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Calagua-Bedoya EA, Rajasekaran V, De Witte L, Perez-Rodriguez MM. The Role of Inflammation in Depression and Beyond: A Primer for Clinicians. Curr Psychiatry Rep 2024; 26:514-529. [PMID: 39187612 DOI: 10.1007/s11920-024-01526-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2024] [Indexed: 08/28/2024]
Abstract
PURPOSE OF REVIEW We evaluate available evidence for the role of inflammation in depression. We reappraise literature involving systemic inflammation, neuroinflammation and neurotransmission and their association with depression. We review the connection between depression, autoimmunity and infectious diseases. We revise anti-inflammatory treatments used in depression. RECENT FINDINGS Peripheral inflammatory markers are present in a subset of patients with depression and can alter common neurotransmitters in this population but there is no clear causality between depression and systemic inflammation. Infectious conditions and autoimmune illnesses do not have a clear correlation with depression. Certain medications have positive evidence as adjunctive treatments in depression but studies are heterogenic, hence they are sparsely used in clinical settings. The current evidence does not fully support inflammation, infections or autoimmunity as possible etiologies of depression. The available studies have numerous confounders that obscure the findings. Anti-inflammatory agents may have potential for treatment of depression, but further research is needed to clarify their usefulness in routine clinical practice.
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Affiliation(s)
- Eduardo Andres Calagua-Bedoya
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
- Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766, USA.
| | | | - Lotje De Witte
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
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Lorkiewicz P, Waszkiewicz N. Viral infections in etiology of mental disorders: a broad analysis of cytokine profile similarities - a narrative review. Front Cell Infect Microbiol 2024; 14:1423739. [PMID: 39206043 PMCID: PMC11349683 DOI: 10.3389/fcimb.2024.1423739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 07/10/2024] [Indexed: 09/04/2024] Open
Abstract
The recent pandemic caused by the SARS-CoV-2 virus and the associated mental health complications have renewed scholarly interest in the relationship between viral infections and the development of mental illnesses, a topic that was extensively discussed in the previous century in the context of other viruses, such as influenza. The most probable and analyzable mechanism through which viruses influence the onset of mental illnesses is the inflammation they provoke. Both infections and mental illnesses share a common characteristic: an imbalance in inflammatory factors. In this study, we sought to analyze and compare cytokine profiles in individuals infected with viruses and those suffering from mental illnesses. The objective was to determine whether specific viral diseases can increase the risk of specific mental disorders and whether this risk can be predicted based on the cytokine profile of the viral disease. To this end, we reviewed existing literature, constructed cytokine profiles for various mental and viral diseases, and conducted comparative analyses. The collected data indicate that the risk of developing a specific mental illness cannot be determined solely based on cytokine profiles. However, it was observed that the combination of IL-8 and IL-10 is frequently associated with psychotic symptoms. Therefore, to assess the risk of mental disorders in infected patients, it is imperative to consider the type of virus, the mental complications commonly associated with it, the predominant cytokines to evaluate the risk of psychotic symptoms, and additional patient-specific risk factors.
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Affiliation(s)
- Piotr Lorkiewicz
- Department of Psychiatry, Medical University of Bialystok, Białystok, Poland
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Ferat-Osorio E, Maldonado-García JL, Pavón L. How inflammation influences psychiatric disease. World J Psychiatry 2024; 14:342-349. [PMID: 38617981 PMCID: PMC11008389 DOI: 10.5498/wjp.v14.i3.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/16/2024] [Accepted: 02/18/2024] [Indexed: 03/19/2024] Open
Abstract
Recent studies highlight the strong correlation between infectious diseases and the development of neuropsychiatric disorders. In this editorial, we comment on the article "Anti-infective therapy durations predict psychological stress and laparoscopic surgery quality in pelvic abscess patients" by Zhang et al, published in the recent issue of the World Journal of Psychiatry 2023; 13 (11): 903-911. Our discussion highlighted the potential consequences of anxiety, depression, and psychosis, which are all linked to bacterial, fungal, and viral infections, which are relevant to the impact of inflammation on the sequelae in mental health as those we are observing after the coronavirus disease 2019 pandemic. We focus specifically on the immune mechanisms triggered by inflammation, the primary contributor to psychiatric complications. Importantly, pathophysiological mechanisms such as organ damage, post-injury inflammation, and infection-induced endocrine alterations, including hypocortisolism or autoantibody formation, significantly contribute to the development of chronic low-grade inflammation, promoting the emergence or development of psychiatric alterations in susceptible individuals. As inflammation can have long-term effects on patients, a multidisciplinary treatment plan can avoid complications and debilitating health issues, and it is crucial to recognize and address the mental health implications.
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Affiliation(s)
- Eduardo Ferat-Osorio
- División de Investigación Clínica de la Coordinación de Investigación en Salud, Instituto Mexicano del Seguro Social, Mexico City 06720, Mexico
| | - José Luis Maldonado-García
- Departamento de Bioquímica, Facultad de Medicina, Universidad Nacional Autónoma de México, Coyoacán 04510, Ciudad de México, Mexico
- Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City 11340, Mexico
| | - Lenin Pavón
- Laboratorio de Psicoinmunología, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City 14370, Mexico
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Traetta ME, Chaves Filho AM, Akinluyi ET, Tremblay MÈ. Neurodevelopmental and Neuropsychiatric Disorders. ADVANCES IN NEUROBIOLOGY 2024; 37:457-495. [PMID: 39207708 DOI: 10.1007/978-3-031-55529-9_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
This chapter will focus on microglial involvement in neurodevelopmental and neuropsychiatric disorders, particularly autism spectrum disorder (ASD), schizophrenia and major depressive disorder (MDD). We will describe the neuroimmune risk factors that contribute to the etiopathology of these disorders across the lifespan, including both in early life and adulthood. Microglia, being the resident immune cells of the central nervous system, could play a key role in triggering and determining the outcome of these disorders. This chapter will review preclinical and clinical findings where microglial morphology and function were examined in the contexts of ASD, schizophrenia and MDD. Clinical evidence points out to altered microglial morphology and reactivity, as well as increased expression of pro-inflammatory cytokines, supporting the idea that microglial abnormalities are involved in these disorders. Indeed, animal models for these disorders found altered microglial morphology and homeostatic functions which resulted in behaviours related to these disorders. Additionally, as microglia have emerged as promising therapeutic targets, we will also address in this chapter therapies involving microglial mechanisms for the treatment of neurodevelopmental and neuropsychiatric disorders.
