26:100518. doi: 10.1016/j.bbih.2022.100518. PMID: 36217374; PMCID: PMC9547233.

This scoping review assessed the effect of anti-inflammatory medications in mental disorders. A search in Medline and the Cochrane database focusing on randomised controlled trials and systematic reviews identified 53 primary research articles, conducted in major depression, bipolar disorder, schizophrenia and somatic symptom disorders and related disorders (SSRD). The findings suggest that there is scope to consider the use of anti-inflammatory agents in mental disorders, however, not as a one-size-fits-all solution. Treatment could be especially helpful in subgroups with evidence of baseline inflammation. Anti-inflammatory medications that seem mostly effective in bipolar disorder or major depressive disorder, such as Celecoxib, Pioglitazone and statins, may differ from the ones with indications of effectiveness in schizophrenia, such as Minocycline and Aspirin. This might suggest a different underlying mechanism for treatment success in those two main illness groups. Further studies with larger sample sizes are needed that take levels of inflammation markers into account.

SARS-CoV-2/COVID-19 associated pediatric acute-onset neuropsychiatric syndrome a case report of female twin adolescents
Efe A. SARS-CoV-2/COVID-19 associated pediatric acute-onset neuropsychiatric syndrome a case report of female twin adolescents. Psychiatry Res Case Rep. 2022 Dec;1(2):100074. doi: 10.1016/j.psycr.2022.100074. Epub 2022 Oct 14. PMID: 36267397; PMCID: PMC9562621.

The only relevant agent underlying those neuropsychiatric and somatic complaints was COVID-19, and it was validated with laboratory testing, such as positive IgG titers of SARS-CoV-2 and negative biomarkers for other possible bacterial or viral agents. Generalized epileptic anomaly and a vermian/folial atrophy in the cerebellum were detected in further evaluations. Treatment options consisted of psychotropic agents, antibiotics, antiepileptic, and intravenous immunoglobulin transfusion finely treated the neuropsychiatric symptoms. Clinicians should consider SARS-CoV-2 as a potential agent, when a child presents with abrupt onset, dramatic neuropsychiatric symptoms also consisting of PANS, even in asymptomatic patients or with mild respiratory symptoms.

“As the first treatment option in suspicion of PANS, proper psychotropic treatments and antibiotic agents (amoxicillin-clavulanate, 2 gr/day, for 21 days) were administered to both sisters. The more affected sibling was treated with fluoxetine (40 mg/day), risperidone (1 mg/day), and sodium valproate (20 mg/kg/day) while the less affected sibling with milder symptoms was treated with sertraline (50 mg/day). After one month following these treatment options, IVIG transfusion was required, because of mildly decreased, however, severely continuing psychiatric and somatic complaints. Surprisingly, the somatic complaints, restrictive food intake, OCD symptoms, severe anxiety with hallucinations, depression, and even mild neurologic symptoms were significantly decreased 1 week after the IVIG transfusion; and the patients had weight gain.”

Therapeutic plasma exchange in adolescent and adult patients with autoimmune neuropsychiatric disorders associated with streptococcal infections
Prus K, Weidner K, Alquist C. Therapeutic plasma exchange in adolescent and adult patients with autoimmune neuropsychiatric disorders associated with streptococcal infections. J Clin Apher. 2022 Dec;37(6):597-599. doi: 10.1002/jca.22023. Epub 2022 Oct 17. PMID: 36251457; PMCID: PMC10092170.

Therapeutic plasma exchange (TPE) has been recommended to remove relevant antibodies and treat symptomatic presentations in children and adolescents, but there are no studies that evaluate the use of TPE in patients who are diagnosed later in life. It is therefore unclear if using an accepted treatment for pediatric PANS/PANDAS patients would be beneficial in adults with prolonged PANDAS/PANS symptomatic histories. This study investigated 16 late adolescent and adult PANDAS/PANS patients’ responses to TPE. Improvement was noted in over half of the patients with available follow-up information.