Food antibodies in acute psychoses

Gluten Psychosis: Confirmation of a New Clinical Entity

Non-celiac gluten sensitivity (NCGS) is a syndrome diagnosed in patients with symptoms that respond to removal of gluten from the diet, after celiac disease and wheat allergy have been excluded. NCGS has been related to neuro-psychiatric disorders, such as autism, schizophrenia and depression. A singular report of NCGS presenting with hallucinations has been described in an adult patient. We report a pediatric case of a psychotic disorder clearly related to NCGS and investigate the causes by a review of literature. The pathogenesis of neuro-psychiatric manifestations of NCGS is unclear. It has been hypothesized that: (a) a "leaky gut" allows some gluten peptides to cross the intestinal membrane and the blood brain barrier, affecting the endogenous opiate system and neurotransmission; or (b) gluten peptides may set up an innate immune response in the brain similar to that described in the gut mucosa, causing exposure from neuronal cells of a transglutaminase primarily expressed in the brain. The present case-report confirms that psychosis may be a manifestation of NCGS, and may also involve children; the diagnosis is difficult with many cases remaining undiagnosed. Well-designed prospective studies are needed to establish the real role of gluten as a triggering factor in neuro-psychiatric disorders.

Biomarkers of gluten sensitivity in patients with non-affective psychosis: a meta-analysis

BACKGROUND

Dohan first proposed that there may be an association between gluten sensitivity and schizophrenia in the 1950s. Since then, this association has been measured using several different serum biomarkers of gluten sensitivity. At this point, it is unclear which serum biomarkers of gluten sensitivity are elevated in patients with schizophrenia. However, evidence suggests that the immune response in this group is different from the immune response to gluten found in patients with Celiac disease.

METHODS

A systematic literature review was performed to identify all original articles that measured biomarkers of gluten sensitivity in patients with schizophrenia and non-affective psychoses compared to a control group. Three databases were used: Ovid MEDLINE, Psych INFO, and Embase, dating back to 1946. Forward tracking and backward tracking were undertaken on retrieved papers. A meta-analysis was performed of specific biomarkers and reported according to MOOSE guidelines.

RESULTS

17 relevant original articles were identified, and 12 met criteria for the meta-analysis. Five biomarkers of gluten sensitivity were found to be significantly elevated in patients with non-affective psychoses compared to controls. The pooled odds ratio and 95% confidence intervals were Anti-Gliadin IgG OR=2.31 [1.16, 4.58], Anti-Gliadin IgA OR=2.57 [1.13, 5.82], Anti-TTG2 IgA OR=5.86 [2.88, 11.95], Anti-Gliadin (unspecified isotype) OR=7.68 [2.07, 28.42], and Anti-Wheat OR=2.74 [1.06, 7.08]. Four biomarkers for gluten sensitivity, Anti-EMA IgA, Anti-TTG2 IgG, Anti-DGP IgG, and Anti-Gluten were not found to be associated with schizophrenia.

CONCLUSIONS

Not all serum biomarkers of gluten sensitivity are elevated in patients with schizophrenia. However, the specific immune response to gluten in this population differs from that found in patients with Celiac disease.

Wheat

Wheat is the dominant crop in temperate countries being used for human food and livestock feed. Its success depends partly on its adaptability and high yield potential but also on the gluten protein fraction which confers the viscoelastic properties that allow dough to be processed into bread, pasta, noodles, and other food products. Wheat also contributes essential amino acids, minerals, and vitamins, and beneficial phytochemicals and dietary fibre components to the human diet, and these are particularly enriched in whole-grain products. However, wheat products are also known or suggested to be responsible for a number of adverse reactions in humans, including intolerances (notably coeliac disease) and allergies (respiratory and food). Current and future concerns include sustaining wheat production and quality with reduced inputs of agrochemicals and developing lines with enhanced quality for specific end-uses, notably for biofuels and human nutrition.

Nutritional therapies for mental disorders

According to the Diagnostic and Statistical Manual of Mental Disorders, 4 out of the 10 leading causes of disability in the US and other developed countries are mental disorders. Major depression, bipolar disorder, schizophrenia, and obsessive compulsive disorder (OCD) are among the most common mental disorders that currently plague numerous countries and have varying incidence rates from 26 percent in America to 4 percent in China. Though some of this difference may be attributable to the manner in which individual healthcare providers diagnose mental disorders, this noticeable distribution can be also explained by studies which show that a lack of certain dietary nutrients contribute to the development of mental disorders. Notably, essential vitamins, minerals, and omega-3 fatty acids are often deficient in the general population in America and other developed countries; and are exceptionally deficient in patients suffering from mental disorders. Studies have shown that daily supplements of vital nutrients often effectively reduce patients' symptoms. Supplements that contain amino acids also reduce symptoms, because they are converted to neurotransmitters that alleviate depression and other mental disorders. Based on emerging scientific evidence, this form of nutritional supplement treatment may be appropriate for controlling major depression, bipolar disorder, schizophrenia and anxiety disorders, eating disorders, attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD), addiction, and autism. The aim of this manuscript is to emphasize which dietary supplements can aid the treatment of the four most common mental disorders currently affecting America and other developed countries: major depression, bipolar disorder, schizophrenia, and obsessive compulsive disorder (OCD).

