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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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2
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SheikhBahaei S, Millwater M, Maguire GA. Stuttering as a spectrum disorder: A hypothesis. CURRENT RESEARCH IN NEUROBIOLOGY 2023; 5:100116. [PMID: 38020803 PMCID: PMC10663130 DOI: 10.1016/j.crneur.2023.100116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/26/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Childhood-onset fluency disorder, commonly referred to as stuttering, affects over 70 million adults worldwide. While stuttering predominantly initiates during childhood and is more prevalent in males, it presents consistent symptoms during conversational speech. Despite these common clinical manifestations, evidence suggests that stuttering, may arise from different etiologies, emphasizing the need for personalized therapy approaches. Current research models often regard the stuttering population as a singular, homogenous group, potentially overlooking the inherent heterogeneity. This perspective consolidates both historical and recent observations to emphasize that stuttering is a heterogeneous condition with diverse causes. As such, it is crucial that both therapeutic research and clinical practices consider the potential for varied etiologies leading to stuttering. Recognizing stuttering as a spectrum disorder embraces its inherent variability, allowing for a more nuanced categorization of individuals based on the underlying causes. This perspective aligns with the principles of precision medicine, advocating for tailored treatments for distinct subgroups of people who stutter, ultimately leading to personalized therapeutic approaches.
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Affiliation(s)
- Shahriar SheikhBahaei
- Neuron-Glia Signaling and Circuits Unit, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, 20892, MD, USA
| | - Marissa Millwater
- Neuron-Glia Signaling and Circuits Unit, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, 20892, MD, USA
| | - Gerald A. Maguire
- CenExel Research/ American University of Health Sciences, Signal Hill, CA, 90755, USA
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3
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Grant JE, Drummond L, Nicholson TR, Fagan H, Baldwin DS, Fineberg NA, Chamberlain SR. Obsessive-compulsive symptoms and the Covid-19 pandemic: A rapid scoping review. Neurosci Biobehav Rev 2022; 132:1086-1098. [PMID: 34740755 PMCID: PMC8570941 DOI: 10.1016/j.neubiorev.2021.10.039] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND There has been much speculation about untoward effects of the Covid-19 pandemic on psychological symptoms. OCD may be expected to be especially impacted. Our aim was to distil the current evidence base on relationships between the pandemic and obsessive-compulsive symptoms, in patients, and general population samples. METHODS We conducted a rapid scoping review, in the form of a systematic literature search, coupled with narrative review. 32 relevant papers were identified. RESULTS AND INTERPRETATION (1) A sizable proportion of people with OCD (but not all) experienced/reported symptom worsening during the pandemic, especially during initial restrictions (approximately 20-65 % of cases in longitudinal studies); (2) contamination/washing symptoms appeared particularly susceptible; and (3) OCD symptoms in general population samples were associated with trait compulsivity and pandemic-related-stress. The literature was heterogeneous with various methodological issues being commonplace. FUTURE DIRECTIONS The review identified important unaddressed issues: how should exposure based therapy be adapted during pandemics? How can we minimise harm from exacerbation of OCD in vulnerable individuals arising from public health messaging? Why do some but not all OCD patients experience worsening? And does Covid-19 infection affect (or lead to) OCD symptoms?
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Affiliation(s)
- Jon E. Grant
- Department of Psychiatry, University of Chicago, Chicago, USA
| | - Lynne Drummond
- South West London and St George’s NHS Trust and University of Hertfordshire, UK
| | - Timothy R. Nicholson
- Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Harry Fagan
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, UK,Southern Health NHS Foundation Trust, Southampton, UK
| | - David S. Baldwin
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, UK,Southern Health NHS Foundation Trust, Southampton, UK
| | - Naomi A. Fineberg
- National Treatment Service for OCD (England and Wales), Hertfordshire, UK
| | - Samuel R. Chamberlain
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, UK,Southern Health NHS Foundation Trust, Southampton, UK,Corresponding author at: Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, UK
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Ajmone-Cat MA, Spinello C, Valenti D, Franchi F, Macrì S, Vacca RA, Laviola G. Brain-Immune Alterations and Mitochondrial Dysfunctions in a Mouse Model of Paediatric Autoimmune Disorder Associated with Streptococcus: Exacerbation by Chronic Psychosocial Stress. J Clin Med 2019; 8:jcm8101514. [PMID: 31547098 PMCID: PMC6833026 DOI: 10.3390/jcm8101514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 09/17/2019] [Accepted: 09/18/2019] [Indexed: 12/18/2022] Open
Abstract
Adverse psychosocial experiences have been shown to modulate individual responses to immune challenges and affect mitochondrial functions. The aim of this study was to investigate inflammation and immune responses as well as mitochondrial bioenergetics in an experimental model of Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus (PANDAS). Starting in adolescence (postnatal day 28), male SJL/J mice were exposed to five injections (interspaced by two weeks) with Group-A beta-haemolytic streptococcus (GAS) homogenate. Mice were exposed to chronic psychosocial stress, in the form of protracted visual exposure to an aggressive conspecific, for four weeks. Our results indicate that psychosocial stress exacerbated individual response to GAS administrations whereby mice exposed to both treatments exhibited altered cytokine and immune-related enzyme expression in the hippocampus and hypothalamus. Additionally, they showed impaired mitochondrial respiratory chain complexes IV and V, and reduced adenosine triphosphate (ATP) production by mitochondria and ATP content. These brain abnormalities, observed in GAS-Stress mice, were associated with blunted titers of plasma corticosterone. Present data support the hypothesis that challenging environmental conditions, in terms of chronic psychosocial stress, may exacerbate the long-term consequences of exposure to GAS processes through the promotion of central immunomodulatory and oxidative stress.
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Affiliation(s)
- Maria Antonietta Ajmone-Cat
- National Center for Drug Research and Evaluation, Istituto Superiore di Sanità, Viale Regina Elena, 299, I-00161 Rome, Italy.
| | - Chiara Spinello
- Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, I-00161 Rome, Italy.
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, NY 11201, USA.
| | - Daniela Valenti
- Institute of Biomembranes, Bioenergetics and Molecular Biotechnologies, National Council of Research, Via Giovanni Amendola 122/O - 70126 Bari, Italy.
| | - Francesca Franchi
- Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, I-00161 Rome, Italy.
| | - Simone Macrì
- Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, I-00161 Rome, Italy.
| | - Rosa Anna Vacca
- Institute of Biomembranes, Bioenergetics and Molecular Biotechnologies, National Council of Research, Via Giovanni Amendola 122/O - 70126 Bari, Italy.
| | - Giovanni Laviola
- Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, I-00161 Rome, Italy.
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Wilkinson-Smith A, Greenberg B, Keech A. The princess and the p-value: A case report of suspected autoimmune encephalitis and functional neurological disorder in a pediatric patient. APPLIED NEUROPSYCHOLOGY-CHILD 2018; 9:13-20. [DOI: 10.1080/21622965.2018.1501373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Alison Wilkinson-Smith
- Department of Psychiatry, Children’s Health Children’s Medical Center, Dallas, Texas, USA
| | - Benjamin Greenberg
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Audrey Keech
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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6
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Stagi S, Lepri G, Rigante D, Matucci Cerinic M, Falcini F. Cross-Sectional Evaluation of Plasma Vitamin D Levels in a Large Cohort of Italian Patients with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. J Child Adolesc Psychopharmacol 2018; 28:124-129. [PMID: 29112476 DOI: 10.1089/cap.2016.0159] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) are immune-mediated diseases characterized by obsessive-compulsive symptoms and/or tics triggered by group A Streptococcus infections. Despite the well-known action of 25-hydroxyvitamin D [25(OH)D] on different conditions driven by systemic inflammation, there are no data about the 25(OH)D status in patients with PANDAS. AIMS To evaluate plasma 25(OH)D levels in a large cohort of children and adolescents with PANDAS and comparing the results with healthy controls. METHODS We have evaluated plasma 25(OH)D levels in 179 Italian patients with PANDAS (49 females, 130 males, mean age at diagnosis: 101.4 ± 30.1 months) and in an age-, gender-, and body mass index-matched control group of 224 healthy subjects. RESULTS Patients with PANDAS have shown more frequently reduced 25(OH)D levels (<30 ng/mL) in comparison with controls (94.6% vs. 82.5%, p = 0.0007). Patients with PANDAS had also lower levels of 25(OH)D than controls (20.4 ± 6.9 ng/mL vs. 24.8 ± 7.3 ng/mL, p < 0.0001). This difference was observed during both winter (13.7 ± 3.25 ng/mL vs. 21.4 ± 5.9 ng/mL, p < 0.0001) and summer (21.8 ± 6.5 ng/mL vs. 32.5 ± 8.7 ng/mL, p < 0.0001). Notably, serum 25(OH)D levels correlated with both number of streptococcal (strep) infections before diagnosis of PANDAS (p < 0.005) and with infection recurrence (p < 0.005). CONCLUSIONS PANDAS patients have reduced 25(OH)D levels, which appear related to streptococcal infections and the probability of recurrence. Further long-term studies with higher number of patients are needed to investigate and confirm this relationship.
