Posts by:
Gabriella True

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.

Neuroimmune mechanisms in fear and panic pathophysiology
McMurray KMJ, Sah R. Neuroimmune mechanisms in fear and panic pathophysiology. Front Psychiatry. 2022 Nov 29;13:1015349. doi: 10.3389/fpsyt.2022.1015349. PMID: 36523875; PMCID: PMC9745203.
“Currently, our understanding of the role of immune mechanisms in the etiology and maintenance of PD remains limited. In the current review, we attempt to summarize findings that support a role of immune dysregulation in PD symptomology. We compile evidence from human studies and panic-relevant rodent paradigms that indicate a role of systemic and brain immune signaling in the regulation of fear and panic-relevant behavior and physiology. Specifically, we discuss how immune signaling can contribute to maladaptive body-to-brain communication and conditioned fear that are relevant to spontaneous and conditioned symptoms of PD and identify putative avenues warranting future investigation.”
Risk of Major Mental Disorder after Severe Bacterial Infections in Children and Adolescents: A Nationwide Longitudinal Study
Hsu TW, Chu CS, Tsai SJ, Bai YM, Su TP, Chen TJ, Chen MH, Liang CS. Risk of Major Mental Disorder after Severe Bacterial Infections in Children and Adolescents: A Nationwide Longitudinal Study. Neuropsychobiology. 2022 Nov 18:1-11. doi: 10.1159/000526984.
    14,024 children and adolescents with hospitalized bacterial infection, and noninfected controls were 1:4 matched from a nationwide cohort between 1997 and 2012,

  • 11 investigated pathogens, namely, Streptococcus, Staphylococcus, Pseudomonas, Klebsiella, Hemophilus, Mycoplasma, Tuberculosis, Meningococcus, Escherichia, Chlamydia, and Scrub typhus.
  • The primary outcomes were the subsequent risk of seven MMDs: 1- autism spectrum disorder (ASD), 2- attention-deficiency hyperactivity disorder (ADHD), 3- obsessive-compulsive disorder (OCD), 4- tic disorder, -5 schizophrenia, 6- bipolar disorder, 7- depressive disorder.
  • The secondary outcomes were the subsequent risk of exposure to psychotropic medications.
Conclusions: After bacterial infection, the risk of MMDs increased in children and adolescents compared to controls, and such associations varied with different pathogens. Future studies are warranted to validate our study findings and investigate the potential mechanisms.
A Survey of Demographics, Symptom Course, Family History, and Barriers to Treatment in Children with Pediatric Acute-Onset Neuropsychiatric Disorders and Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections
SL O’Dor, S Homayoun, OM.Downer, MA Hamel, JS Zagaroli, KA Williams.A Survey of Demographics, Symptom Course, Family History, and Barriers to Treatment in Children with Pediatric Acute-Onset Neuropsychiatric Disorders and Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections.Journal of Child and Adolescent Psychopharmacology.Nov 2022.476-487.http://doi.org/10.1089/cap.2022.0063
  • At onset, OCD was the most common psychiatric symptom 83.06% reported in children, along with a high percentage of medical and psychiatric comorbidities.
  • Most psychiatric comorbidities began or worsened at the onset of PANS/PANDAS symptoms. However, major depressive disorder was the most frequently reported psychiatric disorder to develop after PANS/PANDAS onset (10%).
  • Family members report high frequency of autoimmune and inflammatory conditions, with 29.95% of mothers endorsing one or more autoimmune conditions.
  • Mean caregiver burden is above “burnout” level. Caregivers had mildly elevated levels of depression, anxiety, and stress.
Preexisting Neuropsychiatric Conditions and Associated Risk of Severe COVID-19 Infection and Other Acute Respiratory Infections

Ranger TA, Clift AK, Patone M, et al. Preexisting Neuropsychiatric Conditions and Associated Risk of Severe COVID-19 Infection and Other Acute Respiratory Infections. JAMA Psychiatry. Published online November 09, 2022. doi:10.1001/jamapsychiatry.2022.3614

Conclusions and Relevance  In this longitudinal cohort study, UK patients with preexisting neuropsychiatric conditions and treatments were associated with similarly increased risks of severe outcome from COVID-19 infection and SARIs, except for dementia.