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Obsessive-Compulsive Disorder With Inflammatory Cerebrospinal Fluid Changes and Intrathecal Antinuclear Antibody Staining

D Endres, MA Schiele, BC Frye, A Schlump, B Feige, k Nickel, B Berger, M Reisert, H Urbach, K Domschke, N Venhoff, H Prüss, L Tebartz van Elst. Obsessive-Compulsive Disorder With Inflammatory Cerebrospinal Fluid Changes and Intrathecal Antinuclear Antibody Staining. Biological Psychiatry. Elsevier. 3 September 2022. DOI:https://doi.org/10.1016/j.biopsych.2022.06.037

Autoimmune-mediated obsessive-compulsive disorder (OCD) during childhood has long been established in the context of pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection. In adult psychiatry, the topic has increasingly gained interest in light of new developments regarding autoimmune encephalitis and autoimmune psychosis. Hence, diagnostic criteria for autoimmune OCD in adulthood have been proposed recently, and the first respective cases were reported. For the detection of neuroinflammatory processes, cerebrospinal fluid (CSF) analysis (besides the far more invasive brain biopsy) is considered the most sensitive diagnostic tool. Here, we present 2 paradigmatic OCD patients with inflammatory CSF signals including antinuclear antibody staining in CSF and magnetic resonance imaging (MRI)/electroencephalography (EEG) findings compatible with OCD.

 

 

Group A Beta-Hemolytic Streptococcus-Induced Tic-Like Movement Disorder in an Adult: A Case Report

Ilyas U, Umar Z, Lin D (August 26, 2022) Group A Beta-Hemolytic Streptococcus-Induced Tic-Like Movement Disorder in an Adult: A Case Report. Cureus 14(8): e28451. doi:10.7759/cureus.28451

“Our case report highlights the importance of a thorough history, including inquiring about past infections and investigations to look for autoimmune and infectious etiologies, including ASO and positive DNAse B titers, in adult patients with new onset movement disorders and no other identifiable etiology and risk factors. Further research is mandatory to investigate the incidence of movement disorders in the adult population after a streptococcal infection and the diagnostic approach and treatment modalities needed to manage such patients.”

An unusual case of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections(PANDAS) – diagnostic evaluation, treatment and the remarkable outcome
Divya Raj T, Santosh H, Chaturvedi S. 589 An unusual case of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections(PANDAS) – diagnostic evaluation, treatment and the remarkable outcome Archives of Disease in Childhood 2022;107:A224-A225.

“Conclusion Our observation in this case confirms the value of early diagnosis to reduce the risk of progression to disabling chronic neurologic sequelae in the PANDAS. Children with PANDAS derive a favourable response to IVIG. Our findings support its administration early in the course of the disease and continued until significant improvement or remission is achieved without side-effects.”

Sex and Aggression Characteristics in a Cohort of Patients with Pediatric Acute-Onset Neuropsychiatric Syndrome

Jaynelle Gao, Avis Chan, Theresa Willett, Bahare Farhadian, Melissa Silverman, Paula Tran, Sana Ahmed, Margo Thienemann, and Jennifer Frankovich.Sex and Aggression Characteristics in a Cohort of Patients with Pediatric Acute-Onset Neuropsychiatric Syndrome.Journal of Child and Adolescent Psychopharmacology.ahead of print http://doi.org/10.1089/cap.2021.0084

  • Males had a higher median Modified Overt Aggression Scale (MOAS) score in the first year of clinic when compared with females and a higher median subscore for physical aggression.
  • The median time from PANS symptom onset to first administration of immunotherapy, which did not include nonsteroidal anti-inflammatory drugs or short bursts of oral steroids, was 6.9 years for females and 3.7 years for males.
  • Although the physical aggression measured by the MOAS was significantly higher in males, caregivers of males and females reported similar levels of caregiver burden.
  • The two groups did not differ significantly in age of PANS onset, time from onset to clinic entry, other psychiatric symptom measures, or laboratory markers of inflammation.

Conclusion: Among patients with PANS, males exhibit more aggressive behavior when compared with females, which may advance the decision to treat with immunotherapy. Scores that capture a more global level of functioning show that despite there being a higher level of aggression in males, female patients with PANS have similar levels of overall impairment.

Cytokine dynamics and targeted immunotherapies in autoimmune encephalitis

Nicolás Lundahl Ciano-Petersen, Sergio Muñiz-Castrillo, Cristina Birzu, Alberto Vogrig, Antonio Farina, Macarena Villagrán-García, Bastien Joubert, Dimitri Psimaras, Jérôme Honnorat, Cytokine dynamics and targeted immunotherapies in autoimmune encephalitis, Brain Communications, Volume 4, Issue 4, 2022, fcac196, https://doi.org/10.1093/braincomms/fcac196

“Autoimmune encephalitides constitute a diverse group of immune-mediated central nervous system disorders mainly characterized by the presence of antibodies targeting neuronal or glial antigens. Despite the notable contribution of antibody discovery to the understanding of their physiopathology, the specific immune cells and inflammatory mediators involved in autoimmune encephalitis are still poorly defined. However, cytokines have recently emerged as crucial signalling molecules in the pathogenesis of autoimmune encephalitis…. Autoimmune encephalitides constitute a diverse group of immune-mediated central nervous system disorders mainly characterized by the presence of antibodies targeting neuronal or glial antigens. Despite the notable contribution of antibody discovery to the understanding of their physiopathology, the specific immune cells and inflammatory mediators involved in autoimmune encephalitis are still poorly defined. However, cytokines have recently emerged as crucial signalling molecules in the pathogenesis of autoimmune encephalitis.”

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.