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Affiliation(s)
- Stefano Stagi
- 1 Department of Health Sciences, University of Florence , Florence, Italy
| | - Gemma Lepri
- 2 Rheumatology Section, Department of Internal Medicine, Transition Clinic, University of Florence , Florence, Italy
| | - Donato Rigante
- 3 Institute of Pediatrics , Fondazione Policlinico Universitario A. Gemelli, Università Cattolica Sacro Cuore, Rome, Italy
| | - Marco Matucci Cerinic
- 2 Rheumatology Section, Department of Internal Medicine, Transition Clinic, University of Florence , Florence, Italy
| | - Fernanda Falcini
- 2 Rheumatology Section, Department of Internal Medicine, Transition Clinic, University of Florence , Florence, Italy
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7
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A critical review of PANDAS research in the context of obsessive compulsive disorder. HEALTH PSYCHOLOGY REPORT 2018. [DOI: 10.5114/hpr.2018.70356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Repetitive Behaviours and Restricted Interests in Individuals with Down Syndrome-One Way of Managing Their World? Brain Sci 2017; 7:brainsci7060066. [PMID: 28617347 PMCID: PMC5483639 DOI: 10.3390/brainsci7060066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 06/01/2017] [Accepted: 06/06/2017] [Indexed: 01/11/2023] Open
Abstract
This paper argues that the repetitive behaviour and restrictive interests (RBRI) displayed by individuals with Down syndrome have mostly positive functions. However, as research has developed from interests in Obsessional Compulsive Disorder or Autistic Spectrum Disorder, unfortunately a view has arisen that RBRI in individuals with Down syndrome are also likely to be pathological. This is particularly the case in adults. The paper reviews: (a) measures employed and the perspectives that have been used; (b) the development in typically developing individuals, those with Down syndrome, and those with other conditions associated with intellectual disability; (c) positive and possible negative effects of RBRI; and (d) the need for more research. The conclusion is that, for their level of development, RBRI are helpful for most individuals with Down syndrome.
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9
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Perez EE, Orange JS, Bonilla F, Chinen J, Chinn IK, Dorsey M, El-Gamal Y, Harville TO, Hossny E, Mazer B, Nelson R, Secord E, Jordan SC, Stiehm ER, Vo AA, Ballow M. Update on the use of immunoglobulin in human disease: A review of evidence. J Allergy Clin Immunol 2016; 139:S1-S46. [PMID: 28041678 DOI: 10.1016/j.jaci.2016.09.023] [Citation(s) in RCA: 376] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 09/12/2016] [Accepted: 09/23/2016] [Indexed: 12/20/2022]
Abstract
Human immunoglobulin preparations for intravenous or subcutaneous administration are the cornerstone of treatment in patients with primary immunodeficiency diseases affecting the humoral immune system. Intravenous preparations have a number of important uses in the treatment of other diseases in humans as well, some for which acceptable treatment alternatives do not exist. We provide an update of the evidence-based guideline on immunoglobulin therapy, last published in 2006. Given the potential risks and inherent scarcity of human immunoglobulin, careful consideration of its indications and administration is warranted.
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Affiliation(s)
- Elena E Perez
- Allergy Associates of the Palm Beaches, North Palm Beach, Fla.
| | - Jordan S Orange
- Department of Pediatrics, Section of Immunology Allergy and Rheumatology, Center for Human Immunobiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Tex
| | - Francisco Bonilla
- Department of Pediatrics, Clinical Immunology Program, Children's Hospital Boston and Harvard Medical School, Boston, Mass
| | - Javier Chinen
- Department of Pediatrics, Section of Immunology Allergy and Rheumatology, Center for Human Immunobiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Tex
| | - Ivan K Chinn
- Department of Pediatrics, Section of Immunology Allergy and Rheumatology, Center for Human Immunobiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Tex
| | - Morna Dorsey
- Department of Pediatrics, Allergy, Immunology and BMT Division, Benioff Children's Hospital and University of California, San Francisco, Calif
| | - Yehia El-Gamal
- Department of Pediatrics, Pediatric Allergy and Immunology Unit, Children's Hospital and Ain Shams University, Cairo, Egypt
| | - Terry O Harville
- Departments of Pathology and Laboratory Services and Pediatrics, University of Arkansas, Little Rock, Ark
| | - Elham Hossny
- Department of Pediatrics, Pediatric Allergy and Immunology Unit, Children's Hospital and Ain Shams University, Cairo, Egypt
| | - Bruce Mazer
- Department of Pediatrics, Allergy and Immunology, Montreal Children's Hospital and McGill University, Montreal, Quebec, Canada
| | - Robert Nelson
- Department of Medicine and Pediatrics, Division of Hematology and Oncology and Stem Cell Transplantation, Riley Hospital, Indiana University School of Medicine and the IU Melvin and Bren Simon Cancer Center, Indianapolis, Ind
| | - Elizabeth Secord
- Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, Mich
| | - Stanley C Jordan
- Nephrology & Transplant Immunology, Kidney Transplant Program, David Geffen School of Medicine at UCLA and Cedars-Sinai Medical Center, Los Angeles, Calif
| | - E Richard Stiehm
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, Calif
| | - Ashley A Vo
- Transplant Immunotherapy Program, Comprehensive Transplant Center, Kidney Transplant Program, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Mark Ballow
- Department of Pediatrics, Division of Allergy & Immunology, University of South Florida, Morsani College of Medicine, Johns Hopkins All Children's Hospital, St Petersburg, Fla
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10
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Pediatric Anti-ganglionic Antibody Positive Autonomic Neuropathy: Clinical Presentation and Response to Treatment. Pediatr Neurol 2016; 64:72-76. [PMID: 27569256 DOI: 10.1016/j.pediatrneurol.2016.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 06/09/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Autoimmune autonomic neuropathy is rare in children. There are few pediatric reports documenting anti-ganglionic antibodies. METHODS We present two children with anti-ganglionic antibody positive autonomic neuropathy, including their presentation, results of testing, and treatment course. RESULTS Both children had delayed diagnoses because of the presence of vague autonomic symptoms. Treatment with multiple immunotherapies appears to bring at least a partial response and can be monitored with anti-ganglionic antibody titers. CONCLUSION Our findings contribute to the sparse literature in pediatric autoimmune autonomic neuropathy and highlight the need for additional studies to create diagnostic criteria and define optimal treatment regimens.
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11
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Spinello C, Laviola G, Macrì S. Pediatric Autoimmune Disorders Associated with Streptococcal Infections and Tourette's Syndrome in Preclinical Studies. Front Neurosci 2016; 10:310. [PMID: 27445678 PMCID: PMC4928151 DOI: 10.3389/fnins.2016.00310] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 06/20/2016] [Indexed: 01/08/2023] Open
Abstract
Accumulating evidence suggests that Tourette's Syndrome (TS) - a multifactorial pediatric disorder characterized by the recurrent exhibition of motor tics and/or vocal utterances - can partly depend on immune dysregulation provoked by early repeated streptococcal infections. The natural and adaptive antibody-mediated reaction to streptococcus has been proposed to potentially turn into a pathological autoimmune response in vulnerable individuals. Specifically, in conditions of increased permeability of the blood brain barrier (BBB), streptococcus-induced antibodies have been proposed to: (i) reach neuronal targets located in brain areas responsible for motion control; and (ii) contribute to the exhibition of symptoms. This theoretical framework is supported by indirect evidence indicating that a subset of TS patients exhibit elevated streptococcal antibody titers upon tic relapses. A systematic evaluation of this hypothesis entails preclinical studies providing a proof of concept of the aforementioned pathological sequelae. These studies shall rest upon individuals characterized by a vulnerable immune system, repeatedly exposed to streptococcus, and carefully screened for phenotypes isomorphic to the pathological signs of TS observed in patients. Preclinical animal models may thus constitute an informative, useful tool upon which conducting targeted, hypothesis-driven experiments. In the present review we discuss the available evidence in preclinical models in support of the link between TS and pediatric autoimmune neuropsychiatric disorders associated with streptococcus infections (PANDAS), and the existing gaps that future research shall bridge. Specifically, we report recent preclinical evidence indicating that the immune responses to repeated streptococcal immunizations relate to the occurrence of behavioral and neurological phenotypes reminiscent of TS. By the same token, we discuss the limitations of these studies: limited evidence of behavioral phenotypes isomorphic to tics and scarce knowledge about the immunological phenomena favoring the transition from natural adaptive immunity to pathological outcomes.