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Affiliation(s)
| | | | - Elizabeth Toyin Akinluyi
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
- Department of Pharmacology and Therapeutics, Afe Babalola University, Ado-Ekiti, Nigeria
| | - Marie-Ève Tremblay
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada.
- Département de Médecine Moléculaire, Université Laval, Quebec City, QC, Canada.
- Axe Neurosciences, Center de Recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada.
- Neurology and Neurosurgery Department, McGill University, Montréal, QC, Canada.
- Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, BC, Canada.
- Center for Advanced Materials and Related Technology (CAMTEC), University of Victoria, Victoria, BC, Canada.
- Institute on Aging and Lifelong Health (IALH), University of Victoria, Victoria, BC, Canada.
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5
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Bransfield RC, Mao C, Greenberg R. Microbes and Mental Illness: Past, Present, and Future. Healthcare (Basel) 2023; 12:83. [PMID: 38200989 PMCID: PMC10779437 DOI: 10.3390/healthcare12010083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 01/12/2024] Open
Abstract
A review of the association between microbes and mental illness is performed, including the history, relevant definitions, infectious agents associated with mental illnesses, complex interactive infections, total load theory, pathophysiology, psychoimmunology, psychoneuroimmunology, clinical presentations, early-life infections, clinical assessment, and treatment. Perspectives on the etiology of mental illness have evolved from demonic possession toward multisystem biologically based models that include gene expression, environmental triggers, immune mediators, and infectious diseases. Microbes are associated with a number of mental disorders, including autism, schizophrenia, bipolar disorder, depressive disorders, and anxiety disorders, as well as suicidality and aggressive or violent behaviors. Specific microbes that have been associated or potentially associated with at least one of these conditions include Aspergillus, Babesia, Bartonella, Borna disease virus, Borrelia burgdorferi (Lyme disease), Candida, Chlamydia, coronaviruses (e.g., SARS-CoV-2), Cryptococcus neoformans, cytomegalovirus, enteroviruses, Epstein-Barr virus, hepatitis C, herpes simplex virus, human endogenous retroviruses, human immunodeficiency virus, human herpesvirus-6 (HHV-6), human T-cell lymphotropic virus type 1, influenza viruses, measles virus, Mycoplasma, Plasmodium, rubella virus, Group A Streptococcus (PANDAS), Taenia solium, Toxoplasma gondii, Treponema pallidum (syphilis), Trypanosoma, and West Nile virus. Recognition of the microbe and mental illness association with the development of greater interdisciplinary research, education, and treatment options may prevent and reduce mental illness morbidity, disability, and mortality.
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Affiliation(s)
- Robert C. Bransfield
- Rutgers-Robert Wood Johnson Medical School, Piscataway, NJ 08854, USA
- Hackensack Meridian School of Medicine, Nutey, NJ 07110, USA
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Özge A, Domaç FM, Tekin N, Sünbül EA, Öksüz N, Atalar AÇ, Çallı SY, Fidan YS, Evlice A, Beştepe EE, İzci F, Küsbeci ÖY, Demirel EA, Velioğlu SK, Ungan M. One Patient, Three Providers: A Multidisciplinary Approach to Managing Common Neuropsychiatric Cases. J Clin Med 2023; 12:5754. [PMID: 37685821 PMCID: PMC10488785 DOI: 10.3390/jcm12175754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Neuropsychiatric cases require a multidisciplinary approach for effective management. This paper presented case-based discussions on migraine, dementia, epilepsy, mood disorders, neuralgia, and psychosis from the perspectives of a family physician, neurologist, and psychiatrist. The goal was to highlight the importance of collaboration between healthcare providers in managing these complex cases. METHODS The paper was based on the proceedings of the Mediterranean Neuropsychiatry Symposium, where experts from family medicine, neurology, and psychiatry came together for comprehensive case-based discussions. The CARE framework (Case Report, Appraisal, Research, and Education) was developed to guide reporting and evaluation of case reports in clinical practice. RESULTS Six cases were presented and discussed, highlighting the importance of a multidisciplinary approach in managing neuropsychiatric cases. The cases included chronic migraine with medication overuse, memory dysfunction with language and behavioral problems, refractory epileptic seizures with subjective sensory symptoms, bipolar affective disorder with normal pressure hydrocephalus, postherpetic neuralgia in a case with bipolar affective disorder, and psychosis with recurrent attacks with the abuse of several substances. CONCLUSION A biopsychosocial multidisciplinary approach is essential for managing neuropsychiatric cases effectively on behalf of the patients and public health of the country. The CARE framework can guide the reporting and evaluation of case reports in clinical practice, ensuring that patients receive comprehensive and effective care. Healthcare providers should collaborate to provide the best possible care for patients with complex and multifaceted needs.
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Affiliation(s)
- Aynur Özge
- Department of Neurology, School of Medicine, Mersin University, Mersin 33110, Türkiye;
| | - Füsun Mayda Domaç
- Department of Neurology, Erenkoy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye;
| | - Nil Tekin
- Department of Family Medicine, Izmir Faculty of Medicine, University of Health Sciences, İzmir 35330, Türkiye;
- Department of Family Medicine, Tepecik Education and Research Hospital, University of Health Sciences, İzmir 35330, Türkiye
| | - Esra Aydın Sünbül
- Department of Psychiatry, Erenköy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye; (E.A.S.); (S.Y.Ç.); (Y.S.F.); (E.E.B.); (F.İ.)
| | - Nevra Öksüz
- Department of Neurology, School of Medicine, Mersin University, Mersin 33110, Türkiye;
| | - Arife Çimen Atalar
- Neurology Department, Kanuni Sultan Süleyman Education and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye;
| | - Sümeyye Yasemin Çallı
- Department of Psychiatry, Erenköy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye; (E.A.S.); (S.Y.Ç.); (Y.S.F.); (E.E.B.); (F.İ.)
| | - Yağmur Sever Fidan
- Department of Psychiatry, Erenköy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye; (E.A.S.); (S.Y.Ç.); (Y.S.F.); (E.E.B.); (F.İ.)
| | - Ahmet Evlice
- Department of Neurology, School of Medicine, Çukurova University, Adana 01330, Türkiye;
| | - Engin Emrem Beştepe
- Department of Psychiatry, Erenköy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye; (E.A.S.); (S.Y.Ç.); (Y.S.F.); (E.E.B.); (F.İ.)
| | - Filiz İzci
- Department of Psychiatry, Erenköy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, İstanbul 34668, Türkiye; (E.A.S.); (S.Y.Ç.); (Y.S.F.); (E.E.B.); (F.İ.)
