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Neuro-Inflammation and re-defining the "BIG PICTURE"

10/16/2021

"Neuroinflammation" is DOMINATING much of the RESEARCH regarding "PSYCHIATRIC DISORDERS" --- but it largely hasn't gotten to CLINICIANS.

Monday --- we're getting back to our letter to the American Bar Association.

In some ways, I do think LAWYERS tend to be MORE FLEXIBLE THINKERS and INTEGRATERS OF KNOWLEDGE.

THE CRIMINAL JUSTICE SYSTEM and POLICYMAKERS need FLEXIBILITY OF THOUGHT and and ability to INTEGRATE VAST AMOUNTS OF KNOWLEDGE.

By and large, Flexibility of Thought and Integration of Knowledge involve IDENTIFYING ANOMALIES and RE-WORKING that BIG PICTURE.

Neuroinflammation in psychiatric disorders: PET imaging and promising new targets (2020)

Affiliations

1Campbell Family Mental Health Research Institute, Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
2Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm, Sweden.
3Molecular Imaging Branch, National Institute of Mental Health, Bethesda, MD, USA.
4Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA.
5Molecular Imaging Branch, National Institute of Mental Health, Bethesda, MD, USA.

Brain-Derived Neurotrophic Factor in Brain Disorders: Focus on Neuroinflammation (2019)

University of Groningen Medical Center --- The Netherlands

Pontifical Catholic University of Rio Grande do Sul in Brazil

Abstract

Brain-derived neurotrophic factor (BDNF) is one of the most studied neurotrophins in the healthy and diseased brain.

As a result, there is a large body of evidence that associates BDNF with neuronal maintenance, neuronal survival, plasticity, and neurotransmitter regulation.

Patients with psychiatric and neurodegenerative disorders often have reduced BDNF concentrations in their blood and brain.

A current hypothesis suggests that these abnormal BDNF levels might be due to the chronic inflammatory state of the brain in certain disorders, as neuroinflammation is known to affect several BDNF-related signaling pathways.

Activation of glia cells can induce an increase in the levels of pro- and antiinflammatory cytokines and reactive oxygen species, which can lead to the modulation of neuronal function and neurotoxicity observed in several brain pathologies.

Understanding how neuroinflammation is involved in disorders of the brain, especially in the disease onset and progression, can be crucial for the development of new strategies of treatment.

Despite the increasing evidence for the involvement of BDNF and neuroinflammation in brain disorders, there is scarce evidence that addresses the interaction between the neurotrophin and neuroinflammation in psychiatric and neurodegenerative diseases.

This review focuses on the effect of acute and chronic inflammation on BDNF levels in the most common psychiatric and neurodegenerative disorders and aims to shed some light on the possible biological mechanisms that may influence this effect.

In addition, this review will address the effect of behavior and pharmacological interventions on BDNF levels in these disorders.

Affiliations

1Neurobiology and Developmental Biology Laboratory, Faculty of Biosciences, Pontifical Catholic University of Rio Grande do Sul, Ipiranga Av. 6681, Porto Alegre, 90619-900, Brazil.
2Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 31.001, 9713 GZ, Groningen, The Netherlands.
3Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 31.001, 9713 GZ, Groningen, The Netherlands.

What "Mental Health" Has Been Missing? DEVELOPMENTAL DIFFERENCE & ITS RAMIFICATIONS

10/9/2021

This has been DIFFICULT for BOTH INDIVIDUALS and PROFESSIONALS --- because most people with PSYCHIATRIC DISORDERS have:
- An IQ above 70
- Have AVERAGE or ABOVE-AVERAGE INTELLIGENCE
- OFTEN have special ATHLETIC, CREATIVE and/or INTELLECTUAL ABILITIES

So that didn't seem to describe our CLASSIC UNDERSTANDING of a person with an INTELLECTUAL DEVELOPMENTAL DISABILITY.
- So the IDEA that the Mental Health Profession was going to help people "CHANGE" --- didn't seem out of place.