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Affiliation(s)
- Chiara Spinello
- Section of Behavioural Neuroscience, Department of Cell Biology and Neuroscience, Istituto Superiore di Sanità Roma, Italy
| | - Giovanni Laviola
- Section of Behavioural Neuroscience, Department of Cell Biology and Neuroscience, Istituto Superiore di Sanità Roma, Italy
| | - Simone Macrì
- Section of Behavioural Neuroscience, Department of Cell Biology and Neuroscience, Istituto Superiore di Sanità Roma, Italy
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12
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Cunningham MW, Cox CJ. Autoimmunity against dopamine receptors in neuropsychiatric and movement disorders: a review of Sydenham chorea and beyond. Acta Physiol (Oxf) 2016; 216:90-100. [PMID: 26454143 PMCID: PMC5812018 DOI: 10.1111/apha.12614] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 02/26/2015] [Accepted: 09/23/2015] [Indexed: 12/16/2022]
Abstract
Antineuronal autoantibodies are associated with the involuntary movement disorder Sydenham chorea (SC) and paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) which are characterized by the acute onset of tics and/or obsessive compulsive disorder (OCD). In SC and PANDAS, autoantibodies signal human neuronal cells and activate calcium calmodulin-dependent protein kinase II (CaMKII). Animal models immunized with group A streptococcal antigens demonstrate autoantibodies against dopamine receptors and concomitantly altered behaviours. Human monoclonal antibodies (mAbs) derived from SC target and signal the dopamine D2L (long) receptor (D2R). Antibodies against D2R were elevated over normal levels in SC and acute-onset PANDAS with small choreiform movements, but were not elevated over normal levels in PANDAS-like chronic tics and OCD. The expression of human SC-derived anti-D2R autoantibody V gene in B cells and serum of transgenic mice demonstrated that the human autoantibody targets dopaminergic neurones in the basal ganglia and other types of neurones in the cortex. Here, we review current evidence supporting the hypothesis that antineuronal antibodies, specifically against dopamine receptors, follow streptococcal exposures and may target dopamine receptors and alter central dopamine pathways leading to movement and neuropsychiatric disorders.
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Affiliation(s)
- M W Cunningham
- Department of Microbiology and Immunology, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - C J Cox
- Department of Microbiology and Immunology, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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13
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O’Connor TG, Moynihan JA, Wyman PA, Carnahan J, Lofthus G, Quataert SA, Bowman M, Caserta MT. Depressive symptoms and immune response to meningococcal conjugate vaccine in early adolescence. Dev Psychopathol 2014; 26:1567-76. [PMID: 25422979 PMCID: PMC5771474 DOI: 10.1017/s0954579414001242] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Research findings in psychoneuroimmunology document reliable, bidirectional linkages among psychological processes, the nervous system, and the immune system. However, available data are based almost entirely on animal and adult human studies; the application to children and adolescents is uncertain. We capitalized on the experimental leverage provided by a routine vaccination to examine the link between mood symptoms and the immune response to a vaccine challenge in early adolescence. One hundred twenty-six 11-year-olds for whom vaccine response data were available were assessed at prevaccination and 4 weeks, 3 months, and 6 months following vaccination; self-report ratings of depression and anxiety as well as measures of psychosocial and somatic risk were assessed prior to vaccine response. Analyses indicated that children's internalizing mood symptoms were associated with elevated and persistently higher antibody responses, with evidence extending to two of the four serogroups. The associations remained after controlling for multiple possible confounders (social class, body mass index, sleep, psychosocial risk, and pubertal status). The observed enhanced vaccine response associated with depressive and anxious symptoms in early adolescence may reflect an important developmental difference in immune system-brain interplay between adults and children, and it underscores the need for further developmental studies of psychoneuroimmunology.
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14
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Godar SC, Mosher LJ, Di Giovanni G, Bortolato M. Animal models of tic disorders: a translational perspective. J Neurosci Methods 2014; 238:54-69. [PMID: 25244952 DOI: 10.1016/j.jneumeth.2014.09.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 09/09/2014] [Accepted: 09/11/2014] [Indexed: 12/30/2022]
Abstract
Tics are repetitive, sudden movements and/or vocalizations, typically enacted as maladaptive responses to intrusive premonitory urges. The most severe tic disorder, Tourette syndrome (TS), is a childhood-onset condition featuring multiple motor and at least one phonic tic for a duration longer than 1 year. The pharmacological treatment of TS is mainly based on antipsychotic agents; while these drugs are often effective in reducing tic severity and frequency, their therapeutic compliance is limited by serious motor and cognitive side effects. The identification of novel therapeutic targets and development of better treatments for tic disorders is conditional on the development of animal models with high translational validity. In addition, these experimental tools can prove extremely useful to test hypotheses on the etiology and neurobiological bases of TS and related conditions. In recent years, the translational value of these animal models has been enhanced, thanks to a significant re-organization of our conceptual framework of neuropsychiatric disorders, with a greater focus on endophenotypes and quantitative indices, rather than qualitative descriptors. Given the complex and multifactorial nature of TS and other tic disorders, the selection of animal models that can appropriately capture specific symptomatic aspects of these conditions can pose significant theoretical and methodological challenges. In this article, we will review the state of the art on the available animal models of tic disorders, based on genetic mutations, environmental interventions as well as pharmacological manipulations. Furthermore, we will outline emerging lines of translational research showing how some of these experimental preparations have led to significant progress in the identification of novel therapeutic targets for tic disorders.
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Affiliation(s)
- Sean C Godar
- Department of Pharmacology and Toxicology, School of Pharmacy; University of Kansas, Lawrence, KS, USA
| | - Laura J Mosher
- Department of Pharmacology and Toxicology, School of Pharmacy; University of Kansas, Lawrence, KS, USA
| | - Giuseppe Di Giovanni
- Department of Physiology and Biochemistry, University of Malta, Msida, Malta; School of Biosciences, Cardiff University, Cardiff, UK
| | - Marco Bortolato
- Department of Pharmacology and Toxicology, School of Pharmacy; University of Kansas, Lawrence, KS, USA; Consortium for Translational Research on Aggression and Drug Abuse (ConTRADA), University of Kansas, Lawrence, KS, USA.
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15
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Stagi S, Rigante D, Lepri G, Bertini F, Matucci-Cerinic M, Falcini F. Evaluation of autoimmune phenomena in patients with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Autoimmun Rev 2014; 13:1236-40. [PMID: 25151976 DOI: 10.1016/j.autrev.2014.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 08/02/2014] [Indexed: 10/24/2022]
Abstract
The pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) are basically characterized by obsessive-compulsive symptoms and/or tics triggered by group-A beta-hemolytic Streptococcus infections. Poor data are available about the clear definition of PANDAS's autoimmune origin. The aim of our study was to evaluate the prevalence of autoimmune phenomena, including thyroid function abnormalities, specific celiac disease antibodies, and positivity of organ- or nonorgan-specific autoantibodies in a large cohort of Caucasian children and adolescents with PANDAS. Seventy-seven consecutive patients (59 males, 18 females; mean age 6.3±2.5 years, range 2.0-14.5 years) strictly fulfilling the clinical criteria for PANDAS diagnosis were recruited. In all subjects we evaluated serum concentrations of free-T3, free-T4, thyrotropin, and the following auto-antibodies: anti-thyroperoxidase, anti-thyroglobulin, anti-thyrotropin receptor, anti-gliadin, anti-endomysium, anti-tissue transglutaminase, anti-nuclear, anti-smooth muscle, anti-extractable nuclear antigens, anti-phospholipid, plus lupus-like anticoagulant. The results were compared with those obtained from 197 age- and sex-matched healthy controls (130 males, 67 females; mean age 6.8±2.9 years, range 2.3-14.8 years). The frequencies of subclinical (3.8% vs 3.6%) and overt hypothyroidism (1.2% vs 0%), autoimmune thyroiditis (2.46% vs 1.14%), celiac disease (1.2% vs 0.05%), and positivity of organ- and nonorgan-specific autoantibodies (5.1% vs 4.8%) were not statistically significant between patients with PANDAS and controls. Evaluating the overall disease duration, we did not observe any significant difference between patients with (3.4±2.15 years) and without (3.4±2.89 years) autoimmune abnormalities. However, PANDAS patients with autoimmune diseases or positivity for any organ- and nonorgan-specific antibodies showed significantly higher anti-streptolysin O and anti-DNAse B titers, as well as a history of more frequent throat infections than controls (p<0.0001). Abnormalities of thyroid function and thyroid autoimmune diseases, as well as the association with celiac disease or organ- and nonorgan-specific autoimmunity seem not more frequent in children and adolescents with PANDAS than in healthy controls. A potential relationship between autoimmunity and PANDAS should be assessed further in larger studies. Children and adolescents with PANDAS should not be actually screened for thyroid function, celiac disease and/or autoimmune diseases.