| | - Özge Yılmaz Küsbeci
- Neurology Department, Medical Faculty, Izmir University of Economics, Izmir 35330, Türkiye;
| | - Esra Acıman Demirel
- Department of Neurology, Zonguldak Bulent Ecevit University of Medicine, Zonguldak 67100, Türkiye;
| | - Sibel K. Velioğlu
- Clinical Neurophysiology Unit, Neurology Department, Medical Faculty, Karadeniz Technical University, Trabzon 61080, Türkiye;
| | - Mehmet Ungan
- Department of Family Medicine, Medical Faculty, Ankara University, Ankara 06100, Türkiye;
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Egbert AR, Karpiak S, Havlik R, Cankurtaran S. Global occurrence of depressive symptoms during the COVID-19 pandemic. J Psychosom Res 2023; 166:111145. [PMID: 36736190 PMCID: PMC9838027 DOI: 10.1016/j.jpsychores.2022.111145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 12/30/2022] [Accepted: 12/31/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVE This study aimed to estimate the occurrence of depressive symptoms in a global population of young, middle-aged and older adults amid the COVID-19 pandemic. Study data also assessed the impact of the social restrictions caused by the pandemic on depressive symptomatology. METHODS A self-administered internet-based survey was completed by 111,225 individuals residing in 176 countries (March-April 2020). We retained: demographic data, depressive symptoms (PHQ8), anxieties specific to the COVID-19, personality traits (Big-Five Personality Questionnaire), comorbidity frequency, health quality, behavioral variables (i,e., staying at home, avoiding social gatherings, social distancing in the past week). Occurrence of depressive symptoms was estimated using standard cut-offs (total PHQ8 score ≥ 10). Hierarchical regression modeling examined correlates of depressive symptoms (PHQ8 score) in three groups stratified by age, i.e., 18-34, 35-54 and 55+ years. RESULTS Moderate to severe depressive symptoms were present in 27% of young, 15% middle-aged and 9% older adults. Younger age, female gender, not partnered, higher anxiety, and poorer health were associated with elevated depressive symptoms. Staying at home/not attending social gatherings were minor contributors to depressive symptoms in young and middle-aged adults. These were not significant in older adults. Social distancing was a marginal contributor in middle-aged and near significant in older adults, but not significant in young adults. CONCLUSIONS The occurrence of depressive symptoms is decreasing with advancing age. Increased risk of depressive symptoms was associated with being a younger adult, females, single/divorced, poorer health and higher anxiety. In all age groups, the presence of depressive symptoms was greater than global estimates preceding the COVID-19 pandemic. Social restrictions amid the COVID-19 pandemic were marginal risks for depressive symptoms.
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Affiliation(s)
- Anna Rita Egbert
- Department of Psychology, St. Joseph's University, New York, USA.
| | | | - Richard Havlik
- National Institute on Aging, National Institutes of Health, USA
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8
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Clavijo Prado CA, Aroca Torres J, Abadía Rincon AL, Vargas Ramírez AM, Chauvez Gallego A. Aproximación diagnóstica de la neurosífilis. REPERTORIO DE MEDICINA Y CIRUGÍA 2022. [DOI: 10.31260/repertmedcir.01217372.1185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
La neurosífilis es la enfermedad del sistema nervioso central (SNC) causada por Treponema pallidum, perteneciente al grupo de las espiroquetas; se puede presentar en pacientes inmunocompetentes pero existe una asociación mayor con el virus de inmunodeficiencia humana (VIH). Estos casos son más severos y con manifestaciones neurológicas variables. Si bien la forma típica es la más frecuente, existen expresiones atípicas que pueden llegar a presentarse en 30% de los casos según los estudios radiológicos, por lo cual es importante reconocerlas a fin de garantizar un diagnóstico temprano y una intervención oportuna. No solo es un problema de salud pública por su prevalencia sino también por el amplio espectro clínico que le ha valido el nombre de gran simuladora, siendo desconocidas en muchas ocasiones por los médicos de atención primaria. El siguiente trabajo ha sido planteado con base en tres casos clínicos (2 de vasculitis en SNC, una panuveítis) con el objetivo de desmitificar los tiempos de presentación y aclarar las manifestaciones clínicas que comprometen el SNC, tratando de precisar el diagnóstico para la realización de un tratamiento pertinente y oportuno que reduzca las secuelas.
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Heurich M, Föcking M, Mongan D, Cagney G, Cotter DR. Dysregulation of complement and coagulation pathways: emerging mechanisms in the development of psychosis. Mol Psychiatry 2022; 27:127-140. [PMID: 34226666 PMCID: PMC8256396 DOI: 10.1038/s41380-021-01197-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 06/04/2021] [Accepted: 06/10/2021] [Indexed: 02/06/2023]
Abstract
Early identification and treatment significantly improve clinical outcomes of psychotic disorders. Recent studies identified protein components of the complement and coagulation systems as key pathways implicated in psychosis. These specific protein alterations are integral to the inflammatory response and can begin years before the onset of clinical symptoms of psychotic disorder. Critically, they have recently been shown to predict the transition from clinical high risk to first-episode psychosis, enabling stratification of individuals who are most likely to transition to psychotic disorder from those who are not. This reinforces the concept that the psychosis spectrum is likely a central nervous system manifestation of systemic changes and highlights the need to investigate plasma proteins as diagnostic or prognostic biomarkers and pathophysiological mediators. In this review, we integrate evidence of alterations in proteins belonging to the complement and coagulation protein systems, including the coagulation, anticoagulation, and fibrinolytic pathways and their dysregulation in psychosis, into a consolidated mechanism that could be integral to the progression and manifestation of psychosis. We consolidate the findings of altered blood proteins relevant for progression to psychotic disorders, using data from longitudinal studies of the general population in addition to clinical high-risk (CHR) individuals transitioning to psychotic disorder. These are compared to markers identified from first-episode psychosis and schizophrenia as well as other psychosis spectrum disorders. We propose the novel hypothesis that altered complement and coagulation plasma levels enhance their pathways' activating capacities, while low levels observed in key regulatory components contribute to excessive activation observed in patients. This hypothesis will require future testing through a range of experimental paradigms, and if upheld, complement and coagulation pathways or specific proteins could be useful diagnostic or prognostic tools and targets for early intervention and preventive strategies.