This IDEA of "CHANGING PEOPLE" not only seems out of place --- it seems DANGEROUS in 2021
- Most people with PSYCHIATRIC DISORDERS have "HYPER-CONNECTED BRAINS"
- According to the National Institute of Mental Health, PSYCHIATRIC DISORDERS are NOT DISTINCT --- BUT BLURRED.
- It is not just the BRAIN, but also the IMMUNE SYSTEM, the MICROBIOME and the ENDOCRINE SYSTEM that are involved in "PSYCHIATRIC DISORDERS."

In 2021, "EXECUTIVE FUNCTIONING DIFFERENCES" are certainly recognized in the RESEARCH COMMUNITY as an often COMMON CHALLENGE across "PSYCHIATRIC DISORDERS."

Rather than trying to CHANGE these DEVELOPMENTAL DIFFERENCES, it would be much more helpful if MENTAL HEALTH [or SOMEBODY] would:
- Focus on WORKAROUNDS for Executive Functioning Differences
- Develop Strengths, AND
- and STOP WASTING OUR TIME AND MONEY.

Temple Grandin

Boccamazzo adds that he "can't think of a single soul who has a diagnosis of autism, ADHD or learning disability, who only has a diagnosis of autism, ADHD or learning disability."

"All of us are anxious as hell, pretty much all of us struggle with chronic depression as well, largely due to the fact that we've been told we're a broken version of normal our entire lives," he continues.

------Understanding and supporting neurodiversity in the workplace

Maternal Immune Activation alters Adult Behavior

10/3/2021

Some "EXPERTS" raised SIGNIFICANT ISSUES regarding PSYCHIATRIC DISORDERS---
- It wasn't always clear whether they UNDERSTOOD THE IMPLICATIONS of the ISSUES they were raising --- OR
- They did UNDERSTAND those IMPLICATIONS -- BUT they were TOO PRO SOCIALLY COMPETENT to say them OUT LOUD.

Dr. Thomas Insel

In 2013, the National Institute of Mental Health and its then Director Dr. Thomas Insel started to say some things OUT LOUD.

The DSM 5 is NOT SCIENTIFICALLY VALID because it only describes CLUSTERS of SYMPTOMS and NOT THE UNDERLYING BIOLOGY.
Psychiatric Disorders are much more BLURRED than previously thought --- there are COMMON MECHANISMS.

What has become CLEARER in the INTERIM --- is that MATERNAL IMMUNE ACTIVATION is one of those COMMON MECHANISMS.

Maternal immune activation
alters---

Adult Behavior, Intestinal Integrity, Gut Microbiota and the Gut Inflammation (April 2021)

Affiliations

Henan Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China.
Henan Key Lab of Biological Psychiatry of Xinxiang Medical University, Xinxiang, China.
International Joint Research Laboratory for Psychiatry and Neuroscience of Henan, Xinxiang, China.
Henan Province People's Hospital, Zhengzhou, China.

Maternal Immune Activation
and

Neuropsychiatric Illness:

A Translational Research Perspective

Affiliation

From the New York State Psychiatric Institute, Columbia University Medical Center, New York; the Institute of Pharmacology and Toxicology, University of Zurich-Vetsuisse, Zurich; and the Neuroscience Center Zurich, University of Zurich and ETH Zurich.

Inflammation, Positive "EMODIVERSITY" and CAUSE & EFFECT

9/24/2021

Cause & Effect are complicated in Psychiatric Disorders
Major Psychiatric Disorders are being linked to MATERNAL IMMUNE ACTIVATION and DEVELOPMENTAL INFLAMMATION
"Positive Emodiversity" is interesting but is it a CAUSE or an EFFECT of LOWER INFLAMMATION

Understanding CAUSE & EFFECT is a PROBLEM in our discussions of psychiatric disorders and it is definitely a problem in the Criminal Justice System.

Now one of the reasons CAUSE and EFFECT are such a problem is because PSYCHIATRIC DISORDERS are not just GENETICS but the interplay of GENETICS, MATERNAL IMMUNE ACTIVATION, EPIGENETICS and ENVIRONMENT.

I would submit that people who were born with greater DEVELOPMENTAL INFLAMMATION probably are going to have a significantly harder time achieving the LOWER INFLAMMATION associated with "POSITIVE EMODIVERSITY."

Affiliations

1Department of Human Development, Cornell University.
2Department of Human Development and Family Studies, The Pennsylvania State University.
3Department of Psychology, Arizona State University.