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Affiliation(s)
- Stefano Stagi
- Health Sciences Department, University of Florence, Anna Meyer Childrens University Hospital, Florence, Italy.
| | - Donato Rigante
- Institute of Pediatrics, Università Cattolica Sacro Cuore, Rome, Italy
| | - Gemma Lepri
- Department of Internal Medicine, Section of Rheumatology, Transition Clinic, University of Florence, Florence, Italy
| | - Federico Bertini
- Department of Internal Medicine, Section of Rheumatology, Transition Clinic, University of Florence, Florence, Italy
| | - Marco Matucci-Cerinic
- Department of Internal Medicine, Section of Rheumatology, Transition Clinic, University of Florence, Florence, Italy
| | - Fernanda Falcini
- Department of Internal Medicine, Section of Rheumatology, Transition Clinic, University of Florence, Florence, Italy
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O'Connor TG, Moynihan JA, Caserta MT. Annual research review: The neuroinflammation hypothesis for stress and psychopathology in children--developmental psychoneuroimmunology. J Child Psychol Psychiatry 2014; 55:615-31. [PMID: 24372371 PMCID: PMC4029900 DOI: 10.1111/jcpp.12187] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2013] [Indexed: 12/14/2022]
Abstract
Experimental animal and adult human data suggest that stress exposure is associated with alterations in immune system function that may underlie increased susceptibility to disease and behavioral disorders. The implications of these data for child psychology and psychiatry are not yet clear. The current review seeks to distil and translate the relevant animal and adult human work to children to advance a developmental model of psychoneuroimmunology. In addition to reviewing key specific findings, we consider biological/conceptual models and technical aspects of psychoneuroimmunology work in pediatric populations, and outline the rationales and advantages of integrating hypotheses concerning neuroinflammation in developmental studies of psychopathology.
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Lotan D, Benhar I, Alvarez K, Mascaro-Blanco A, Brimberg L, Frenkel D, Cunningham MW, Joel D. Behavioral and neural effects of intra-striatal infusion of anti-streptococcal antibodies in rats. Brain Behav Immun 2014; 38:249-62. [PMID: 24561489 PMCID: PMC4000697 DOI: 10.1016/j.bbi.2014.02.009] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 02/07/2014] [Accepted: 02/12/2014] [Indexed: 02/03/2023] Open
Abstract
Group A β-hemolytic streptococcal (GAS) infection is associated with a spectrum of neuropsychiatric disorders. The leading hypothesis regarding this association proposes that a GAS infection induces the production of auto-antibodies, which cross-react with neuronal determinants in the brain through the process of molecular mimicry. We have recently shown that exposure of rats to GAS antigen leads to the production of anti-neuronal antibodies concomitant with the development of behavioral alterations. The present study tested the causal role of the antibodies by assessing the behavior of naïve rats following passive transfer of purified antibodies from GAS-exposed rats. Immunoglobulin G (IgG) purified from the sera of GAS-exposed rats was infused directly into the striatum of naïve rats over a 21-day period. Their behavior in the induced-grooming, marble burying, food manipulation and beam walking assays was compared to that of naïve rats infused with IgG purified from adjuvant-exposed rats as well as of naïve rats. The pattern of in vivo antibody deposition in rat brain was evaluated using immunofluorescence and colocalization. Infusion of IgG from GAS-exposed rats to naïve rats led to behavioral and motor alterations partially mimicking those seen in GAS-exposed rats. IgG from GAS-exposed rats reacted with D1 and D2 dopamine receptors and 5HT-2A and 5HT-2C serotonin receptors in vitro. In vivo, IgG deposits in the striatum of infused rats colocalized with specific brain proteins such as dopamine receptors, the serotonin transporter and other neuronal proteins. Our results demonstrate the potential pathogenic role of autoantibodies produced following exposure to GAS in the induction of behavioral and motor alterations, and support a causal role for autoantibodies in GAS-related neuropsychiatric disorders.
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Affiliation(s)
- Dafna Lotan
- School of Psychological Sciences and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Itai Benhar
- Department of Molecular Microbiology and Biotechnology, George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Kathy Alvarez
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Adita Mascaro-Blanco
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Lior Brimberg
- School of Psychological Sciences and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel,The Feinstein Institute for Medical Research, Center for Autoimmune and Musculoskeletal Diseases, Manhasset, NY, USA
| | - Dan Frenkel
- Department of Neurobiology, George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Madeleine W. Cunningham
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Daphna Joel
- School of Psychological Sciences and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
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Cox CJ, Sharma M, Leckman JF, Zuccolo J, Zuccolo A, Kovoor A, Swedo SE, Cunningham MW. Brain human monoclonal autoantibody from sydenham chorea targets dopaminergic neurons in transgenic mice and signals dopamine D2 receptor: implications in human disease. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2013; 191:5524-41. [PMID: 24184556 PMCID: PMC3848617 DOI: 10.4049/jimmunol.1102592] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
How autoantibodies target the brain and lead to disease in disorders such as Sydenham chorea (SC) is not known. SC is characterized by autoantibodies against the brain and is the main neurologic manifestation of streptococcal-induced rheumatic fever. Previously, our novel SC-derived mAb 24.3.1 was found to recognize streptococcal and brain Ags. To investigate in vivo targets of human mAb 24.3.1, VH/VL genes were expressed in B cells of transgenic (Tg) mice as functional chimeric human VH 24.3.1-mouse C-region IgG1(a) autoantibody. Chimeric human-mouse IgG1(a) autoantibody colocalized with tyrosine hydroxylase in the basal ganglia within dopaminergic neurons in vivo in VH 24.3.1 Tg mice. Both human mAb 24.3.1 and IgG1(a) in Tg sera were found to react with human dopamine D2 receptor (D2R). Reactivity of chorea-derived mAb 24.3.1 or SC IgG with D2R was confirmed by dose-dependent inhibitory signaling of D2R as a potential consequence of targeting dopaminergic neurons, reaction with surface-exposed FLAG epitope-tagged D2R, and blocking of Ab reactivity by an extracellular D2R peptide. IgG from SC and a related subset of streptococcal-associated behavioral disorders called "pediatric autoimmune neuropsychiatric disorder associated with streptococci" (PANDAS) with small choreiform movements reacted in ELISA with D2R. Reaction with FLAG-tagged D2R distinguished SC from PANDAS, whereas sera from both SC and PANDAS induced inhibitory signaling of D2R on transfected cells comparably to dopamine. In this study, we define a mechanism by which the brain may be altered by Ab in movement and behavioral disorders.
