Ordering Knowledge in the Markers of Psychiatric/Mental Disorders

Amnestic syndrome in the course of seronegative limbic encephalitis complicated by drug-resistant epilepsy: a case report

We present the case of a 35-year-old female patient admitted to the hospital with symptoms of rapidly increasing disturbances of consciousness and fever for 48 hours. A lumbar puncture, bacteriological and virological examinations, and initial imaging studies did not show abnormalities. Brain magnetic resonance imaging (MRI), repeated several times, showed hyperintense confluent lesions in both temporal lobes and atrophy of both hippocampi. General examination, cerebrospinal fluid culture, the panel of antineuronal antibodies, and tumor markers remained negative on subsequent repeats. Despite several laboratory and imaging studies, the etiology of the disease could not be established, infections were excluded, and no autoantibodies were found. A diagnosis of probable limbic encephalitis, amnestic syndrome resulting from organic brain damage, and drug-resistant epilepsy was made. The patient, with limbic encephalitis complicated by drug-resistant status epilepticus, was treated with cycles of immunoglobulin and subsequent plasmapheresis. She was then transferred to the Department of Psychiatry for diagnosis and treatment of intermittent psychotic disorders. During hospitalization, the patient was observed to have multiple epileptic seizures with temporal and frontal morphology, amnestic syndrome with confabulations, and periodic psychotic disorders with the occurrence of visual hallucinations. Antiepileptic treatment was escalated by including cenobamate in increasing doses. To control the mental disorders, duloxetine, tiapride, and cognitive function exercises were introduced. There was a slight improvement in memory, a cessation of confabulations, and an emergence of the patient's criticism of the symptoms presented. The psychotic symptoms subsided, and the number of epileptic seizures decreased. The described case portrays a unique co-occurrence of disease symptoms that are difficult to treat. It shows the therapeutic difficulties that can occur in patients with suspected autoimmune encephalitis. Furthermore, it shows the need for multispecialty care of a patient with psychotic symptoms in the course of epilepsy accompanied by amnestic syndrome.

The Immunoseasonal Theory of Psychiatric Disorders

Although the influence of the weather on the well-being and mental health of psychiatric patients has been widely seen, the relationships between various seasonal weather factors and depressive, manic, anxiety, and psychotic states have not been systematized in the literature. The current article describes the seasonal changes in weather-related immune responses and their impact on the development of episodes of depression, mania, psychosis, and anxiety, highlighting the T-helper 1 (Th1) and Th2 immune balance as their potential trigger. In autumn-winter depression, the hyperactivation of the Th1 system, possibly by microbial/airborne pathogens, may lead to the inflammatory inhibition of prefrontal activity and the subcortical centers responsible for mood, drive, and motivation. Depressive mood periods are present in most people suffering from schizophrenia. In the spring and summertime, when the compensating anti-Th1 property of the Th2 immune system is activated, it decreases the Th1 response. In individuals immunogenetically susceptible to psychosis and mania, the inhibition of Th1 by the Th2 system may be excessive and lead to Th2-related frontal and subcortical hyperactivation and subsequent psychosis. In people suffering from bipolar disorder, hyperintense changes in white matter may be responsible for the partial activation of subcortical areas, preventing full paranoid psychosis. Thus, psychosis may be mood-congruent in affective disorders.

Is SARS-CoV-2 a Risk Factor of Bipolar Disorder?-A Narrative Review

For 2.5 years we have been facing the coronavirus disease (COVID-19) and its health, social and economic effects. One of its known consequences is the development of neuropsychiatric diseases such as anxiety and depression. However, reports of manic episodes related to COVID-19 have emerged. Mania is an integral part of the debilitating illness-bipolar disorder (BD). Due to its devastating effects, it is therefore important to establish whether SARS-CoV-2 infection is a causative agent of this severe mental disorder. In this narrative review, we discuss the similarities between the disorders caused by SARS-CoV-2 and those found in patients with BD, and we also try to answer the question of whether SARS-CoV-2 infection may be a risk factor for the development of this affective disorder. Our observation shows that disorders in COVID-19 showing the greatest similarity to those in BD are cytokine disorders, tryptophan metabolism, sleep disorders and structural changes in the central nervous system (CNS). These changes, especially intensified in severe infections, may be a trigger for the development of BD in particularly vulnerable people, e.g., with family history, or cause an acute episode in patients with a pre-existing BD.

Intestinal Permeability and Depression in Patients with Inflammatory Bowel Disease

Depression is a global health problem that requires an early and accurate diagnosis to ensure quick access to appropriate treatment. Among multiple psychopathological paths, recent attention has focused on analysing the brain–gut–microbiota axis. The intestinal barrier plays a key role, and dysfunctions occurring at this level have implications for mental health. The aim of the present study was to investigate the role of intestinal permeability biomarkers, i.e., calprotectin, zonulin, lipopolysaccharide-binding protein (LBP) and intestinal fatty acid-binding protein (I-FAB), in relation to depression in patients with inflammatory bowel disease (IBD). This is the first study of this kind taking place in Romania, Eastern Europe, with an emphasis on patients with Crohn’s disease and ulcerative colitis. The correlations identified between depression and calprotectin and depression and LBP have the potential to shed light on the process of rapid diagnosis of depression with the help of biomarkers. Since depression is correlated with a decrease in the quality of life in patients with IBD, the need for access to appropriate treatments must be urgent.

Markers of Schizophrenia—A Critical Narrative Update

Schizophrenia is a long-term mental disease, associated with functional impairment. Therefore, it is important to make an accurate diagnosis and implement the proper treatment. Biomarkers may be a potential tool for these purposes. Regarding advances in biomarker studies in psychosis, the current symptom-based criteria seem to be no longer sufficient in clinical settings. This narrative review describes biomarkers of psychosis focusing on the biochemical (peripheral and central), neurophysiological, neuropsychological and neuroimaging findings as well as the multimodal approach related with them. Endophenotype markers (especially neuropsychological and occulomotor disturbances) can be currently used in a clinical settings, whereas neuroimaging glutamate/glutamine and D2/D3 receptor density changes, as well as immunological Th2 and PRL levels, seem to be potential biomarkers that need further accuracy tests. When searching for biochemical/immunological markers in the diagnosis of psychosis, the appropriate time of body fluid collection needs to be considered to minimize the influence of the stress axis on their concentrations. In schizophrenia diagnostics, a multimodal approach seems to be highly recommended.