Epigenetics in Critical Illness:
A New Frontier (2013)

Emodiversity and biomarkers of inflammation (2018)

Abstract

There is growing evidence that inflammatory responses may help to explain how emotions get “under the skin” to influence disease susceptibility.

Moving beyond examination of individuals’ average level of emotion, this study examined how the breadth and relative abundance of emotions that individuals experience— emodiversity—is related to systemic inflammation.

Using diary data from 175 adults aged 40 to 65 who provided end-of-day reports of their positive and negative emotions over 30 days, we found that greater diversity in day-to-day positive emotions was associated with lower circulating levels of inflammation (indicated by IL-6, CRP, fibrinogen), independent of mean levels of positive and negative emotions, body mass index, anti-inflammatory medications, medical conditions, personality, and demographics.

No significant associations were observed between global or negative emodiversity and inflammation.

These findings highlight the unique role daily positive emotions play in biological health.

IL-6 -- Interleukin-6 (CUSABIO)

Cytokine (Oxford Languages):

any of a number of substances, such as interferon, interleukin, and growth factors, which are secreted by certain cells of the immune system and have an effect on other cells.

Interleukin-6, also known as IL-6, is a cytokine that belongs to the class of interleukins.

It is produced by fibroblasts, monocytes/macrophages, T lymphocytes, B lymphocytes, epithelial cells, keratinocytes, and various tumor cells.

The production of interleukin-6 can be induced in normal cells by various factors, involving IL-1, TNF-a, PDGF, viral infection, double-stranded RNA and so on.

For this reason, IL-6 plays a critical role in acute inflammatory response.

Mayo Clinic

The level of C-reactive protein (CRP) increases when there's inflammation in your body.

A simple blood test can be done to check your C-reactive protein level.

Fibrinogen (Fg) is a biomarker of inflammation (1-5) which, when elevated, indicates the presence of inflammation and identifies individuals with a high risk for cardiovascular disorders.
Inflammatory Markers: Serum Amyloid A, Fibrinogen and C ...

More on Inflammation, Fetal brain Development & Psychiatric Disorders

9/20/2021

3 Related Insights from the Research:

The Blurring of Traditional Psychiatric Categories, AND
The Relationship of MATERNAL IMMUNE INFLAMMATION to those CATEGORIES
ADHD and AUTISM (Traditional Developmental Differences a part of those BLURRED CATEGORIES and part of what we're traditionally thinking of as NEURO-DIVERSITY

Central South University, Hunan, China

SUNY Upstate Medical Center

Inflammation-related biomarkers in major psychiatric disorders: a cross-disorder assessment of reproducibility and specificity in 43 meta-analyses

Affiliations

1Department of Psychiatry, The Second Xiangya Hospital; Mental health Institute of the Second Xiangya Hospital; National Clinical Research Center on Mental Disorders; National Technology Institute on Mental Disorders, Central South University, Changsha, Hunan, China.
2Department of Psychiatry, Hunan Provincial Brain Hospital; Clinical Research Center for Mental Behavioral Disorder in Hunan Province, Clinical Medical School of Hunan University of Chinese Medicine, Changsha, Hunan, China.
3Center for Medical Genetics & Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China.
4Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, USA.
5Center for Medical Genetics & Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China.
6Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, USA. [email protected].
7School of Psychology, Shaanxi Normal University, Xi'an, Shaanxi, China

Prevalence and correlates of low-grade systemic inflammation in adult psychiatric inpatients (2018)

"A notable proportion of acutely unwell psychiatric patients from all ICD-10 major diagnostic groups show evidence of low-grade inflammation, suggesting inflammation may be relevant for all psychiatric disorders."

Cambridge Biomedical Campus -- UK

aDepartment of Psychiatry, University of Cambridge, Cambridge, England, UK
bCambridgeshire and Peterborough NHS Foundation Trust, Cambridge, England, UK
*Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus

Study shows DHA supplement may offset impact of maternal stress on unborn males

9/13/2021

IS THIS TRANSLATIONAL MEDICINE OR JUSTICE?

To me, what is so INTERESTING about this is that it points to how INTER-CONNECTED we all are.