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Affiliation(s)
- Carol J. Cox
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Biomedical Research Center, Oklahoma City, OK 73104
| | - Meenakshi Sharma
- Department of Biomedical and Pharmacological Sciences, College of Pharmacy, University of Rhode Island, Kingston, RI 02881
| | - James F. Leckman
- Yale Child Study Center and Departments of Pediatrics and Psychiatry, Yale University School of Medicine, New Haven, CT 06519
| | - Jonathan Zuccolo
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Biomedical Research Center, Oklahoma City, OK 73104
| | - Amir Zuccolo
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Biomedical Research Center, Oklahoma City, OK 73104
| | - Abraham Kovoor
- Department of Biomedical and Pharmacological Sciences, College of Pharmacy, University of Rhode Island, Kingston, RI 02881
| | - Susan E. Swedo
- Pediatrics and Developmental Neuroscience Branch, National Institute of Mental Health, Department of Health and Human Services, Bethesda, MD 20892
| | - Madeleine W. Cunningham
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Biomedical Research Center, Oklahoma City, OK 73104
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Luleyap HU, Onatoglu D, Yilmaz MB, Alptekin D, Tahiroglu AY, Cetiner S, Pazarbasi A, Unal I, Avci A, Comertpay G. Association between pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections disease and tumor necrosis factor-α gene-308 g/a, -850 c/t polymorphisms in 4-12-year-old children in Adana/Turkey. INDIAN JOURNAL OF HUMAN GENETICS 2013; 19:196-201. [PMID: 24019622 PMCID: PMC3758727 DOI: 10.4103/0971-6866.116116] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) is a newly defined disease in neuropsychiatry and occurs with an autoimmune mechanism after Group A Beta Hemolytic Streptococcus (GABHS) infection. Tumor necrosis factor (TNF), encoded by TNF-α gene has an important role in the apoptotic mechanisms of autoimmune diseases. Recently, TNF-α polymorphisms and autoimmune/psychiatric disorders have been reported to be related. In this regard, we focused on to investigate a possible relation between the TNF-α gene promoter region−308 G/A and − 850 C/T polymorphisms and PANDAS. MATERIALS AND METHODS: In this study, ages of PANDAS patient and control groups were ranging from 4 years to 12-year-old. Patient group includes childhood onset PANDAS patients (n = 42) and control group includes healthy children (n = 58). Diagnoses have been carried out according to Diagnostic and Statistical Manual of Mental Disorder (DSM-IV) criteria with Affective Disorders and Schizophrenia-Present and Lifetime (KSAD-S-PL) and Children Yale-Brown Obsessive Compulsive Scale Moreover, PANDAS criteria established by the American National Psychiatry Institute have been employed for diagnoses. For identifying polymorphisms; Polymerase Chain Reaction, Restriction Fragment Length Polymorphism and Polyacrylamid Gel Electrophoresis were used. RESULTS AND DISCUSSION: For −308 polymorphism, 37 of 42 PANDAS patients’ results and for −850 C/T polymorphism, 38 of 42 PANDAS patients’ results were obtained. According to our statistical analysis there is a positive relationship between PANDAS patients for −308 G/A polymorphism but not for −850 C/T polymorphism. There is no positive relationship between −308 G/A polymorphism and antistrep-tolysin O (ASO) titers and no relationship between −850 C/T polymorphism and ASO titers. We found, however, positive relationship between genders of patients (boys) and the disease. According to our results, we propose that the AA polymorphism of −308 G/A polymorphism can be used as a molecular indicator for PANDAS.
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Affiliation(s)
- H Umit Luleyap
- Department of Medical Biology, Faculty of Medicine, Balcali Hospital, University of Cukurova, 01330 Adana, Turkey
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Immune-mediated animal models of Tourette syndrome. Neurosci Biobehav Rev 2013; 37:1120-38. [PMID: 23313649 DOI: 10.1016/j.neubiorev.2013.01.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 12/11/2012] [Accepted: 01/03/2013] [Indexed: 12/20/2022]
Abstract
An autoimmune diathesis has been proposed in Tourette syndrome (TS) and related neuropsychiatric disorders such as obsessive-compulsive disorder, attention-deficit/hyperactivity disorder, autism and anorexia nervosa. Environmental triggers including infection and xenobiotics are hypothesized to lead to the production of brain-directed autoantibodies in a subset of genetically susceptible individuals. Although much work has focused on Group A Streptococcus (GAS), the role of this common childhood infection remains controversial. Animal model studies based on immune and autoantibody findings in TS have demonstrated immunoglobulin (Ig) deposits and stereotypic movements and related behavioral disturbances reminiscent of TS following exposure to GAS, other activators of host anti-microbial responses, soluble immune mediators and anti-GAS or anti-neuronal antibodies. Demonstration of the ability to recreate these abnormalities through passive transfer of serum IgG from GAS-immunized mice into naïve mice and abrogation of this activity through depletion of IgG has provided compelling evidence in support of the autoimmune hypothesis. Immunologically-based animal models of TS are a potent tool for dissecting the pathogenesis of this serious neuropsychiatric syndrome.
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Glenn S, Cunningham C, Nananidou A. A cross-sectional comparison of routinized and compulsive-like behaviours in typical children aged from 2 to 11 years. EUROPEAN JOURNAL OF DEVELOPMENTAL PSYCHOLOGY 2012. [DOI: 10.1080/17405629.2011.639139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abstract
Several studies have examined levels of proinflammatory cytokines, such as tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and IL-6. This meta-analysis was conducted to examine the association between obsessive-compulsive disorder (OCD) and plasma serum levels of proinflammatory cytokines. Twelve studies met inclusion criteria. The meta-analysis demonstrated a significant reduction in IL-1β levels in OCD. No significant difference in plasma levels of IL-6 or TNF-α was demonstrated. Stratified subgroup analysis revealed possible moderating effects of age and medication use on IL-6 levels. Studies including children on psychotropic medication had lower plasma IL-6 levels. Stratified subgroup analysis revealed a moderating effect of comorbid depression on TNF-α levels. Elevated TNF-α levels were reported in studies that included individuals with comorbid depression. Future studies examining immune function in OCD should adjust for potential confounding due to medication use and comorbid depression. Further studies assessing cerebrospinal fluid cytokine levels in OCD are also needed.
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Rhee H, Cameron DJ. Lyme disease and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS): an overview. Int J Gen Med 2012; 5:163-74. [PMID: 22393303 PMCID: PMC3292400 DOI: 10.2147/ijgm.s24212] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Lyme disease (LD) is a complex, multisystemic illness. As the most common vector- borne disease in the United States, LD is caused by bacterial spirochete Borrelia burgdorferi sensu stricto, with potential coinfections from agents of anaplasmosis, babesiosis, and ehrlichiosis. Persistent symptoms and clinical signs reflect multiorgan involvement with episodes of active disease and periods of remission, not sparing the coveted central nervous system. The capability of microorganisms to cause and exacerbate various neuropsychiatric pathology is also seen in pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS), a recently described disorder attributed to bacterium Streptococcus pyogenes of group A beta-hemolytic streptococcus in which neurologic tics and obsessive-compulsive disorders are sequelae of the infection. In the current overview, LD and PANDAS are juxtaposed through a review of their respective infectious etiologies, clinical presentations, mechanisms of disease development, courses of illness, and treatment options. Future directions related to immunoneuropsychiatry are also discussed.
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Kapadia M, Sakic B. Autoimmune and inflammatory mechanisms of CNS damage. Prog Neurobiol 2011; 95:301-33. [DOI: 10.1016/j.pneurobio.2011.08.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Revised: 08/18/2011] [Accepted: 08/19/2011] [Indexed: 12/13/2022]
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Glutamate abnormalities in obsessive compulsive disorder: neurobiology, pathophysiology, and treatment. Pharmacol Ther 2011; 132:314-32. [PMID: 21963369 DOI: 10.1016/j.pharmthera.2011.09.006] [Citation(s) in RCA: 222] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Accepted: 08/29/2011] [Indexed: 11/22/2022]
Abstract
Obsessive compulsive disorder is prevalent, disabling, incompletely understood, and often resistant to current therapies. Established treatments consist of specialized cognitive-behavioral psychotherapy and pharmacotherapy with medications targeting serotonergic and dopaminergic neurotransmission. However, remission is rare, and more than a quarter of OCD sufferers receive little or no benefit from these approaches, even when they are optimally delivered. New insights into the disorder, and new treatment strategies, are urgently needed. Recent evidence suggests that the ubiquitous excitatory neurotransmitter glutamate is dysregulated in OCD, and that this dysregulation may contribute to the pathophysiology of the disorder. Here we review the current state of this evidence, including neuroimaging studies, genetics, neurochemical investigations, and insights from animal models. Finally, we review recent findings from small clinical trials of glutamate-modulating medications in treatment-refractory OCD. The precise role of glutamate dysregulation in OCD remains unclear, and we lack blinded, well-controlled studies demonstrating therapeutic benefit from glutamate-modulating agents. Nevertheless, the evidence supporting some important perturbation of glutamate in the disorder is increasingly strong. This new perspective on the pathophysiology of OCD, which complements the older focus on monoaminergic neurotransmission, constitutes an important focus of current research and a promising area for the ongoing development of new therapeutics.