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Affiliation(s)
- Meike Heurich
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK.
| | - Melanie Föcking
- grid.4912.e0000 0004 0488 7120Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David Mongan
- grid.4912.e0000 0004 0488 7120Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gerard Cagney
- grid.7886.10000 0001 0768 2743School of Biomolecular and Biomedical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - David R. Cotter
- grid.4912.e0000 0004 0488 7120Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
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Coleman B, Casiraghi E, Blau H, Chan L, Haendel M, Laraway B, Callahan TJ, Deer RR, Wilkins K, Reese J, Robinson PN. Increased risk of psychiatric sequelae of COVID-19 is highest early in the clinical course. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.11.30.21267071. [PMID: 34909790 PMCID: PMC8669857 DOI: 10.1101/2021.11.30.21267071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background COVID-19 has been shown to increase the risk of adverse mental health consequences. A recent electronic health record (EHR)-based observational study showed an almost two-fold increased risk of new-onset mental illness in the first 90 days following a diagnosis of acute COVID-19. Methods We used the National COVID Cohort Collaborative, a harmonized EHR repository with 2,965,506 COVID-19 positive patients, and compared cohorts of COVID-19 patients with comparable controls. Patients were propensity score-matched to control for confounding factors. We estimated the hazard ratio (COVID-19:control) for new-onset of mental illness for the first year following diagnosis. We additionally estimated the change in risk for new-onset mental illness between the periods of 21-120 and 121-365 days following infection. Findings We find a significant increase in incidence of new-onset mental disorders in the period of 21-120 days following COVID-19 (3.8%, 3.6-4.0) compared to patients with respiratory tract infections (3%, 2.8-3.2). We further show that the risk for new-onset mental illness decreases over the first year following COVID-19 diagnosis compared to other respiratory tract infections and demonstrate a reduced (non-significant) hazard ratio over the period of 121-365 days following diagnosis. Similar findings are seen for new-onset anxiety disorders but not for mood disorders. Interpretation Patients who have recovered from COVID-19 are at an increased risk for developing new-onset mental illness, especially anxiety disorders. This risk is most prominent in the first 120 days following infection. Funding National Center for Advancing Translational Sciences (NCATS).
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Affiliation(s)
- Ben Coleman
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
- Institute for Systems Genomics, University of Connecticut, Farmington, CT 06032, USA
| | - Elena Casiraghi
- AnacletoLab, Dipartimento di Informatica, Università degli Studi di Milano, Italy
| | - Hannah Blau
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Lauren Chan
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Melissa Haendel
- Center for Health AI, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Bryan Laraway
- Center for Health AI, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Tiffany J Callahan
- University of Colorado Anschutz Medical Campus, Center for Health AI, Aurora 80045, CO, USA
| | - Rachel R Deer
- University of Texas Medical Branch, Galveston, TX, 77550 USA
| | - Ken Wilkins
- Biostatistics Program, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Justin Reese
- Division of Environmental Genomics and Systems Biology, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Peter N Robinson
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
- Institute for Systems Genomics, University of Connecticut, Farmington, CT 06032, USA
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Kritzer MD, Buch K, Mukerji SS, Biffi A, Chemali Z. Cases of Neuroinfectious Disease Highlighting Frontotemporal Neurocircuitry in Cognitive and Affective Processing. Prim Care Companion CNS Disord 2021; 23:20cr02894. [PMID: 34738354 PMCID: PMC9121741 DOI: 10.4088/pcc.20cr02894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Michael D Kritzer
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Corresponding author: Michael D. Kritzer, MD, PhD, Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114
| | - Karen Buch
- Department of Radiology, Massachusetts General Hospital, Boston, Massachuetts
| | - Shibani S Mukerji
- Department of Neurology, Massachusetts General Hospital, Boston, Massachuetts
| | - Alessandro Biffi
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Division of Behavioral and Cognitive Neurology, Department of Neurology, Massachusetts General Hospital, Boston, Massachuetts
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, Massachuetts
| | - Zeina Chemali
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Neurology, Massachusetts General Hospital, Boston, Massachuetts
- Division of Behavioral and Cognitive Neurology, Department of Neurology, Massachusetts General Hospital, Boston, Massachuetts
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, Massachuetts
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12
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Desai S, Sheikh B, Belzie L. New-Onset Psychosis Following COVID-19 Infection. Cureus 2021; 13:e17904. [PMID: 34548990 PMCID: PMC8437203 DOI: 10.7759/cureus.17904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2021] [Indexed: 11/05/2022] Open
Abstract
Previous studies have suggested that some individuals experience neuropsychiatric symptoms following coronavirus disease 2019 (COVID-19) infection. We describe a case of new-onset psychosis following COVID-19 infection in a 55-year-old female with no prior psychiatric history. The patient started exhibiting symptoms of COVID-19 infection three weeks prior and was treated in the hospital with 4 L oxygen, dexamethasone 6 mg, and remdesivir therapy for seven days. Throughout her hospital stay, the patient had no neuropsychiatric symptoms. During her last week of stay, she was solely getting oxygen at home before presenting to the emergency department (ED) with severe psychosis. Her COVID-19 test in ED presentation was negative, and all potential etiologies for psychosis were ruled out. She was effectively treated for two weeks with 10 mg haloperidol and 1000 mg sodium valproate daily, followed by outpatient care. While variables such as a family history of bipolar disorder, psychosocial stressors, and steroid medication may have contributed to the patient's presentation, these circumstances alone did not result in neuropsychiatric symptoms in the past. COVID-19 infection may enhance the likelihood of developing neuropsychiatric problems on its own or amplify the effects of risk factors associated with an increased risk of psychosis. Neuropsychiatric consequences of COVID-19 infection may be under- or over-reported in individuals treated with steroids. Further research is necessary to identify individuals at risk of experiencing neuropsychiatric issues owing to COVID-19 infection and the prognosis.
