Posts by:
Gabriella True

Back to the Future: The Role of Infections in Psychopathology. Focus on OCD

Della Vecchia A, Marazziti D. Back to the Future: The Role of Infections in Psychopathology. Focus on OCD. Clin Neuropsychiatry. 2022;19(4):248-263. doi:10.36131/cnfioritieditore20220407

“Several pathogens have been associated with an increased risk to develop a broad spectrum of neuropsychiatric conditions, such as schizophrenia, mood disorders, autism, attention-deficit/hyperactivity disorder, anorexia nervosa, and post-traumatic stress disorder. Some evidence supported a possible role of infections also in the pathophysiology of OCD. Infections from Herpes simplex virus 1, Borna disease virus, Group A-Beta Hemolytic Streptococcus, Borrelia spp., and Toxoplasma gondii were actually found in patients with OCD. Although different mechanisms have been hypothesized, all would converge to trigger functional/structural alterations of specific circuits or immune processes, with cascade dysfunctions of several other systems.”

Cytokine profile of pediatric patients with obsessive-compulsive and/or movement disorder symptoms: A review

Fabricius RA, Sørensen CB, Skov L, Debes NM, Cytokine profile of pediatric patients with obsessive-compulsive and/or movement disorder symptoms: A review. Frontiers in Pediatrics. Vol 10, 2022. DOI: 10.3389/fped.2022.893815 

  • Cytokines modulate the immune system. Significantly altered in many neurological and psychiatric disorders, like OCD, movement disorder, and PANDAS
  • Review of current literature on the cytokine profile of pediatric patients with symptoms of OCD and/or movement disorder symptoms. 19 studies were found. 12 included a healthy control group. 4 had control groups of children with other disorders, primarily neurological or psychiatric. 1 compared cytokines measurements to reference intervals. 2 had a longitudinal design.
  • Many cytokines were found to have significant changes in patients with symptoms of OCD and/or movement disorders compared to both healthy controls and other control groups.
  • Differences were found when comparing cytokines in periods of exacerbation with periods of remission of symptoms in study participants.
  • The cytokines that most studies with healthy control groups found to be significantly altered were TNF-α, IL-1β and IL-17.
  • The exact role of these cytokines in OCD and movement disorder symptoms remains unclear, but the available literature suggests a proinflammatory cytokine profile offering interesting perspectives on the pathogenesis of OCD and/or movement disorder symptoms in children
  • Further research into the implications of cytokines in neuropsychiatric disorders is warranted.
Neurological and psychiatric risk trajectories after SARS-CoV-2 infection: an analysis of 2-year retrospective cohort studies including 1 284 437 patients
Taquet M, Dercon Q, Harrison PJ. Six-month sequelae of post-vaccination SARS-CoV-2 infection: A retrospective cohort study of 10,024 breakthrough infections. Brain Behav Immun. 2022 Jul;103:154-162. doi: 10.1016/j.bbi.2022.04.013. Epub 2022 Apr 18. PMID: 35447302
  • 2-year retrospective cohort studies of individuals diagnosed with COVID-19 showed increased incidence of mood and anxiety disorders was transient, with no overall excess of these diagnoses compared with other respiratory infections.
  • In contrast, the increased risk of psychotic disorder, cognitive deficit, dementia, and epilepsy or seizures persisted throughout.
  • The differing trajectories suggest different pathogenesis for these outcomes.
  • Children have a more benign overall profile of psychiatric risk than do adults and older adults, but their sustained higher risk of some diagnoses is of concern. Unlike adults, cognitive deficit in children had a finite risk horizon (75 days) and a finite time to equal incidence (491 days). 
  • The fact that neurological and psychiatric outcomes were similar during the delta and omicron waves indicates that the burden on the healthcare system might continue even with variants that are less severe in other respects.
Infection and speech: Disfluency and other speech symptoms in Pediatric Acute-onset Neuropsychiatric Syndrome

U Prosell, H Norman, A Sand, A McAllister, Infection and speech: Disfluency and other speech symptoms in Pediatric Acute-onset Neuropsychiatric Syndrome, Journal of Communication Disorders, 2022, 106250, https://doi.org/10.1016/j.jcomdis.2022.106250.

  • Onset of speech disfluency in association with PANS or PANDAS was reported by 54.5% of the caregivers, supporting a connection between PANS and PANDAS and speech disfluency
  • A possible link between infection and disfluency is reactualized from the 1900s
  • Most frequent disfluency symptoms were
    • higher speech rate, superfluous verbal behavior, verbal block, associated motor symptoms
  • Previous findings of vocal tics, baby talk, and mutistic behavior are supported
  • Reported disfluency shares several characteristics with stuttering and cluttering, but the caregivers did not consistently associate it with stuttering.
  • Exposed previously unreported symptoms such as
    • impaired articulation, reduced intelligibility, reduced speech production, language impairment
  • Indicates a substantial impact on speech fluency, speech, and language in affected children, reducing quality of life.
  • Eleven caregivers reported that medical treatment had a positive effect on speech fluency
Paediatric Acute-onset Neuropsychiatric Syndrome (PANS) and intravenous immunoglobulin (IVIG): comprehensive open-label trial in ten children

Hajjari, P., Oldmark, M.H., Fernell, E. et al. Paediatric Acute-onset Neuropsychiatric Syndrome (PANS) and intravenous immunoglobulin (IVIG): comprehensive open-label trial in ten children. BMC Psychiatry 22, 535 (2022). https://doi.org/10.1186/s12888-022-04181-x

Conclusion: Considerable and pervasive improvements in symptoms and clinical impairments were seen in these ten children after three monthly IVIG treatments. Moderate to severe transient side effects occurred in three cases.

  • Considerable improvements of PANS global symptoms and impairment were seen on the PANS Scale, CGI-S, CGI-I, and improved OCD symptoms on the CY-BOCS scale, lasting at least one month after the third IVIG treatment (at Visit 3).
  • All children had improved at Visit 1 (one month after the first IVIG treatment).
  • At Visit 3 – 8 of 10 children had lasting improvements, but 2 showed symptom rebounds
    • 1 patient had good but transient responses lasting only 2–3 weeks after each IVIG, followed by deteriorations
    • One had a concurrent viral infection at Visit 3.
  • At baseline the severe symptoms had considerable impact on the children’s school attendance
    • Marked improvements in attendance were seen post-treatment
    • School absence during 3 months before baseline was 47% of the school days/month, compared to 13% after the third IVIG treatment.
  • The main side effects were of a previously well-known type, i.e. transient headache, neck pain, nausea/vomiting (mild to severe), stomach pain, mild transient anemia, and brief allergic reaction.