Autoimmunity, infection and mental health Flashcards
What are the two stages of Lyme disease?
Local infection and early disseminated infection
What is the localised infection state of Lyme disease?
The infection period is typically 2 to 30 days.
It includes a rash ‘erythema migrans’
Lymphadenopathy
Systemic symptoms, including fever, chills, fatigue, and muscle and joint aches
What is the early disseminated infection stage of Lyme disease?
Typically lasts days to months
Neurological symptoms, including facial palsy, meningitis, radiculoneuritis.
Muscular skeletal symptoms such as myalgia and arthralgia.
Cardiovascular symptoms (rare)
Ocular and hepatic features (rare)
What are the clinical features of Lyme disease?
Encephalopathy
Arthritis
Late encephalomyelitis (rare)
Acrodermatitis chronica atrophicans (rare)
What are some unproven features of Lyme disease?
Sexual transmission
Only subjective symptoms
Incurable if not treated early
Causes autism, multiple sclerosis, dementia birth defects 
What are the influenza a viruses?
H3N2 and H1N1
HSV
Sexually transmitted
Associated with cognitive impairment and schizophrenia and bipolar affective disorder and HSV-1
What is the relationship between schizophrenia and autoimmune disease?
Having schizophrenia is associated with a 55% increased relative risk for autoimmune disease
What is lupus?
Systemic lupus erythema ptosis is a chronic systemic autoimmune condition characterised by auto antibody formation. It has a wide array of clinical symptoms and immunological abnormalities. 
What is the gender predominance of systemic lupus erythematosus?
There is a female predominant at a ratio of 9:1.
What are the two main types of immunity?
Innate and adaptive immunity 
Which cells does innate immunity involve?
Macrophages and monocytes
Which cells does a adaptive immunity involve?
T cells be cells and plasma cells
What is PANS?
An abrupt dramatic onset of OCD plus at least two of
- Anxiety
- Emotional lability or depression
- Behavioural regression
- Irritability
- Deterioration in school performance
- Sensory or motor abnormalities
- Somatic lines, e.g. asleep
What does PANS stand for?
Paediatric acute neuro psychiatric syndrome
What does PANDAS stand for?
Paediatric autoimmune psychiatric disorders associated with streptococcal infections
What is the clinical diagnostic criteria for PANDAS?
Significant obsession, compulsions or tics
Abrupt concept of symptoms or relapsing remitting
Prepubertal onset
Association with streptococcal infection
Association with other neuro psychiatric symptoms
What are the proposed mechanisms for PANS/PANDAS?
An autoimmune response to infection
The production of anti-basal ganglia antibodies
The presence of dopamine receptor antibodies 
What are the treatments for PANS/PANDAS?
IVIG/PLEX performs better than placebo
IVIG in an unlined trial
Azithromycin better than placebo
Penicillin prophylaxis similar to placebo
There is insufficient evidence for the treatment of PANS/PANDAS via which methods
Steroids or psychiatric medication
There is evidence against which treatment method for PANS/PANDAS
Tonsillectomy
There is no evidence for which treatment for PANS/PANDAS
Rituximab or MMF
What are the general principles for treating PANS/PANDAS
Established the correct diagnosis
Provide symptomatic relief
Treat underlying infections
Treat symptoms from neuro inflammation
Evaluate the effectiveness of the treatment frequently
Taper treatment once symptoms resolve
What is the relationship between CASPR2 antibodies and neurodevelopmental disorders?
CASPR2 antibodies are more common and mothers of children with neuro developmental disorders and possibly autism spectrum disorder 