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Affiliation(s)
- Saral Desai
- Department of Psychiatry, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Batool Sheikh
- Department of Psychiatry, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Louis Belzie
- Department of Psychiatry, Brookdale University Hospital Medical Center, Brooklyn, USA
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Ge XH, Wei WR, Feng TN, Xu LL, Hu YQ, Yuan CR. Analysis of risk factor for pediatric intensive care unit delirium in children: a case-control study. Am J Transl Res 2021; 13:9143-9151. [PMID: 34540029 PMCID: PMC8430069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 05/14/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study aimed to survey the prevalence of delirium in the pediatric intensive care unit (PICU) and explore the associated risk factors. DESIGN A retrospective case-control study. SETTING Two PICUs within a tertiary-A general hospital. PATIENTS Patients aged from 1 month to 7 years who stayed in either PICU for at least 1 day were included. METHODS A total of 639 patients admitted to PICU of a tertiary-A general hospital from December 2018 to August 2019 were enrolled. Demographic, clinical, laboratory data and length of stay in the PICU were collected. The patients were screened twice a day with the Chinese version of Cornell Assessment of Pediatric Delirium (CAPD), and were divided into the delirium group and the non-delirium group. A risk factor analysis was conducted, with ICU pediatric delirium as primary outcome, by performing a multivariable logistic regression analysis. RESULTS Of the 639 patients, the prevalence of ICU pediatric delirium was 31.30%. Of the 200 children with delirium across 3703 study days, 36% children were hyperactive, 41% were hypoactive, and 23% displayed the mixed type of delirium. Univariate analysis and multivariate logistic regression analysis showed that age, PRISM IV score (OR, 2.20; 95% CI, 1.42-3.41), hypoxia (OR, 2.69; 95% CI, 1.53-4.71), metabolic dis-function (OR, 3.73; 95% CI, 2.08-6.71), duration of infection (OR, 1.22; 95% CI, 1.10-1.36), and mechanical ventilation (OR, 3.78; 95% CI, 2.25-6.35) were statistically correlated with ICU pediatric delirium. The ROC curve analysis shows the combination CRP with duration of infection has good predictive performance. CONCLUSIONS Age, PRISM IV score, ICU retention time, metabolic dis-function, duration of infection, hypoxia, CRP and mechanical ventilation were the independent risk factors for ICU pediatric delirium. We suggest that active preventive measures should be taken to reduce the occurrence of ICU pediatric delirium.
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Affiliation(s)
- Xiao-Hua Ge
- School of Nursing, Naval Medical UniversityShanghai, China
- Department of Nursing, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghai, China
| | - Wan-Rui Wei
- School of Nursing, Shanghai Jiao Tong UniversityShanghai, China
| | - Tie-Nan Feng
- Clinical Research Institute, Shanghai Jiao Tong University School of MedicineShanghai, China
| | - Li-Li Xu
- Pediatric Intensive Care Unit, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghai, China
| | - Ya-Qin Hu
- Pediatric Intensive Care Unit, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghai, China
| | - Chang-Rong Yuan
- School of Nursing, Naval Medical UniversityShanghai, China
- School of Nursing, Fudan UniversityShanghai, China
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14
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Kumar P, Kamal S, Tuli S, Gupta N. COVID-19 and manifest psychological morbidity: A case series. Indian J Psychiatry 2021; 63:294-296. [PMID: 34211225 PMCID: PMC8221209 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_152_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 12/27/2022] Open
Abstract
The COVID-19 pandemic in India has been reported to be associated with numerous major mental health issues globally; the most common is - stress, anxiety, depressive symptoms, insomnia, denial, anger, and fear. This case series presents three different cases, wherein the COVID-19 pandemic resulted not only in deterioration of previous symptoms experienced by patients (obsessive-compulsive disorder and depression) but also led to the development of new symptoms specifically related to coronavirus (Psychosis). Authors highlight the need to develop preventive strategies for vulnerable groups and try to understand the etiopathogenesis of illnesses so developing, in order to identify support systems and management strategies during the pandemicrelated crisis.
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Affiliation(s)
| | | | | | - Nitin Gupta
- Gupta Mind Healing and Counselling Centre, Chandigarh, India
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15
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Acute Enterovirus Encephalitis as a Cause for Isolated Visual and Auditory Hallucinations in a 22-Year-Old Patient. Case Rep Psychiatry 2021; 2021:6687735. [PMID: 33976949 PMCID: PMC8087486 DOI: 10.1155/2021/6687735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 04/15/2021] [Accepted: 04/17/2021] [Indexed: 11/17/2022] Open
Abstract
Viral encephalitis often presents with severe illness, headache, fever, behavioral changes, altered level of consciousness, and focal neurologic deficits. One of the most feared kind of virus encephalitis is herpes simplex encephalitis; however, other central virus infections are also capable of presenting with psychiatric symptoms. Here, we report the case of a 22-year-old woman with first time visual and auditory hallucinations due to an acute enterovirus encephalitis with no cerebrospinal fluid abnormalities but a positive PCR result for enterovirus (ECHO). During treatment, the symptoms deteriorated, and she hat to be shifted to the sheltered ward because of imperative suicidal auditory hallucinations. Under treatment with risperidone and olanzapine, symptoms suddenly stopped and did not reoccur under subsequent reduction of the antipsychotic medication.
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16
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Nickoloff-Bybel EA, Calderon TM, Gaskill PJ, Berman JW. HIV Neuropathogenesis in the Presence of a Disrupted Dopamine System. J Neuroimmune Pharmacol 2020; 15:729-742. [PMID: 32506353 PMCID: PMC7905900 DOI: 10.1007/s11481-020-09927-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 05/26/2020] [Indexed: 12/23/2022]
Abstract
Antiretroviral therapy (ART) has transformed HIV into a chronic condition, lengthening and improving the lives of individuals living with this virus. Despite successful suppression of HIV replication, people living with HIV (PLWH) are susceptible to a growing number of comorbidities, including neuroHIV that results from infection of the central nervous system (CNS). Alterations in the dopaminergic system have long been associated with HIV infection of the CNS. Studies indicate that changes in dopamine concentrations not only alter neurotransmission, but also significantly impact the function of immune cells, contributing to neuroinflammation and neuronal dysfunction. Monocytes/macrophages, which are a major target for HIV in the CNS, are responsive to dopamine. Therefore, defining more precisely the mechanisms by which dopamine acts on these cells, and the changes in cellular function elicited by this neurotransmitter are necessary to develop therapeutic strategies to treat neuroHIV. This is especially important for vulnerable populations of PLWH with chemically altered dopamine concentrations, such as individuals with substance use disorder (SUD), or aging individuals using dopamine-altering medications. The specific neuropathologic and neurocognitive consequences of increased CNS dopamine remain unclear. This is due to the complex nature of HIV neuropathogenesis, and logistical and technical challenges that contribute to inconsistencies among cohort studies, animal models and in vitro studies, as well as lack of demographic data and access to human CNS samples and cells. This review summarizes current understanding of the impact of dopamine on HIV neuropathogenesis, and proposes new experimental approaches to examine the role of dopamine in CNS HIV infection. Graphical abstract HIV Neuropathogenesis in the Presence of a Disrupted Dopamine System. Both substance abuse disorders and the use of dopaminergic medications for age-related diseases are associated with changes in CNS dopamine concentrations and dopaminergic neurotransmission. These changes can lead to aberrant immune function, particularly in myeloid cells, which contributes to the neuroinflammation, neuropathology and dysfunctional neurotransmission observed in dopamine-rich regions in HIV+ individuals. These changes, which are seen despite the use antiretroviral therapy (ART), in turn lead to further dysregulation of the dopamine system. Thus, in individuals with elevated dopamine, the bi-directional interaction between aberrant dopaminergic neurotransmission and HIV infection creates a feedback loop contributing to HIV associated neurocognitive dysfunction and neuroHIV. However, the distinct contributions and interactions made by HIV infection, inflammatory mediators, ART, drugs of abuse, and age-related therapeutics are poorly understood. Defining more precisely the mechanisms by which these factors influence the development of neurological disease is critical to addressing the continued presence of neuroHIV in vulnerable populations, such as HIV-infected older adults or drug abusers. Due to the complexity of this system, understanding these effects will require a combination of novel experimental modalities in the context of ART. These will include more rigorous epidemiological studies, relevant animal models, and in vitro cellular and molecular mechanistic analysis.
