Posts by:
Gabriella True

M Jacofsky, M Fitzpatrick, F Neziroglu. Chapter 24 – Obsessive-compulsive disorder and body dysmorphic disorder: Pediatric manifestation and treatment. Bio Behavioral Institute.  https://doi.org/10.1016/B978-0-323-85757-4.00008-0

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal
infection In several cases of pediatric OCD, its onset may be triggered by a
streptococcal infection either in the child or in the mother while the child is in utero 

Susanne Bejerot, Sofia Sigra Stein, Elisabet Welin, Daniel Eklund, Ulrika Hylén, Mats B. Humble, Rituximab as an adjunctive treatment for schizophrenia spectrum disorder or obsessive-compulsive disorder: Two open-label pilot studies on treatment-resistant patients. Journal of Psychiatric Research. Volume 158, 2023, Pages 319-329, https://doi.org/10.1016/j.jpsychires.2022.12.0

• Treatment-resistant schizophrenia benefitted from add-on treatment with rituximab.

• Patients with schizophrenia, but not those with OCD, were much improved.

• A ≥ 40% decrease of symptoms was seen in 7/9 patients with schizophrenia week 12.

• Disability was diminished by 64% in patients with schizophrenia week 12.

• Rituximab was well tolerated, and antipsychotic-related side effects decreased.

Isung J, Isomura K, Williams K, et al. Association of Primary Immunodeficiencies in Parents With Psychiatric Disorders and Suicidal Behavior in Their Offspring. JAMA Psychiatry. 2023;80(4):323–330. doi:10.1001/jamapsychiatry.2022.4786

• Cohort study (4,294,169 offspring) revealed increased psychiatric disorder and suicidal behavior risk in offspring of mothers (not fathers) with PIDs.
• Risk persisted after adjusting for parental psychopathology and autoimmune diseases, even when excluding offspring with PIDs and autoimmune diseases.
• Maternal PIDs are associated with an elevated risk of psychiatric disorders and suicidal behavior in offspring, aligning with the maternal immune activation (MIA) hypothesis.
• While supporting the MIA hypothesis, the precise mechanisms necessitate further investigation, particularly concerning the heightened risk when co-occurring with autoimmune diseases.

Cappellari AM, Rogani G, Filocamo G, Petaccia A. Corticosteroid Treatment in Sydenham Chorea: A 27-Year Tertiary Referral Center Experience. Children. 2023; 10(2):262. https://doi.org/10.3390/children10020262

Nath K, Panja S. An Adolescent with Incapacitating Tics. Ind J Priv Psychiatry 2023;17(1):47–48. Article link.

Case description: This case is about a male of age 15 years with a history of fever 3 years back, after which symptoms such as abnormal sounds and body movements gradually started, which were involuntary. After many trials with different antipsychotics, the patient started responding
but symptoms persist along with anxiety and irritability at times.

Conclusion: Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections occur in about 1 in 1,000 children, which is a rare disorder and is difficult to diagnose. The treatment is challenging as a suitable antipsychotic has to be picked in terms of efficacy and dosing.

Antonella Gagliano, Alessandra Carta, Marcello G Tanca & Stefano
Sotgiu (2023) Pediatric Acute-Onset Neuropsychiatric Syndrome: Current Perspectives,
Neuropsychiatric Disease and Treatment, 1221-1250, DOI: 10.2147/NDT.S362202

“The current approach to PANS treatment emphasizes immunomodulation/anti-inflammatory treatments in association with both psychotropic and cognitive-behavioral therapies, while antibiotics are suggested when an active bacterial infection is established. A dimensional view, taking into account the multifactorial origin of psychiatric disorders, should suggest neuro-inflammation as a possible shared substrate of different psychiatric phenotypes. Hence, PANS and PANS-related disorders should be considered as a conceptual framework describing the etiological and phenotypical complexity of many psychiatric disorders.”

Peter J. van Roessel, Giacomo Grassi, Elias N. Aboujaoude, José M. Menchón, Michael Van Ameringen, Carolyn I. Rodríguez. Treatment-resistant OCD: Pharmacotherapies in adults,
Comprehensive Psychiatry, Volume 120, 2023,152352, ISSN 0010-440X, https://doi.org/10.1016/j.comppsych.2022.152352.

• Many individuals with OCD do not sufficiently benefit from first-line treatment with serotonin reuptake inhibitors.
• A broad range of pharmacotherapies have been explored as adjunctive or alternative interventions for treatment-resistant OCD.
• Glutamatergic and anti-inflammatory interventions, among others, may offer favorable benefit to risk profiles.
• Dopamine antagonist treatments remain the best evidenced augmentation strategy for treatment-resistant OCD.