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Maternal history of autoimmune disease in children presenting with tics and/or obsessive-compulsive disorder. J Neuroimmunol 2010; 229:243-7. [PMID: 20864184 DOI: 10.1016/j.jneuroim.2010.08.017] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 06/28/2010] [Accepted: 08/26/2010] [Indexed: 12/18/2022]
Abstract
OBJECTIVES A commonality across a number of pediatric neuropsychiatric disorders is a higher than typical rate of familial - and especially maternal - autoimmune disease. Of recent interest, a subtype of obsessive-compulsive disorder (OCD) and tic disorders known collectively as Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus (PANDAS) is believed to be secondary to central nervous system (CNS) autoimmunity that occurs in relation to group A streptococcal infection. Thus, we hypothesized that a sample of children with OCD and/or tics would have an increased maternal risk for an autoimmune response relative to population norms. We also expected maternal prevalence of various autoimmune diseases to be higher among those participants that met the putative criteria for PANDAS. METHODS We examined, via structured interview, the medical history of the biological mothers of 107 children with OCD and/or tics. RESULTS Autoimmune disorders were reported in 17.8% of study mothers, which is significantly greater than the general prevalence among women in the United States (approximately 5%). Further, study mothers were more likely to report having an autoimmune disease if their children were considered "likely PANDAS" cases versus "unlikely PANDAS" cases. CONCLUSIONS The results offer preliminary support for hypothesized links between maternal autoimmune disease and both OCD/tics and PANDAS in youth. Further research is necessary to clarify these general associations; links to specific autoimmune disease; and relevance of autoimmune disease in other family members (e.g., fathers).
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Murphy DL, Timpano KR, Wheaton MG, Greenberg BD, Miguel EC. Obsessive-compulsive disorder and its related disorders: a reappraisal of obsessive-compulsive spectrum concepts. DIALOGUES IN CLINICAL NEUROSCIENCE 2010. [PMID: 20623919 PMCID: PMC3181955 DOI: 10.31887/dcns.2010.12.2/dmurphy] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a clinical syndrome whose hallmarks are
excessive, anxiety-evoking thoughts and compulsive behaviors that are generally
recognized as unreasonable, but which cause significant distress and impairment.
When these are the exclusive symptoms, they constitute uncomplicated OCD. OCD
may also occur in the context of other neuropsychiatric disorders, most commonly
other anxiety and mood disorders. The question remains as to whether these
combinations of disorders should be regarded as independent, cooccurring
disorders or as different manifestations of an incompletely understood
constellation of OCD spectrum disorders with a common etiology. Additional
considerations are given here to two potential etiology-based subgroups: (i) an
environmentally based group in which OCD occurs following apparent causal events
such as streptococcal infections, brain injury, or atypical neuroleptic
treatment; and (ii) a genomically based group in which OCD is related to
chromosomal anomalies or specific genes. Considering the status of current
research, the concept of OCD and OCD-related spectrum conditions seems fluid in
2010, and in need of ongoing reappraisal.
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Affiliation(s)
- Dennis L Murphy
- Laboratory of Clinical Science, NIMH Intramural Research Program, Bethesda, Maryland 20892, USA.
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Oosterveer DM, Overweg-Plandsoen WCT, Roos RAC. Sydenham's chorea: a practical overview of the current literature. Pediatr Neurol 2010; 43:1-6. [PMID: 20682195 DOI: 10.1016/j.pediatrneurol.2009.11.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Revised: 11/24/2009] [Accepted: 11/25/2009] [Indexed: 10/19/2022]
Abstract
Sydenham's chorea is characterized by uncoordinated movements, emotional instability, and hypotonia. It can occur up to several months after group A beta-hemolytic Streptococcus infection. A diagnosis of Sydenham's chorea in a patient with acute chorea involves an application of the Jones criteria and the exclusion of other causes of chorea. In patients with an atypical history or hemichorea, cranial magnetic resonance imaging is indicated to exclude other cerebral pathologies. A pathogenesis has not been elucidated, and therapy has not been investigated in placebo-controlled trials. Antibiotic treatment and a 2-week or 3-week schedule of antibiotic prophylaxis are recommended. If the chorea is severe, valproate or carbamazepine can be effective. In more severely affected patients, dopamine receptor blocking agents or corticosteroids can be used.
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Vincenzi B, O'Toole J, Lask B. PANDAS and anorexia nervosa-a spotters' guide: Suggestions for medical assessment. EUROPEAN EATING DISORDERS REVIEW 2010; 18:116-23. [DOI: 10.1002/erv.977] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Viswanathan S, Moses PD, Varkki S, Russell PS, Brahmadathan KN. Association between neuropsychiatric morbidity and streptococcal infections in children. Indian Pediatr 2009; 47:168-70. [PMID: 19430078 DOI: 10.1007/s13312-010-0026-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Accepted: 10/10/2008] [Indexed: 11/29/2022]
Abstract
We conducted a case control study to study the association between neuropsychiatric morbidity and group A streptococcal infections in children. Twenty two cases of neuropsychiatric morbidity were compared with 64 controls. Fourteen (63.6%) of the 22 cases were positive for ASO and/or ADNB while 21 of the 64 controls (32.8%) were positive for either or both antibodies (OR = 3.428; CI: 1.15-10.18; P=0.026). We conclude that there is a statistically significant association between neuropsychiatric morbidity and streptococcal infection in children.
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Affiliation(s)
- S Viswanathan
- Department of Child Health, Christian Medical College, Vellore, Tamil Nadu, India
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Hirschtritt ME, Hammond CJ, Luckenbaugh D, Buhle J, Thurm AE, Casey BJ, Swedo SE. Executive and attention functioning among children in the PANDAS subgroup. Child Neuropsychol 2009; 15:179-94. [PMID: 18622810 PMCID: PMC2693234 DOI: 10.1080/09297040802186899] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Evidence from past studies indicates that adults and children with Obsessive-Compulsive Disorder (OCD) and Tourette syndrome (TS) experience subtle neuropsychological deficits. Less is known about neuropsychological functioning of children and adolescents with a symptom course consistent with the PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infection) subgroup of OCD and tics. To provide such information, we administered three tests of attention control and two of executive function to 67 children and adolescents (ages 5-16) diagnosed with OCD and/or tics and a symptom course consistent with the PANDAS subgroup and 98 healthy volunteers (HV) matched by age, sex, and IQ. In a paired comparison of the two groups, the PANDAS subjects were less accurate than HV in a test of response suppression. Further, in a two-step linear regression analysis of the PANDAS group in which clinical variables were added stepwise into the model and in the second step matching variables (age, sex, and IQ) were added, IQ emerged as a predictor of performance on this task. In the same analysis, ADHD diagnosis and age emerged as predictors of response time in a continuous performance task. Subdividing the PANDAS group by primary psychiatric diagnosis revealed that subjects with TS or OCD with tics exhibited a longer response time compared to controls than subjects with OCD only, replicating previous findings within TS and OCD. This study demonstrates that children with PANDAS exhibit neuropsychological profiles similar to those of their primary psychiatric diagnosis.
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Affiliation(s)
- Matthew E. Hirschtritt
- National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Pediatrics and Developmental Neuropsychiatry Branch, Bethesda, Maryland, USA
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Christopher J. Hammond
- National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Pediatrics and Developmental Neuropsychiatry Branch, Bethesda, Maryland, USA
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - David Luckenbaugh
- National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Jason Buhle
- Weill Medical College of Cornell University, Sackler Institute for Developmental Psychobiology, New York, New York, USA
- Columbia University, Social Cognitive Affective Neuroscience Unit, Department of Psychology, New York, New York, USA
| | - Audrey E. Thurm
- National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Pediatrics and Developmental Neuropsychiatry Branch, Bethesda, Maryland, USA
| | - B. J. Casey
- Weill Medical College of Cornell University, Sackler Institute for Developmental Psychobiology, New York, New York, USA
| | - Susan E. Swedo
- National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Pediatrics and Developmental Neuropsychiatry Branch, Bethesda, Maryland, USA
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da Rocha FF, Correa H, Teixeira AL. Obsessive-compulsive disorder and immunology: a review. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32:1139-46. [PMID: 18262706 DOI: 10.1016/j.pnpbp.2007.12.026] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2007] [Revised: 12/23/2007] [Accepted: 12/24/2007] [Indexed: 11/17/2022]
Abstract
Interest in the possibility of an immune-mediated pathophysiology of obsessive-compulsive disorder and related disorders has increased. In the late 1980s, the National Institute of Mental Health reported an increase in obsessive-compulsive symptoms (OCS) in patients with Sydenham chorea (SC). Subsequently, a precipitating streptococcal infection in children with sudden onset of OCS but no chorea led to the coining of PANDAS (Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection). This association has furthered interest in biological measures for immune and genetic susceptibility in non-PANDAS obsessive-compulsive disorder patients (OCD). Furthermore, some studies are trying to demonstrate alterations of immune parameters in OCD patients, with few positive results. In this narrative review, our objective was to describe the immunologic findings in OCD, PANDAS, and their association with SC.
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Affiliation(s)
- Felipe Filardi da Rocha
- Service of Psychiatry, Federal University of Minas Gerais, Belo Horizonte, Brazil; Department of Pharmacology, Federal University of Minas Gerais, Belo Horizonte, Brazil.