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Affiliation(s)
- E A Nickoloff-Bybel
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA, 19102, USA
| | - T M Calderon
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - P J Gaskill
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA, 19102, USA.
| | - J W Berman
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, 10461, USA.
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, 10461, USA.
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17
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Garcez FB, Aliberti MJR, Poco PCE, Hiratsuka M, Takahashi SDF, Coelho VA, Salotto DB, Moreira MLV, Jacob‐Filho W, Avelino‐Silva TJ. Delirium and Adverse Outcomes in Hospitalized Patients with COVID-19. J Am Geriatr Soc 2020; 68:2440-2446. [PMID: 32835425 PMCID: PMC7460960 DOI: 10.1111/jgs.16803] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Little is known about the association between acute mental changes and adverse outcomes in hospitalized adults with COVID-19. OBJECTIVES To investigate the occurrence of delirium in hospitalized patients with COVID-19 and explore its association with adverse outcomes. DESIGN Longitudinal observational study. SETTING Tertiary university hospital dedicated to the care of severe cases of COVID-19 in São Paulo, Brazil. PARTICIPANTS A total of 707 patients, aged 50 years or older, consecutively admitted to the hospital between March and May 2020. MEASUREMENTS We completed detailed reviews of electronic medical records to collect our data. We identified delirium occurrence using the Chart-Based Delirium Identification Instrument (CHART-DEL). Trained physicians with a background in geriatric medicine completed all CHART-DEL assessments. We complemented our baseline clinical information using telephone interviews with participants or their proxy. Our outcomes of interest were in-hospital death, length of stay, admission to intensive care, and ventilator utilization. We adjusted all multivariable analyses for age, sex, clinical history, vital signs, and relevant laboratory biomarkers (lymphocyte count, C-reactive protein, glomerular filtration rate, D-dimer, and albumin). RESULTS Overall, we identified delirium in 234 participants (33%). On admission, 86 (12%) were delirious. We observed 273 deaths (39%) in our sample, and in-hospital mortality reached 55% in patients who experienced delirium. Delirium was associated with in-hospital death, with an adjusted odds ratio of 1.75 (95% confidence interval = 1.15-2.66); the association held both in middle-aged and older adults. Delirium was also associated with increased length of stay, admission to intensive care, and ventilator utilization. CONCLUSION Delirium was independently associated with in-hospital death in adults aged 50 years and older with COVID-19. Despite the difficulties for patient care during the pandemic, clinicians should routinely monitor delirium when assessing severity and prognosis of COVID-19 patients.
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Affiliation(s)
- Flavia B. Garcez
- Laboratorio de Investigacao Medica em Envelhecimento (LIM‐66), Servico de Geriatria, Hospital das ClinicasFaculdade de Medicina da Universidade de São Paulo (FMUSP)São PauloBrazil
| | - Marlon J. R. Aliberti
- Laboratorio de Investigacao Medica em Envelhecimento (LIM‐66), Servico de Geriatria, Hospital das ClinicasFaculdade de Medicina da Universidade de São Paulo (FMUSP)São PauloBrazil
| | - Paula C. E. Poco
- Laboratorio de Investigacao Medica em Envelhecimento (LIM‐66), Servico de Geriatria, Hospital das ClinicasFaculdade de Medicina da Universidade de São Paulo (FMUSP)São PauloBrazil
| | - Marcel Hiratsuka
- Laboratorio de Investigacao Medica em Envelhecimento (LIM‐66), Servico de Geriatria, Hospital das ClinicasFaculdade de Medicina da Universidade de São Paulo (FMUSP)São PauloBrazil
| | - Silvia de F. Takahashi
- Laboratorio de Investigacao Medica em Envelhecimento (LIM‐66), Servico de Geriatria, Hospital das ClinicasFaculdade de Medicina da Universidade de São Paulo (FMUSP)São PauloBrazil
| | - Venceslau A. Coelho
- Laboratorio de Investigacao Medica em Envelhecimento (LIM‐66), Servico de Geriatria, Hospital das ClinicasFaculdade de Medicina da Universidade de São Paulo (FMUSP)São PauloBrazil
| | - Danute B. Salotto
- Laboratorio de Investigacao Medica em Envelhecimento (LIM‐66), Servico de Geriatria, Hospital das ClinicasFaculdade de Medicina da Universidade de São Paulo (FMUSP)São PauloBrazil
| | - Marlos L. V. Moreira
- Laboratorio de Investigacao Medica em Envelhecimento (LIM‐66), Servico de Geriatria, Hospital das ClinicasFaculdade de Medicina da Universidade de São Paulo (FMUSP)São PauloBrazil
| | - Wilson Jacob‐Filho
- Laboratorio de Investigacao Medica em Envelhecimento (LIM‐66), Servico de Geriatria, Hospital das ClinicasFaculdade de Medicina da Universidade de São Paulo (FMUSP)São PauloBrazil
| | - Thiago J. Avelino‐Silva
- Laboratorio de Investigacao Medica em Envelhecimento (LIM‐66), Servico de Geriatria, Hospital das ClinicasFaculdade de Medicina da Universidade de São Paulo (FMUSP)São PauloBrazil
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18
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Chacko M, Job A, Caston F, George P, Yacoub A, Cáceda R. COVID-19-Induced Psychosis and Suicidal Behavior: Case Report. SN COMPREHENSIVE CLINICAL MEDICINE 2020; 2:2391-2395. [PMID: 33015547 PMCID: PMC7519695 DOI: 10.1007/s42399-020-00530-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 12/12/2022]
Abstract
The COVID-19 pandemic is associated with different types of stressors: fear of infection, financial burden, and social isolation. Additionally, COVID-19 infection seems to increase the risk for neuropsychiatric symptoms including psychosis. We present a case of a 52-year-old male with no previous psychiatric history who developed severe paranoia leading to a suicide attempt. He was successfully treated with a combination of milieu treatment, pharmacotherapy, and electroconvulsive therapy. We add to the nascent literature that COVID-19, as other coronaviruses, can increase the risk for severe psychosis and suicidal behavior.