If we're really interested in addressing MALE DEVELOPMENTAL ISSUES and some associated bad behavior in our society---- FEMALES maybe want to take this DHA Supplement during PREGNANCY.

So we see the importance of going beyond the FIRST CHAIN or LINK of CAUSALITY.

BUT we are so FOCUSED ON PUNISHMENT. Do we now want to PUNISH the WOMAN if she FAILS to take the DHA Supplement?

BUT why did she FAIL to take the Supplement -- what's going on there?

This is about BIG PICTURE THINKING but it is also about DETAIL-ORIENTED THINKING and trying to INTEGRATE THOSE:

So we don't make the HUGE REASONING MISTAKES that are most dramatically playing out in the Criminal Justice System

Mental Health Professionals surprisingly often don't have a BIG PICTURE VIEW of their ROLE in some of this:

Why is that?
They are focused on complying with STATUTES
- That's not a bad thing, BUT
- The Society is also relying on these professionals to tell us what STATUTES we should have --- at least in some measure
  - How is it that Colorado has an INSANITY Statute that looks like it was written in the Middle Ages --- surely mental health professionals have been clamoring to get that changed
    - Well, not exactly

From my perspective, part of the BIG PICTURE is Mental Health Professionals have not been getting:

The STATUS or
MONEY that other Medical Professionals get
BUT they are behind on the RESEARCH
- How are these mental health professionals viewing PSYCHIATRIC DISORDERS -- there are a lot of gaps, especially if one isn't getting the research in a timely manner
  - AND a lot of those GAPS are being filled in with PRO SOCIAL COMPETENCE
    - BUT does PRO SOCIAL COMPETENCE get you to a DHA Supplement?

Click Picture to go to Article on Eureka Alert! ---- American Association for the Advancement of Science (AAAS)

Dr. David Beversdorf, lead Author and Professor at the University of Missouri

Making Our Peace with the State of Nature

Covid exposing anomalies in our current understanding of psychiatric Disorders

9/5/2021

New research shows people with psychiatric disorders more at risk for severe COVID-19

----Aug. 2021

Channel 6 News --- Minnesota

As the county and state monitor the pandemic, scientists and medical researchers continue to learn more about COVID-19. Mayo Clinic released a new study that says younger people with psychiatric disorders are at a higher risk for severe disease or even death from the virus. . . .

This research was a partnership between Mayo Clinic, Olmsted Medical Center, Olmsted County Public Health, and Zumbro Valley Health Center.

"Things like effective disorders, severe psychiatric conditions, severe developmental disorders - we would never really expect that those would put people at an especially high risk of a more severe outcome," Sauver said (Sauver is Jennifer St. Sauver, professor of Epidemiology at the Mayo Clinic)

"But according to this new research they do."

Val's Take: Under current clinical mental health paradigms --- it would be a surprise that people with psychiatric conditions would be more at risk of COVID.

BUT under the NEW PARADIGMS emerging from the RESEARCH --- IT IS NOT SURPRISING that people with psychiatric disorders would be more at risk of COVID.

WHY IS THAT?

The NEW RESEARCH of the last 10 years is revealing that psychiatric disorders (and for that matter developmental disorders) are intimately tied to the IMMUNE SYSTEM.

Thomas Kuhn, author of "The Structure of Scientific Revolutions" (1962)

"Psychiatric conditions and cancer predicted a threefold greater risk of severe outcomes from COVID-19 among younger people who tested positive for the illness, according to a recent study by the Rochester Epidemiology Project of Mayo Clinic."

On Page 14 of the study --- "PERSONALITY DISORDERS" are included in the list of disorders that make COVID worse.

Hmmm . . .

Human Beings and Human Societies --- often when we don't have good understandings of illness or behavior:

the person is CURSED BY GOD
the person is POSSESSED BY A DEMON, and
In Modern Times
- Eugenics, or
- a BLIND FAITH in FREE WILL and NEUROPLASTICITY

A lot of the information collected on "Anti-Social Personality Disorder" is of VALUE --- it is just that it is SO PARTIAL.

Understanding "Anti-Social Personality Disorder" as some researchers in the US, Finland and Japan are ---- as a DEVELOPMENTAL DISORDER associated with "ADHD" and DEVELOPMENTAL NEURO-INFLAMMATION starts painting a DIFFERENT PICTURE even if we're not rejecting observed associations with the disorder.

