Immune Dysfunction in Obsessive-Compulsive Disorder: From Risk Factors to Multisystem Involvement

Maia A., Barahona-Corrêa B., Oliveira-Maia A.J., Oliveira J. (2021) Immune Dysfunction in Obsessive-Compulsive Disorder: From Risk Factors to Multisystem Involvement. In: Berk M., Leboyer M., Sommer I.E. (eds) Immuno-Psychiatry. Springer, Cham. DOI: 10.1007/978-3-030-71229-7_17

“Immune dysfunction has been proposed as an important component of the pathophysiology of obsessive-compulsive disorder (OCD), motivating innovative research hypotheses with potential clinical interest. In this chapter, we will review published evidence supporting a model for immune dysfunction in OCD as multifactorial, constitutive, and environmental, contributing to illness development, clinical presentation, and multisystem impact. The fact that OCD patients present comorbidity with several systemic illnesses, including auto-immune disorders, and that the majority of recognized risk factors, such as perinatal complications, traumatic life events or childhood infections, induce inflammation, motivated the development of studies trying to achieve a deeper comprehension regarding the association between inflammation and OCD.”

Artificial Neural Networks Analysis of polysomnographic and clinical features in Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): from sleep alteration to “Brain Fog”

Gagliano A, Puligheddu M, Ronzano N, Congiu P, Tanca MG, Cursio I, Carucci S, Sotgiu S, Grossi E, Zuddas A. Artificial Neural Networks Analysis of polysomnographic and clinical features in Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): from sleep alteration to “Brain Fog”. Nat Sci Sleep. 2021;13:1209-1224. DOI: 10.2147/NSS.S300818

  • Disordered sleep represents is a cardinal symptom in patients with PANS
  • Polysomnography showed abnormality in 17 out of 23 recruited subjects (73.9%).
  • 8/17 children (47%) had ineffective sleep
  • 10/17 (58.8%) fragmented sleep
  • 8/17 (47.1%) periodic limb movement disorder (PLMD)
  • 11/17 (64.7%) REM-sleep without atonia (RSWA).
  • Most subjects presented more than one sleep disturbance
  • Among the 19/23 patients diagnosed with Tic/Tourette disorder, 8/19 (42.1%) show PLMD and 10/19 (52.6%) RSWA
Lyme Borreliosis and Associations With Mental Disorders and Suicidal Behavior: A Nationwide Danish Cohort Study

Lyme Borreliosis and Associations With Mental Disorders and Suicidal Behavior: A Nationwide Danish Cohort Study. Brian A. Fallon, M.D., M.P.H., Trine Madsen, Ph.D., Annette Erlangsen, Ph.D., Michael E. Benros, M.D., Ph.D. Published Online:28 Jul 2021 https://doi.org/10.1176/appi.ajp.2021.20091347

“Having more than one episode of Lyme borreliosis was associated with increased incidence rate ratios for mental disorders, affective disorders, and suicide attempts, but not for death by suicide. Individuals diagnosed with Lyme borreliosis in the hospital setting had an increased risk of mental disorders, affective disorders, suicide attempts, and suicide. Although the absolute population risk is low, clinicians should be aware of potential psychiatric sequelae of this global disease.”

COVID-19 Infection: A Neuropsychiatric Perspective

Theodora A. Manolis, M.D., Evdoxia J. Apostolopoulos, B.Sc., Antonis A. Manolis, M.S., B.Sc., Helen Melita, M.D., Antonis S. Manolis, M.D., COVID-19 Infection: A Neuropsychiatric Perspective.

“In addition to acute neuropsychiatric manifestations, COVID-19 may also produce late neuropsychiatric sequelae as a function of the psychoneuroimmunological cascade that it provokes. The present article presents a state-of-the-science review of these issues through an integrative review and synthesis of case series, large-cohort studies, and relevant meta-analyses. Heuristics for evaluation and further study of the neuropsychiatric manifestations of SARS-CoV-2 infection are offered.”

Allergic diseases influence symptom severity and T lymphocyte subgroups of children with tic disorders
Liu X, Wang X, Zhang X, et al. Allergic diseases influence symptom severity and T lymphocyte subgroups of children with tic disorders.
  • Reviews the severity of tics and T lymphocyte subgroups in patients with tic disorders and allergic diseases
  • 85 children (ages 6-10)- Compared TD but no allergic disease with chronic allergic diseases (including allergic rhinitis, atopic dermatitis, asthma) and tic disorders (TD)
  • Children with TD plus allergic diseases have heavier motor and vocal tic symptoms
  • Children with TD plus allergic diseases had significantly lower levels of CD3, CD4, and CD4:CD8 than those with TD without allergic diseases
  • Allergic disease aggravates imbalance of T lymphocyte subsets and cellular immune

    dysfunction in children with TD
  • Allergic diseases increased illness severity and cellular immune function is increased in children with TD
  • Treat and prevent allergic diseases in children starting at diagnosis of TD
Breastfeeding in Pediatric Acute-Onset Neuropsychiatric Syndrome: An Italian Observational Study