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Affiliation(s)
- Mason Chacko
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY USA
- Department of Hospital Medicine, Southside Hospital, Bay Shore, NY USA
| | - Asha Job
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY USA
| | - Fred Caston
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY USA
| | - Prem George
- OP Private Practice/SUNY Downstate, Brooklyn, NY USA
| | - Adeeb Yacoub
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY USA
| | - Ricardo Cáceda
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY USA
- Psychiatry Service, Northport VA Medical Center, Northport, NY USA
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19
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Ferrando SJ, Klepacz L, Lynch S, Tavakkoli M, Dornbush R, Baharani R, Smolin Y, Bartell A. COVID-19 Psychosis: A Potential New Neuropsychiatric Condition Triggered by Novel Coronavirus Infection and the Inflammatory Response? PSYCHOSOMATICS 2020; 61:551-555. [PMID: 32593479 PMCID: PMC7236749 DOI: 10.1016/j.psym.2020.05.012] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Stephen J Ferrando
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY; Department of Psychiatry, New York Medical College, Valhalla, New York.
| | - Lidia Klepacz
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY; Department of Psychiatry, New York Medical College, Valhalla, New York
| | - Sean Lynch
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY; Department of Psychiatry, New York Medical College, Valhalla, New York
| | - Mohammad Tavakkoli
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY; Department of Psychiatry, New York Medical College, Valhalla, New York
| | - Rhea Dornbush
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY; Department of Psychiatry, New York Medical College, Valhalla, New York
| | - Reena Baharani
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY; Department of Psychiatry, New York Medical College, Valhalla, New York
| | - Yvette Smolin
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY; Department of Psychiatry, New York Medical College, Valhalla, New York
| | - Abraham Bartell
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY; Department of Psychiatry, New York Medical College, Valhalla, New York
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20
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Dalgalarrondo P, Moraes MJD, Celeri EHRV, Santos Júnior AD. Das psicoses associadas a infecções no Brasil: 100 anos da contribuição psicopatológica de Antonio Austregésilo. REVISTA LATINOAMERICANA DE PSICOPATOLOGIA FUNDAMENTAL 2020. [DOI: 10.1590/1415-4714.2020v23n3p645-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
No presente trabalho, analisa-se a contribuição do neurologista e neuropsiquiatra Antonio Austregésilo (1876--1960) para o estudo psicopatológico e sistematização das chamadas psicoses infecciosas, no Brasil. Baseando-se em Emil Kraepelin e lançando mão de observações clínicas em doenças infecciosas globais e tropicais, Austregésilo revela detalhado conhecimento clínico e intervém no debate sobre etiologia, especificidades de fatores causais e curso da doença, na fronteira entre as doenças físicas infecciosas e os transtornos mentais.
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21
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Loftis JM, Taylor J, Hudson R, Firsick EJ. Neuroinvasion and cognitive impairment in comorbid alcohol dependence and chronic viral infection: An initial investigation. J Neuroimmunol 2019; 335:577006. [PMID: 31325774 DOI: 10.1016/j.jneuroim.2019.577006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/03/2019] [Accepted: 07/09/2019] [Indexed: 12/16/2022]
Abstract
Viruses that invade the central nervous system (CNS) can cause neuropsychiatric impairments. Similarly, chronic alcohol exposure can induce inflammatory responses that alter brain function. However, the effects of a chronic viral infection and comorbid alcohol use on neuroinflammation and behavior are not well-defined. We investigated the role of heavy alcohol intake in regulating inflammatory responses and behavioral signs of cognitive impairments in mice infected with lymphocytic choriomeningitis virus (LCMV) clone 13. LCMV-infected mice exposed to alcohol had increased peripheral inflammation and impaired cognitive function (as indicated by performance on the novel object recognition test). Initial findings suggest that brain region-specific dysregulation of microglial response to viral infection may contribute to cognitive impairments in the context of heavy alcohol use.
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Affiliation(s)
- Jennifer M Loftis
- Research & Development Service, Veterans Affairs Portland Health Care System, Portland, OR, USA; Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA; Methamphetamine Abuse Research Center, Veterans Affairs Portland Health Care System, Oregon Health & Science University, Portland, OR, USA.
| | - Jonathan Taylor
- Research & Development Service, Veterans Affairs Portland Health Care System, Portland, OR, USA; Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Rebekah Hudson
- Research & Development Service, Veterans Affairs Portland Health Care System, Portland, OR, USA; Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Evan J Firsick
- Research & Development Service, Veterans Affairs Portland Health Care System, Portland, OR, USA
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22
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Baldin G, Ciccullo A, Rusconi S, Capetti A, Sterrantino G, Colafigli M, d'Ettorre G, Giacometti A, Cossu MV, Borghetti A, Gennari W, Mussini C, Borghi V, Di Giambenedetto S. Long-term data on the efficacy and tolerability of lamivudine plus dolutegravir as a switch strategy in a multi-centre cohort of HIV-1-infected, virologically suppressed patients. Int J Antimicrob Agents 2019; 54:728-734. [PMID: 31521809 DOI: 10.1016/j.ijantimicag.2019.09.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/08/2019] [Accepted: 09/08/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Results from clinical trials and observational studies suggest that lamivudine plus dolutegravir (3TC+DTG) could be an effective and tolerated option for simplification in human immunodeficiency virus (HIV)-1-positive patients. MATERIALS AND METHODS This observational study enrolled HIV-1-infected, virologically suppressed patients switching to 3TC+DTG. Kaplan-Meyer survival analysis was performed to evaluate time to virological failure (VF; defined by a single HIV-RNA determination ≥1000 copies/mL or by two consecutive HIV-RNA determinations ≥50 copies/mL) and time to treatment discontinuation (TD; defined as interruption of either 3TC or DTG), Cox regression was performed to assess predictors, and linear mixed model was performed for repeated measures to measure changes in immunological and metabolic parameters. RESULTS Five hundred and fifty-six patients were eligible for analysis. Their median CD4+ count at baseline was 668 cells/mm3 and median time of virological suppression was 88 months. Estimated probabilities of maintaining virological suppression at 96 and 144 weeks of follow-up were 97.5% [standard deviation (SD) 0.8] and 96.5% (SD 1.0), respectively. Years since HIV diagnosis was the only predictor of VF. In patients with time of virological suppression <88 months, the rate of VF was higher in the presence of the M184V mutation. Estimated probabilities of remaining on 3TC+DTG at 96 and 144 weeks of follow-up were 79.2% (SD 1.9) and 75.2% (SD 2.2), respectively. A significant increase in CD4 cell count (+44 cells/mm3, P=0.015), CD4/CD8 ratio (+0.10, P=0.002) and high-density lipoprotein cholesterol (+5.4 mg/dL, P=0.036) was found at 144 weeks of follow-up; meanwhile, total cholesterol (-9.1 mg/dL, P=0.007) and triglycerides (-2.7, P=0.009) decreased significantly. CONCLUSIONS These findings confirm the efficacy and tolerability of 3TC+DTG in virologically suppressed patients.