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What every psychiatrist should know about PANDAS: a review. Clin Pract Epidemiol Ment Health 2008; 4:13. [PMID: 18495013 PMCID: PMC2413218 DOI: 10.1186/1745-0179-4-13] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Accepted: 05/21/2008] [Indexed: 11/10/2022]
Abstract
The term Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus infections (PANDAS) was coined by Swedo et al. in 1998 to describe a subset of childhood obsessive-compulsive disorders (OCD) and tic disorders triggered by group-A beta-hemolytic Streptococcus pyogenes infection. Like adult OCD, PANDAS is associated with basal ganglia dysfunction. Other putative pathogenetic mechanisms of PANDAS include molecular mimicry and autoimmune-mediated altered neuronal signaling, involving calcium-calmodulin dependent protein (CaM) kinase II activity. Nonetheless the contrasting results from numerous studies provide no consensus on whether PANDAS should be considered as a specific nosological entity or simply a useful research framework. Herein we discuss available data that could provide insight into pathophysiology of adult OCD, or might explain cases of treatment-resistance. We also review the latest research findings on diagnostic and treatment.
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Grisham JR, Anderson TM, Sachdev PS. Genetic and environmental influences on obsessive-compulsive disorder. Eur Arch Psychiatry Clin Neurosci 2008; 258:107-16. [PMID: 18297419 DOI: 10.1007/s00406-007-0789-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
It is important to understand how genetic and environmental factors interact in the development of obsessive-compulsive disorder (OCD) in order to provide a cohesive model of the underlying pathogenic mechanisms. In this article, we provide an overview of the current knowledge of possible genetic and environmental contributions to the development of OCD. We consider the significant challenges for identifying risk factors for OCD as well as promising avenues for overcoming these obstacles in future research. In particular, we discuss the value of focusing on certain phenotypes, applying a dimensional approach, and investigating possible endophenotypes. We also describe innovative study designs that may be used in future research to explore the interaction between genetic vulnerability and environmental risk factors for OCD.
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Affiliation(s)
- Jessica R Grisham
- School of Psychology, University of New South Wales, Sydney, NSW, Australia.
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Abstract
A 2-year-old boy with a history of presumed viral pharyngitis presented with rheumatic fever. The episode of pharyngitis was not treated with antibiotic at five years of age, physicians should be aware of the sequelae of untreated group A beta-hemolytic streptococcal pharyngitis.
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Dillon JE, Blunden S, Ruzicka DL, Guire KE, Champine D, Weatherly RA, Hodges EK, Giordani BJ, Chervin RD. DSM-IV diagnoses and obstructive sleep apnea in children before and 1 year after adenotonsillectomy. J Am Acad Child Adolesc Psychiatry 2007; 46:1425-36. [PMID: 18049292 PMCID: PMC2408827 DOI: 10.1097/chi.0b013e31814b8eb2] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Obstructive sleep apnea, a common indication for adenotonsillectomy in children, has been linked to behavioral morbidity. We assessed psychiatric diagnoses in children before and after adenotonsillectomy and examined whether baseline sleep apnea predicted improvement after surgery. METHOD Subjects of this prospective cohort study were children ages 5.0 to 12.9 years old who had been scheduled for adenotonsillectomy (n = 79) or care for unrelated surgical conditions (n = 27, among whom 13 had surgery after baseline assessment). Before intervention and 1 year later, subjects underwent structured diagnostic interviews and polysomnography. The main outcome measure was frequency of DSM-IV attention and disruptive behavior disorder diagnoses at baseline and follow-up. RESULTS At baseline, attention and disruptive behavior disorders were diagnosed in 36.7% of adenotonsillectomy subjects and 11.1% of controls (p < .05); attention-deficit/hyperactivity disorder was found in 27.8% and 7.4%, respectively (p < .05). One year later, group differences were nonsignificant; attention and disruptive behavior disorders were diagnosed in only 23.1% (p < .01), and 50% of subjects with baseline attention-deficit/hyperactivity disorder no longer met diagnostic criteria. Obstructive sleep apnea on polysomnography at baseline did not predict concurrent psychiatric morbidity or later improvement. CONCLUSIONS Attention and disruptive behavior disorders, diagnosed by DSM-IV criteria, were more common before clinically indicated adenotonsillectomy than 1 year later. Surgery may be associated with reduced morbidity, even among subjects lacking polysomnographic evidence of obstructive sleep apnea.
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Affiliation(s)
- James E Dillon
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, USA.
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Menzies L, Chamberlain SR, Laird AR, Thelen SM, Sahakian BJ, Bullmore ET. Integrating evidence from neuroimaging and neuropsychological studies of obsessive-compulsive disorder: the orbitofronto-striatal model revisited. Neurosci Biobehav Rev 2007; 32:525-49. [PMID: 18061263 PMCID: PMC2889493 DOI: 10.1016/j.neubiorev.2007.09.005] [Citation(s) in RCA: 822] [Impact Index Per Article: 48.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Revised: 09/24/2007] [Accepted: 09/28/2007] [Indexed: 12/16/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a common, heritable and disabling neuropsychiatric disorder. Theoretical models suggest that OCD is underpinned by functional and structural abnormalities in orbitofronto-striatal circuits. Evidence from cognitive and neuroimaging studies (functional and structural magnetic resonance imaging (MRI) and positron emission tomography (PET)) have generally been taken to be supportive of these theoretical models; however, results from these studies have not been entirely congruent with each other. With the advent of whole brain-based structural imaging techniques, such as voxel-based morphometry and multivoxel analyses, we consider it timely to assess neuroimaging findings to date, and to examine their compatibility with cognitive studies and orbitofronto-striatal models. As part of this assessment, we performed a quantitative, voxel-level meta-analysis of functional MRI findings, which revealed consistent abnormalities in orbitofronto-striatal and other additional areas in OCD. This review also considers the evidence for involvement of other brain areas outside orbitofronto-striatal regions in OCD, the limitations of current imaging techniques, and how future developments in imaging may aid our understanding of OCD.
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Affiliation(s)
- Lara Menzies
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK.
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Herbert MR. Clinical implications of environmental toxicology for children’s neurodevelopment in autism. FUTURE NEUROLOGY 2007. [DOI: 10.2217/14796708.2.2.167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Martha R Herbert
- Harvard Medical School, Pediatric Neurology, Center for Morphometric Analysis, Massachusetts General Hospital, Center for Child & Adolescent Development, Cambridge Health Alliance, Charlestown, MA 02129, USA
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Tobias R, Walitza S. [Severe early-childhood obsessive-compulsive disorder--case report on a 4-year-old girl]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2007; 34:287-93. [PMID: 16927571 DOI: 10.1024/1422-4917.34.4.287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES OCD is seldom diagnosed in children younger than six years of age. The present report deals with the diagnosis and therapy of OCD at a very early onset in childhood. METHODS Reported is the case of a 4-year-old girl who was affected by severe compulsive behaviour, with marked impairment of her familial and extra-domestic social activities, including an inability to attend kindergarten. RESULTS The girl was affected to an extreme extent by compulsive symptoms pertaining to symmetry and order, and suffered from severe psychological strain. Her symptoms improved markedly following behaviour therapy in an inpatient setting. Adjuvant medication was not necessary. Her parents were counselled intensively and included in the therapeutic process. She was able to return to her family, resuming activities appropriate for a child her age, and to attend kindergarten. CONCLUSIONS OCD can develop in a child as early as at the age of four. For diagnostic procedure in cases of "very early onset", OCD criteria described by ICD-10 and DSM-IV can be applied. Behaviour therapy was effective even in this case of early manifestation of OCD. Particularly important is the inclusion of the parents in the therapeutic process.
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Affiliation(s)
- Renner Tobias
- Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie der Universität Würzburg.
