Autoimmunity And Mental Health

Question 1

What are the four stages of syphilis?

Answer 1

Primary: ulcer/chancre
Secondary: (4-10 weeks) generalised skin/mucosal lesions
Latent: asymptomatic
Tertiary: CNS, cardiovascular

Question 2

When might neurosyphilis symptoms appear?

Answer 2

Any time

Early - meningitis, meningovascular
Late - neuropsychiatric

Question 3

What are symptoms of neurosyphilis?

Answer 3

Any psychiatric symptom
Dementia particularly common
Grandiosity
Disinhibition
Personality change
Paranoia
Depression
Neurasthenia

Question 4

What is the prognosis for syphilitic dementia paralytica?

Answer 4

Death 4-5 years
Progression with seizures and paralysis

Question 5

What psychiatric disorders is toxoplasma associated with?

Answer 5

Schizophrenia
Bipolar disorder
Anxiety disorder
Addiction
Also: suicide, self harm, road accidents (impulsivity)

Question 6

What neuropsychiatric disorders are associated with HSV?

Answer 6

Encephalitis
Alzheimer’s (post mortem)
Cognitive impairment in bipolar and schizophrenia

Question 7

What immune related gene region is associated with schizophrenia?

Answer 7

HLA region (adaptive immunity)

Question 8

What cancer treatments may lead to encephalopathy/encephalitis?

Answer 8

Immunotherapies
CAR-T

Question 9

Why is blood serum not a useful marker for autoimmune encephalitis?

Answer 9

Antibodies are equally present in healthy controls and psychosis patients.
CSF should be tested

Question 10

How does autoimmune psychosis respond to antipsychotics?

Answer 10

Adverse response
Neuroleptic malignant syndrome: rigidity, hyperthermia, increased creatine kinase

Question 11

What are diagnostic biomarkers of autoimmune psychosis?

Answer 11

CSF pleocytisis (5+ cells), oligoclonal bands
MRI - Bilateral brain abnormality at medial temporal lobes
EEG - rhythmic slowing, intermittent delta or theta activity, extreme delta brush, focal changes
Presence of antineuronal antibody

Question 12

What bacterial infection is associated with OCD and tics?

Answer 12

Streptococcus

Question 13

What is the definition of PANS?

Answer 13

Paediatric acute onset neuropsychiatric syndrome

Abrupt dramatic onset of OCD of restricted food intake, not better explained by a known neurological/medical disorder along with 2 of
Anxiety
Emotional lability/Depression
Irritability/aggression
Behavioural regression
Deterioration in school performance
Sensory/ motor abnormalities
Somatic signs (sleep, enuresis/urinary frequency)

Question 14

How is PANDAS defined

Answer 14

Paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections

Significant obsessions or tics
Abrupt onset or relapsing-remitting
Prepubertal onset
Association with strep infection
Association with other NP symptoms (PANS)

Question 15

What is the treatment for PANDAS?

Answer 15

Antibiotics if strep infection was recent

Question 16

How long can strep antibodies stay high post infection?

Answer 16

Up to a year (may not be a good biomarker)

Question 17

What are some problems with the association of streptococcus to PANDAS?

Answer 17

Streptococcus is everywhere
Antibodies lower in patients than their siblings
10 days of antibiotics needed to eradicate strep but patients improve after one dose (placebo?)
No association between levels of antibodies and clinical exacerbations

Question 18

What are the criteria for autoimmune disorder?

Answer 18

Self reactive antibody
An identifiable auto antigen
The disorder can be caused in animals
Transfer of antibodies to an animal can trigger the disorder