Murciano M, Biancone DM, De Luca F, Piras MD, Guido CA, Spalice A. Breastfeeding in Pediatric Acute-Onset Neuropsychiatric Syndrome: An Italian Observational Study. Frontiers in Pediatrics. Vol 9. 2021. DOI:10.3389/fped.2021.682108

  • Looks at neurodevelopmental evolution and problems among 52 children with PANS who were Human Milk only (HMO), received formula, or had mixed feedings
  • PANS patients fed HMO reported fewer cases of growth problems, school performance problems or the need for school support, and a delay in the age of babbling/speaking compared to the other patients
  • Further studies needed to investigate the mechanisms underlying PANS role HMO may play in their short- and long-term neurodevelopment

 

DIAGNOSTICS, DIFFERENTIAL DIAGNOSTICS AND TREATMENT OF PANDAS SYNDROME: DESCRIPTION OF THE CASE

DIAGNOSTICS, DIFFERENTIAL DIAGNOSTICS AND TREATMENT OF PANDAS SYNDROME: DESCRIPTION OF THE CASE. Mukhtorjonova Khusnigul Nodirbekovna, Elmurodova Zarina Aslanovna. Matkarimova Dilnoza Doniyorovna, Tashkent Pediatric Medical Institute. ISSN: 2776-0960 Volume 2, Issue 6, June 2021

The analysis of this clinical case demonstrates the existence of a group of patients with a good therapeutic response to the administration of immunoglobulins and antibiotics. The mechanisms of development and course of this condition are not fully understood and require further research.

Obsessive-Compulsive Disorders and Functional Urinary Disorders: A Fortuitous Association?

Ng QX, Lim YL, Loke W, Yeo WS, Chee KT. Obsessive-Compulsive Disorders and Functional Urinary Disorders: A Fortuitous Association? Behavioral Sciences. 2021; 11(6):89. DOI: 10.3390/bs11060089

  • Patients with OC symptoms appeared to have increased occurrence of functional urinary symptoms, e.g., overactive bladder, increase in urgency, frequency, incontinence and enuresis.
  • This is even more common amongst patients with PANS and PANDAS, as only OCD
Elevated levels of neutrophil gelatinase-associated lipocalin among OCD patients: an exploratory study

Raposo-Lima, C., Pereira, I.M., Marques, F. et al. Elevated levels of neutrophil gelatinase-associated lipocalin among OCD patients: an exploratory study. BMC Psychiatry 21, 272 (2021). DOI: 10.1186/s12888-021-03289-w

“Although PANDAS might be of relevance for only a minor proportion of OCD cases, this immune/inflammation hypothesis may be significant given the prevalence of OCS among patients with autoimmune diseases [9]…. In conclusion, we herein report differences in NGAL levels among OCD patients compared to healthy controls. We offer additional evidence to the immune dysregulation hypothesis of OCD by reporting elevated levels of NGAL among OCD patients versus healthy controls, with higher differences being found among women”

Metabolomic Characterization of Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS)

F Murgia, A Gagliana, MG Tanca, N Or-Geva, A Hendren, S Carucci, M Pintor, F Cera, F Cossu, S Sotgiu, L Atzori, A Zuddas. Metabolomic Characterization of Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS). Frontiers in Neuroscience. Vol 15. 2021. DOI: 10.3389/fnins.2021.645267  

  • Found unique plasma metabolic profile in PANS patients that is significantly different from healthy children
  • Suggests involvement of specific patterns of neurotransmission (tryptophan, glycine, histamine/histidine)
  • Suggests a general state of neuroinflammation and oxidative stress (glutamine, 2-Hydroxybutyrate, and tryptophan-kynurenine pathway) in the disorder.
  • Offers new insights into biological mechanisms underpinning the disorder and supports research of other potential biomarkers implicated in PANS.
Sydenham Chorea Managed With Immunoglobulin in Acute Rheumatic Fever

Ali A, Anugwom G O, Rehman U, et al. (May 12, 2021) Sydenham Chorea Managed With Immunoglobulin in Acute Rheumatic Fever. Cureus 13(5): e14990. doi:10.7759/cureus.14990

Conclusions:  SC is a rare presentation of ARF. Without adequate treatment and supportive care, SC can cause severe functional impairment. ARF should be considered as a differential diagnosis in school-aged children presenting with choreiform movements. Chorea can be managed with antiepileptics and antipsychotics; however, evidence on IVIG use for chorea has also been reported. There is no international consensus on the standard choice of treatment; therefore, IVIG should be used in severe functional impairment when unresponsive to other therapies.

Paediatric Acute onset Neuropsychiatric Syndrome: Exploratory study finds no evidence of HLA class II association but high rate of autoimmunity in first‐degree relatives

Elisabeth Fernell, Mikael Sundin, Anders Fasth, Lisa Dinkler, Martyna Galazka, Christopher Gillberg, Mats Johnson Acta Paediatr. DOI: 10.1111/apa.15805

Conclusion
No HLA allele association such as seen in children with narcolepsy after H1N1 immunisation could be confirmed in this group of children with PANS. However, more than half the group had a first‐degree relative with a diagnosed autoimmune disease.

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