Research

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.

Long COVID Syndrome Presenting as Neuropsychiatric Exacerbations in Autism Spectrum Disorder: Insights for Treatment

Jyonouchi, H.; Geng, L.; Rossignol, D.A.; Frye, R.E. Long.COVID Syndrome Presenting as Neuropsychiatric Exacerbations in Autism Spectrum Disorder: Insights for Treatment. J. Pers. Med. 2022, 12,1815. https://doi.org/10.3390/jpm12111815

Neurological and neuropsychiatric symptoms are emerging as major long-term sequalae. In patients with pre-existing behavioral symptoms, such as individuals with autism spectrum disorders (ASD), the emergence of neuropsychiatric symptoms due to long COVID can be difficult to diagnose and manage. Herein, we present three ASD cases who presented with markedly worsening neuropsychiatric symptoms following COVID-19 exposure and subsequent difficulty in managing the post-COVID neuropsychiatric symptoms.

Interdisciplinary Collaboration to Care for Students Diagnosed with PANDAS: An Education and Referral Intervention
Boyd TM, Moyer SM, Lambert D. Interdisciplinary Collaboration to Care for Students Diagnosed with PANDAS: An Education and Referral Intervention. The Journal of School Nursing. 2022;0(0). doi:10.1177/10598405221129553

Implications: This project has implications for school nursing. The results of this project suggest that an interdisciplinary education program assisted school staff to increase their knowledge on PANDAS. An increase in knowledge about PANDAS may assist school staff to identify students who may be exhibiting PANDAS behaviors and better utilize district resources, including school nurses, who can assess and care for this student population. This interdisciplinary collaboration amongst school nurses, counselors, psychologists, and principals enhances the learning environment and helps strengthen the success of students at school (Johnson, 2017; Kocoglu & Emiroglu, 2017; NASN, n.d., 2017; Yoder, 2020). Students with chronic health conditions and concerning symptoms that necessitate primary or specialty health care referrals benefit from school nurse adoption of systematic referral documentation strategies.

Correlation between COVID-19 severity and previous exposure of patients to Borrelia spp.

Szewczyk-Dąbrowska, A., Budziar, W., Harhala, M. et al. Correlation between COVID-19 severity and previous exposure of patients to Borrelia spp.. Sci Rep 12, 15944 (2022). https://doi.org/10.1038/s41598-022-20202-x

Also, read Medical News Today article.

  • In this study, all hospitalized COVID-19 patients tested positive for Borrelia burgdorferi-specific IgG, with significantly higher levels in severe cases.
  • Patients with a history of Borrelia exposure showed increased susceptibility to severe COVID-19 upon SARS-CoV-2 infection.
  • Severe COVID-19 patients also exhibited higher levels of IgGs specific to Anaplasma antigens, suggesting a potential link between increased COVID-19 risks and tick bites and related infections.
  • Testing for Borrelia-specific IgM revealed higher positivity in hospitalized COVID-19 patients compared to mild/asymptomatic patients and those not infected with SARS-CoV-2. Logistic regression analysis indicated that the odds of COVID-19 hospitalization increased with each positive read for a Lyme disease-related antigen for IgG antibodies.
  • Multivariate analysis highlighted specific Borrelia antigens associated with increased odds of hospitalization for both IgG and IgM antibodies. These findings suggest a potential connection between Borrelia exposure and the severity of COVID-19 outcomes.