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Attention-Deficit Hyperactivity Disorder. Neurobiol Dis 2007. [DOI: 10.1016/b978-012088592-3/50059-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Shears D, Nadel S, Gledhill J, Gordon F, Garralda ME. Psychiatric adjustment in the year after meningococcal disease in childhood. J Am Acad Child Adolesc Psychiatry 2007; 46:76-82. [PMID: 17195732 DOI: 10.1097/01.chi.0000242234.83140.56] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess psychiatric status after meningococcal disease. METHOD Cohort study of 66 children (34 boys, 32 girls) ages 4 to 17 years admitted to pediatric hospitals with meningococcal disease. The main outcome measure was psychiatric disorder (1-year period and point prevalence on the Schedule for Affective Disorders and Schizophrenia for School-Age Children interview for children 6 years or older; point prevalence in younger children on the Behavior Screening Questionnaire). RESULTS During the course of the year after discharge from hospital, psychiatric disorders were identified in 23 of 40 (57%) children ages 6 years or older. The most common primary disorders were depressive, oppositional defiant, and anxiety disorders. At the time of 12-month follow-up, psychiatric disorders were present in 13 of 40 (32%) of those ages 6 or older and in 7 of 26 (26%) under 6 years old. Two children had a diagnosis of posttraumatic stress disorder. Logistic regression analysis showed that global meningococcal illness severity score, clinical shock on admission, and impairing premorbid emotional and behavioral problems in the child were independent predictors of psychiatric disorder at 12-month follow-up. CONCLUSIONS Psychiatric disorders are common in the year after meningococcal disease. Especially at risk are children who are severely medically ill and those with more impairing premorbid emotional and behavioral problems.
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Affiliation(s)
- Daniel Shears
- Drs. Shears, Gledhill, and Garralda are with the Imperial College London, Academic Unit of Child and Adolescent Psychiatry; Dr. Nadel is with the St. Mary's Hospital, London; and Dr. Gordon is with the Imperial College London, Statistical Advisory Service
| | - Simon Nadel
- Drs. Shears, Gledhill, and Garralda are with the Imperial College London, Academic Unit of Child and Adolescent Psychiatry; Dr. Nadel is with the St. Mary's Hospital, London; and Dr. Gordon is with the Imperial College London, Statistical Advisory Service
| | - Julia Gledhill
- Drs. Shears, Gledhill, and Garralda are with the Imperial College London, Academic Unit of Child and Adolescent Psychiatry; Dr. Nadel is with the St. Mary's Hospital, London; and Dr. Gordon is with the Imperial College London, Statistical Advisory Service
| | - Fabiana Gordon
- Drs. Shears, Gledhill, and Garralda are with the Imperial College London, Academic Unit of Child and Adolescent Psychiatry; Dr. Nadel is with the St. Mary's Hospital, London; and Dr. Gordon is with the Imperial College London, Statistical Advisory Service
| | - M Elena Garralda
- Drs. Shears, Gledhill, and Garralda are with the Imperial College London, Academic Unit of Child and Adolescent Psychiatry; Dr. Nadel is with the St. Mary's Hospital, London; and Dr. Gordon is with the Imperial College London, Statistical Advisory Service..
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Zai G, Arnold PD, Burroughs E, Richter MA, Kennedy JL. Tumor necrosis factor-alpha gene is not associated with obsessive-compulsive disorder. Psychiatr Genet 2006; 16:43-5. [PMID: 16395130 DOI: 10.1097/01.ypg.0000185026.12687.92] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Dysregulation of the immune system has been suggested to play a role in the complex etiology of obsessive-compulsive disorder. In this context, tumor necrosis factor-alpha is considered an interesting candidate for genetic studies as overproduction of tumor necrosis factor-alpha, which may be genetically modulated, can exert neurotoxic effects and influence neural cell growth and proliferation. Moreover, the tumor necrosis factor-alpha gene is located on chromosome 6p21.3, a region that has been found to be weakly associated with obsessive-compulsive disorder in linkage studies. One functional polymorphism, G-308A, has been found within the gene.
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Affiliation(s)
- Gwyneth Zai
- Institute of Medical Science, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Sadhasivam S, Litman RS. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections - anesthetic implications and literature review. Paediatr Anaesth 2006; 16:573-7. [PMID: 16677269 DOI: 10.1111/j.1460-9592.2005.01768.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) are rare neurobehavioral disorders in children. Affected children may have a diverse array of perioperative manifestations including compulsive behavior, agitation, and abnormal movements. Perioperative management might be more challenging for anesthesiologists. Series of therapeutic plasmapheresis in these children may complicate their anesthesia management. We describe the first case of a patient with PANDAS and its anesthesia implications.
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Affiliation(s)
- Senthilkumar Sadhasivam
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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Termine C, Balottin U, Rossi G, Maisano F, Salini S, Di Nardo R, Lanzi G. Psychopathology in children and adolescents with Tourette's syndrome: a controlled study. Brain Dev 2006; 28:69-75. [PMID: 15967616 DOI: 10.1016/j.braindev.2005.04.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2004] [Revised: 04/11/2005] [Accepted: 04/13/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Few controlled studies have considered, in paediatric subjects, associations between Tourette's syndrome (TS) and psychiatric/behavioural disorders. We conducted a case-control study to verify the reproducibility of the few data published on this topic to date. METHOD Clinicians' impression (i.e. structured interviews and usual history taking), standardized psychiatric and behavioural rating scales (CBCL, TAI, CDI, CRS-R:L, Y-GTSS, CY-BOCS) were used to investigate these associations in 17 youngsters with TS and in 17 age- and sex-matched controls. RESULTS The clinician's diagnoses revealed TS alone in 23.5% of the patients (4/17), TS plus attention-deficit/hyperactivity disorder (ADHD) in 11.8% (2/17), TS plus obsessive-compulsive disorder (OCD) in 41.2% (7/17), and TS plus ADHD and OCD in 23.5% (4/17). No control subject presented ADHD and/or OCD. These clinical findings were confirmed by Child Behaviour Check List (CBCL) results. The TS group, compared with the controls, recorded significantly higher CBCL scores in scales relating to the main comorbid conditions. No significant differences emerged on the Children's Depression Inventory or Test Anxiety Inventory. CONCLUSION TS patients have a high prevalence of psychiatric and behavioural problems compared with controls. The CBCL is a rapid and useful screening-diagnostic instrument for highlighting the main psychiatric and behavioural problems in TS.
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Affiliation(s)
- Cristiano Termine
- Child Neuropsychiatry Unit, Department of Clinical and Biological Sciences, University of Insubria, Via F. del Ponte 19, 21100 Varese, Italy.
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Lorber B. Infection and mental illness: Do bugs make us batty? Anaerobe 2005; 11:303-7. [PMID: 16701589 DOI: 10.1016/j.anaerobe.2005.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2005] [Accepted: 05/27/2005] [Indexed: 11/22/2022]
Affiliation(s)
- Bennett Lorber
- Section of Infectious Diseases, Temple University School of Medicine and Hospital, Broad and Ontario Streets, Philadelphia, PA 19140, USA.
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Abstract
Anxiety symptoms and disorders are associated with a range of general medical disorders. This association may be a physiologic consequence of the general medical disorder, a psychologic reaction to the experience of having a medical illness, a side effect of treatment, or a chance occurrence. This article briefly reviews the associations of panic disorder with seizure disorder, Klüver-Bucy syndrome, mitral valve prolapse, and respiratory disorders; of generalized anxiety disorder with chronic obstructive airway disease and cardiovascular and endocrine disorders; of social anxiety disorder with Parkinson's disease; of obsessive-compulsive disorder with striatal disorders; and of posttraumatic stress disorder with head injury and pain. Such associations provide important clues for understanding the neurobiology of anxiety disorders.
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Affiliation(s)
- Jacqueline E Muller
- Medical Research Council Unit on Anxiety Disorders, Department of Psychiatry, Tygerberg, Cape Town 7505, South Africa.
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Keitzer R. Akutes rheumatisches Fieber (ARF) und Poststreptokokken reaktive Arthritis (PSRA)—. Z Rheumatol 2005; 64:295-307. [PMID: 15965814 DOI: 10.1007/s00393-005-0749-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2005] [Accepted: 05/02/2005] [Indexed: 11/30/2022]
Abstract
Betahemolytic strains of streptococcus A are able to induce a spectrum of immunologically induced diseases, depending on the immunogenic M structure of the bacteria as well as on the genetic determined reaction of the host. In acute rheumatic fever (ARF) the Jones criteria, revised and modified several times and updated in 1992, remain the diagnostic standard. Echocardiography, still not included in the Jones criteria, has become a very important diagnostic tool, especially as half of the ARF induced carditis cases are clinically inapparent. Diagnosis may be very difficult if arthritis is the only major sign, especially if not occurring in the typical migrating pattern, a fact frequently reported from countries with a high risk of ARF. Poststreptococcal reactive arthritis (PSRA) has been described as a different entity as well as a part of rheumatic fever. There is a lack of validated diagnostic criteria to establish a reliable diagnosis. There are no accepted recommendations for antibiotic prophylaxis in PSRA.
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Affiliation(s)
- R Keitzer
- Klinik für Pädiatrie mit Schwerpunkt Pneumologie und Immunologie, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin.
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