Autoimmunity and Mental Health Flashcards
(40 cards)
Who is wagner-Jauregg
1st psychiatrist of 3 ever to win a noblel prize for malarial therapy in treating dementia paralytica in 1927
What are the mulitple organisms implicated in schizophrenia, bipolar, autism and OCD?
herpes viruses (HSV, CMV, EBV), influenza, toxoplasma more
What is the role of the microbial cells?
secrete neurotransmitters (serotonin, GABA), influence immune response, metabolise nutrients, affect brain development and function (not understood how)
2016 there were _____ syphilis diagnoses a ____ increase in previous year and ____ rise on 2012
5,920 syphilis diagnoses, 12%, 97%
How does rogues gallery: syphilis mainly occur?
men who have sex with men
What are the 4 stages of disease?
Primary: ulcer or chancre at site of inoculation
Secondary (4-10 wks): early generalised lesions in skin and mucous membranes
Latent: asymptomatic
Tertiary: vascular, cardiac, CNS problems
What are early and late stage neurosyphilis examples
Early: acute meningitis, meningovascular
Late: tabes dorsalis, general paresis of the insane (GPI)
What are the psychiatric symptoms of spyhilis?
General paresis/dementia paralytica
Personality change
Disinhibition
Grandiosity/mania (less common)
Simple dementing form (more common)
Depressive, paranoid and neurasthenic forms all described
Dementia progresses, with seizures and paralysis, until death 4-5 years after diagnosis.
Who is susceptible to toxoplasma?
Devastating infection in neonates and immunosuppresed people (e.g. in HIV)
What psychiatric symptoms is toxoplasma associated with
Appears to associate with impulsive behaviour in humans
Increased risk of suicide/self harm/automobile accidents
Associated with increased risk of schizophrenia and possibly other psychiatric disorders
Evidence for association w/ bipolar disorder, anxiety disorders, addictions
What does toxoplasma infection cause (in animals?)
production of brain reactive antibodies and perturbation of dopamine function in animals.
The first stage of lyme disease is…. with what symptoms?
Localized infection (2-30 days)
Any of the following, none of which are always present
Rash at site of bite: Classically ‘Erythema Migrans’
Lymphadenopathy
Systemic symptoms: Fever, chills, fatigue, muscle/joints aches
The second stage of lyme disease is…. with what symptoms?
. Early disseminated infection (Days - months):
Neurological: facial palsy/other cranial nerve lesions, meningitis, radiculoneuritis (shingles-like pain without rash over area of pain)
Musculoskeletal: ongoing myalgia & arthralgia +/-itis
Cardiovascular: conduction abnormalities - rare
Ocular & Hepatic features: v. rare
What are other clinical features of lyme disease?
- Encephalopathy: memory & concentration problems. Cytokine mediated response to systemic infection?
- Arthritis: of large joints, esp a ‘boggy’ & not particularly painful knee. Rarer in UK acquired infection.
And rarely……
- Late encephalomyelitis: spastic paraparesis, broader/more severe cognitive impairment, cranial neuropathy, bladder dysfunction & dysarthria
- Acrodermatitis chronica atrophicans: late skin complication – often occurs with peripheral neuropathy
What is herpes virus?
Large family of dsDNA viruses: includes HSV-1, HSV-2, HHV-6, CMV, EBV, VZV
Can establish latency in sensory ganglion neurons (HSV-1 + 2, VZV) or in lymphocytes (EBV) or other cell types.
Neurotropic; can cause encephalitis in rare cases
Often sexually transmitted
Very widespread infections: often >90% prevalence
What are the psychiatric associations of herpes viruses?
Well-replicated association with cognitive impairment in schizophrenia and BPAD and HSV-1
CBV/EBV infection frequently reported before CFS/ME
Postmortem evidence of HSV-1 in Alzheimer’s disease brains
What is influenza?
Seasonal influenza A viruses (H3N2 and H1N1) circulate within the population, causing yearly epidemics.
Pandemic viruses are the result of cross-species transmission, after which they adapt to humans and spread worldwide.
1918 H1N1 ‘Spanish flu’
1957 H2N2 ‘Asian flu’
1968 ‘Hong Kong flu’
2009 H1N1 ‘Mexican flu’ or ‘swine flu’.
Acute infection can present with encephalitis, but v rare.
Influenza and increased risk of
schizophrenia (esp first half of pregnancy), BPAD
Influenza led to what model
Maternal Immune Activation (MIA) model
+Molecular mimicry: multiple peptide homologies with various brain proteins (inc NMDAR)
What genes are implicated in psychosis?
MHC genes, other immune SNPs
What are inflammatory markers of the blood/CSF?
C-reactive protein, cytokines
Schizophrenia is associated with a ____ risk for autoimmune disease
55%
highest relative risk autoimmune hepatitis (5.4-5.6)
only negative relative risk is rheumatoid arthritis
What is encephalitis and the types?
Inflammation of the brain
infectious encephalitis, unknown and immune mediated encephalitis (post-infectious, autoimmune encephalitis)
What are the causes of infective encephalitis?
Viral: HSV-1, HSV-2, HIV, measles, influenza VZV, CMV, EBV, HHV-6, HHV-7, poliovirus, rabies virus, dengue, West Nile, Zika, JC virus
Bacterial: syphilis, borrelia (Lyme disease), Mycobacterium tuberculosis
Protozoal: malaria, toxoplasma, human African trypanosomiasis (sleeping sickness)
Rickettsial: Q fever
Fungal: cryptococcus, aspergillosis, candidiasis