Most antidepressants and other prescription drugs cause severe side effects, which usually discourage patients from taking their medications. Such noncompliant patients who have mental disorders are at a higher risk for committing suicide or being institutionalized. One way for psychiatrists to overcome this noncompliance is to educate themselves about alternative or complementary nutritional treatments. Although in the cases of certain nutrients, further research needs to be done to determine the best recommended doses of most nutritional supplements, psychiatrists can recommend doses of dietary supplements based on previous and current efficacious studies and then adjust the doses based on the results obtained.

Psychological aspects of food allergy

Food allergies may impact the emotions of patients through both direct and indirect mechanisms. Direct mechanisms include the effects on the central nervous system from biologic mediators released during an allergic reaction to food. Indirect mechanisms include the stress of coping with a food allergy--for example, food preparation and avoidance--as well as managing the fear of the potential consequences of ingesting the food. Indirect effects may also be mediated through family members--for example, the impact of a parent's stress on the child. These relationships are difficult to study, in part because many patients who report food allergy symptoms do not have objective symptoms when challenged with the offending food. Symptoms may be misinterpreted as food allergy more often by patients with certain psychological profiles. In this paper, relevant literature is reviewed, and clinical treatment designed to minimize the emotional suffering of patients and their families is presented through the description of a case vignette.

Schizophrenia: is the potato the environmental culprit?

The pathology and aetiology of schizophrenia are reviewed in the light of the most recent research into the genetic/sporadic occurrence of this disease complex of world-wide distribution but of variable incidence. Although the aetiology is still unknown, numerous hypotheses have been postulated including dietetic factors but never has the potato (Solanum tuberosum L.) been suspected. However, a strong case can be advanced incriminating this widely, in fact almost universally, consumed vegetable tuber with its variable content of steroidal glycoalkaloids (SGAs) with known toxic action on both animals and humans, including possible teratogenic and cell membrane-damaging properties, as a very likely aetiological contender in most but possibly not all cases.

Increased allergic reactivity of atopic type in mood disorders and schizophrenia

The allergic reactivity of atopic type was investigated in 54 patients with mood disorders in the course of depressive episode and in 39 patients with schizophrenia. The assessment was done by three methods: intradermal tests, determination of IgE concentration and determination of specific immunoglobulin E (IgE) antibodies. The hypersensitivity to three or more allergens on intradermal tests was found in 40% of depressive and in 27% of schizophrenic patients. The concentration of IgE > 100 IU/mL was found in 45% of patients with depression and in 46% of patients with schizophrenia, more frequently in subjects with hyperactivity of hypothalamic-pituitary-adrenal axis, and in depression, in patients with higher intensity of symptoms. The positive results of the Phadiatop test which detects specific antibodies for inhalatory antigens, were found in 46% of depressive and in 40% of schizophrenic patients The indices of atopy for all three tests were higher in males than in females in both mood disorders and in schizophrenia. However, these indices were similar for unipolar and bipolar depressed patients as well as for patients with paranoid or residual schizophrenia.

Could schizophrenia be reasonably explained by Dohan's hypothesis on genetic interaction with a dietary peptide overload?

1. Dohan has proposed that schizophrenia is a genetic disposition which interacts with an overload of dietary proteins such as casein and gluten or gliadin. 2. A systematic attempt is made to see if this hypothesis is possible faced with aspects of schizophrenia that must be accounted for. 3. The authors conclusion is that it is possible, but more serious work in this field is urgently needed.

Specific IgA antibody increases in schizophrenia

IgA antibody levels in serum were examined in two groups of schizophrenic patients. All were diagnosed according to DSM-III-R criteria. One group of 36 males and 12 females were compared to historical controls. The other group consisted of 13 males off drugs for at least 3 months; these were compared with age- and sex-matched controls. An increase in specific IgA antibodies was found. More schizophrenics than controls showed IgA antibody levels above the upper normal limit to gliadin, beta-lactoglobulin, and casein.

Clinical assessment of emotional milestones in infancy and early childhood

It is now possible to monitor, assess, and, where necessary, facilitate emotional development in infants, young children, and their families. The focus on the infant and the family from multiple aspects of development has made it possible to formulate developmental stages that focus on the infant's social and emotional functioning. This article includes an outline for the emotional evaluation of infants and young children.

Human psychoneuroimmunology today

Studies in human psychoneuroimmunology began around 1919, but a systematic approach wasn't used until the work of Solomon in the 1960s. Recently, the new specialty has achieved relative independence due to considerable data acquisition. Stress research has revealed relationships between neuroendocrine and immune changes. In parallel, increasing evidence of immunological alterations in psychiatric diseases has expanded the field; presently, immunological correlates of psychosomatic diseases and personality are sought. On the other hand, while immunological disease has been psychologically assessed for many years, a clear-cut link between psyche and immunological changes has yet to be shown. This fact, along with the therapeutic implications of advancing knowledge, will influence strongly the future trends of psychoneuroimmunology. Concepts emerging from the study of this field will be of heuristic value to both psychiatry and immunology and will help define new and expanded limits for both disciplines.

Small intestine permeability in schizophrenia

Gastrointestinal permeability was assessed by means of absorption of 51Cr-labelled EDTA in 24 patients with schizophrenia (12 in relapse and 12 in remission). The results were compared with those for patients with coeliac disease and those for normal controls. Significant differences between the schizophrenic patients and the normal controls were not established. The results for the schizophrenic patients in remission were no different from those for the patients in relapse, and there was no evidence from the study of an effect on gastrointestinal permeability of either anticholinergic or antidepressant medication. It is concluded that schizophrenia is, at least in the majority of cases, unrelated to coeliac disease.