Research

Anorexia nervosa and autoimmune comorbidities: A bidirectional route?
Sirufo MM, Magnanimi LM, Ginaldi L, De Martinis M. Anorexia nervosa and autoimmune comorbidities: A bidirectional route? CNS Neurosci Ther. 2022 Dec;28(12):1921-1929. doi: 10.1111/cns.13953. Epub 2022 Sep 16. PMID: 36114699; PMCID: PMC9627382.
In this review, in addition to reporting the numerous cases described in which autoimmune disorders are associated with anorexia or vice versa, we summarize the many aspects of this relationship between the immune system (IS) and AN. We describe how the microbiota affects the IS, disrupts gut-brain communication, and possibly triggers eating disorders. We also describe the shared immunological pathways of autoimmune and eating disorders and in particular the occurrence of disrupted T cell tolerance and autoantibodies in AN. The described observations represent the starting point for possible, future research directions.
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.

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.