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.

Long Covid brain fog: a neuroinflammation phenomenon?

Kavanagh E. Long Covid brain fog: a neuroinflammation phenomenon? J Neuroinflammation. 2022;19(1):265. doi:10.1186/s12974-022-02665-6.

Neuroinflammation and Long COVID “brain fog”

  • Reviews evidence that persistent cognitive symptoms after COVID are linked to neuroinflammation rather than ongoing viral infection.

  • Highlights roles for microglial activation, cytokine signaling, and disrupted neuroimmune regulation.

  • Proposes that immune-mediated effects on synaptic function and neuronal metabolism can explain attention, memory, and processing-speed deficits.

  • Frames brain fog as a biological inflammatory process, not a psychological or functional complaint.

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.
Roles of Th17 cytokines in microglial and neurovascular responses to recurrent intranasal Streptococcus pyogenes infections

Theses Doctoral. Columbia Academic Commons. https://doi.org/10.7916/62va-6330

Academic Units: Cellular, Molecular and Biomedical Studies
Thesis Advisors: Agalliu, Dritan
Degree: Ph.D., Columbia University
Published:  September 7, 2022

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.”

Leah’s Story

Leah’s Story

In August of 2014 our daughter, Leah, was 6 years old.  We had just returned home from a month-long trip to Illinois to visit family.  When we arrived home in Arizona, she suddenly (overnight) developed a fear of vomit.