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Affiliation(s)
- Gianmaria Baldin
- Institute of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy; Mater Olbia Hospital, Olbia, Italy
| | - Arturo Ciccullo
- Institute of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy.
| | - Stefano Rusconi
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Amedeo Capetti
- Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - Gaetana Sterrantino
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Manuela Colafigli
- Infectious Dermatology and Allergology Unit, IFO S. Gallicano Institute (IRCCS), Rome, Italy
| | - Gabriella d'Ettorre
- Department of Public Health and Infectious Diseases, Azienda Policlinico Umberto I, Rome, Italy
| | - Andrea Giacometti
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona, Italy
| | - Maria Vittoria Cossu
- Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - Alberto Borghetti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Malattie Infettive, Rome, Italy
| | - William Gennari
- Azienda Ospedaliero Universitaria di Modena Laboratorio di Microbiologia e Virologia, Modena, Italy
| | - Cristina Mussini
- Azienda Ospedaliero Universitaria di Modena, Clinica Malattie Infettive e Tropicali, Modena, Italy
| | - Vanni Borghi
- Azienda Ospedaliero Universitaria di Modena, Clinica Malattie Infettive e Tropicali, Modena, Italy
| | - Simona Di Giambenedetto
- Institute of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Malattie Infettive, Rome, Italy
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23
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Silverman M, Frankovich J, Nguyen E, Leibold C, Yoon J, Mark Freeman G, Karpel H, Thienemann M. Psychotic symptoms in youth with Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) may reflect syndrome severity and heterogeneity. J Psychiatr Res 2019; 110:93-102. [PMID: 30605785 DOI: 10.1016/j.jpsychires.2018.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 11/04/2018] [Accepted: 11/13/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE In the clinical syndrome Pediatric Acute-onset Neuropsychiatric Syndrome (PANS), obsessive compulsive disorder (OCD) and/or food refusal symptoms have an abrupt-onset (over 48 h) coupled with at least two other specified neuropsychiatric symptoms. We aimed to characterize in detail for the first time, psychotic symptoms experienced by children with PANS as well as the impact of psychotic symptoms on disease severity and course of illness. We inform about the diagnosis of the clinical description: PANS and hope to improve evaluation, treatment, diagnostic validity and future investigation. METHODS Retrospective review of 143 consecutive PANS clinic patient charts meeting inclusion criteria. The Caregiver Burden Inventory, Global Impairment Score, and Children's Global Assessment Scale were used to assess impairment. RESULTS Visual and auditory hallucinations were each experienced by 36%, of which most (83%) were transient and complex (non-threatening voices or figures). 6.3% and 5.5% of patients experienced delusions and thought disorganization respectively. Those with psychotic symptoms showed statistically significant differences in disease impairment and caregiver burden. There were no differences in time to treatment access or length of illness. CONCLUSIONS Over 1/3 of children with PANS experienced transient hallucinations. They were more impaired than those without psychotic symptoms, but showed no differences in disease progression. This difference may point toward heterogeneity in PANS. When evaluating children with acute psychotic symptoms, clinicians should screen for abrupt-onset of a symptom cluster including OCD and/or food refusal, with neuropsychiatric symptoms (enuresis, handwriting changes, tics, hyperactivity, sleep disorder) before initiating treatment.
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Affiliation(s)
- Melissa Silverman
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States; Stanford Pediatric Acute-onset Neuropsychiatric Sydrome Clinic and Research Program at Lucile Packard Children's Hospital, Stanford University, Stanford, CA, United States.
| | - Jennifer Frankovich
- Pediatric Division of Allergy, Immunology, and Rheumatology, Stanford University, Stanford, CA, United States; Stanford Pediatric Acute-onset Neuropsychiatric Sydrome Clinic and Research Program at Lucile Packard Children's Hospital, Stanford University, Stanford, CA, United States
| | - Emily Nguyen
- Stanford Pediatric Acute-onset Neuropsychiatric Sydrome Clinic and Research Program at Lucile Packard Children's Hospital, Stanford University, Stanford, CA, United States
| | - Collin Leibold
- Pediatric Division of Allergy, Immunology, and Rheumatology, Stanford University, Stanford, CA, United States; Stanford Pediatric Acute-onset Neuropsychiatric Sydrome Clinic and Research Program at Lucile Packard Children's Hospital, Stanford University, Stanford, CA, United States
| | - Jong Yoon
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States; VA Palo Alto Health Care System, 3801 Miranda Ave., Building 4, 2nd Floor, Palo Alto, CA, 94304, United States
| | - G Mark Freeman
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Hannah Karpel
- Pediatric Division of Allergy, Immunology, and Rheumatology, Stanford University, Stanford, CA, United States; Stanford Pediatric Acute-onset Neuropsychiatric Sydrome Clinic and Research Program at Lucile Packard Children's Hospital, Stanford University, Stanford, CA, United States
| | - Margo Thienemann
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States; Stanford Pediatric Acute-onset Neuropsychiatric Sydrome Clinic and Research Program at Lucile Packard Children's Hospital, Stanford University, Stanford, CA, United States
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Haidar-Elatrache S, Wolf M, Fabie NAV, Sahai S. Approach to Children with Aggressive Behavior for General Pediatricians and Hospitalists: Part 1-Epidemiology and Etiology. Pediatr Ann 2018; 47:e402-e407. [PMID: 30308676 DOI: 10.3928/19382359-20180918-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Children and adolescents are increasingly presenting to the hospital and emergency department with aggressive behavior and psychiatric emergencies. The rise in pediatric mental health problems, coupled with a lack of much needed resources, necessitates that pediatricians safely diagnose and treat patients presenting with aggressive behavior. In this article, we discuss the broad differential diagnosis that should be considered when initially evaluating a patient presenting with aggression or altered mental status; underlying causes include predisposing factors, comorbid conditions, and acute organic causes involving almost every organ system. Emergency and hospital physicians should tailor their examination and testing individually based on the patient's history and presentation. [Pediatr Ann. 2018;47(10):e402-e407.].
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