Inflammatory "INSULTS"

9/3/2021

The Impact of Systemic Inflammation on Neurodevelopment --- Trends in Molecular Medicine (2018) --- click image to go to article.

For many people with PSYCHIATRIC DISORDERS ---- from the Research it appears Maternal Immune Activation is a SIGNIFICANT FACTOR.

One of the things that is happening is that the Medical Profession's call to INTEGRATE Physical and Mental Health is PAYING OFF in NEW DISCOVERIES in a BIG WAY.

A lot of our CHRONIC DISEASE & MENTAL HEALTH ISSUES are being linked to the IMMUNE SYSTEM and INFLAMMATION.

Certainly with PSYCHIATRIC DISORDERS including blurred Traditional Mental Illnesses such as " Bipolar Disorder", "Depression" and "Schizophrenia" as well as Traditional Developmental Disabilities such as ADHD and AUTISM ---- those all often involve MATERNAL IMMUNE ACTIVATION.

We're talking about something outside of one generation BUT the last time we talked about that our solution was EUGENICS --- that is NOT THE RIGHT ANSWER ---- and the fact of the matter is that these "DISORDERS" are well represented at top of this SOCIETY.

So what happened --- we found out that NOT ALL of "MENTAL ILLNESS" was GENETIC --- just 80%.

We came up with some problematic medications that work on the brain globally that actually are a big step up from LOBOTOMY (Progress, NOT PERFECTION);
We got rid of our ASYLUMS, and
We didn't invest in HIGH-END COMMUNITY TREATMENT largely because we didn't think we needed it --- if those RECALCITRANT MENTAL HEALTH PATIENTS would just take the MEDICATION --- it would be fine.

WELL IT WASN"T FINE.

In 2021, the largest institutions for people with PSYCHIATRIC DISORDERS are JAILS & PRISON and BRAIN INJURY is even more prevalent according to the current DATA --- although there is often a lot of overlap --- and I suspect when we start including ADHD in the calculation --- it will look a little different than our current estimations.

What's that other 20%? Just PURE FREE WILL, right? Not exactly. A big part of that looks like MATERNAL IMMUNE ACTIVATION and EPIGENETICS.

It may be that we have reached A CRITICAL MASS of people with psychiatric disorders, auto-immune diseases and chronic health issues that we're willing to invest in the RESEARCH, TRANSLATIONAL RESEARCH and COMMUNITY SUPPORTS that are necessary until better treatments are made available.

How Neuro-Immune Interactions Burn Deep Fat

*** The Immune System, Physical Health Issues & Mental Health

Selected Research on Twins and the Immune System

8/12/2021

This is getting to one of the many reasons PSYCHIATRIC DISORDERS have been so hard to CRACK from a scientific point of view.

People have thought "MENTAL ILLNESS" was BIOLOGICAL of a sort for a long time.

A Long Time being THOUSANDS of years --- there were also DEMONS & DEVILS. More recently, certainly in the 20s and 30s people thought "MENTAL ILLNESS" was HERITABLE.

But one of the BIG PROBLEMS came when one discovered that TWIN STUDIES didn't CONFIRM this the way we thought it would be confirmed if it was STRICTLY HERITABLE --- and we were largely focused on the BRAIN to the best of our ability.

Some people had thought the IMMUNE SYSTEM might play a role --- BUT they were not able to confirm that the way it is being confirmed in the 21st Century.

So in the 20th Century researchers were looking at the BRAIN, GENETICS and "TRAUMA," especially CHILDHOOD TRAUMA because that was recognized as influencing BRAIN DEVELOPMENT when it came to PSYCHIATRIC DISORDERS.

It was also recognized that some people might be more genetically susceptible to PTSD.

When we're looking at IMMUNITY were looking at

Genetics
Maternal Immune Activation during Pregnancy
Innate Immunity: Immunity One is Born with
Adaptive Immunity: the Immune System is Adapting over the course of the person's life, and
Epigenetics

At this time -- to me, PSYCHIATRIC DISORDERS appear to be a subset of AUTO-IMMUNE and CHRONIC INFLAMMATORY DISEASES with GENETIC, ENVIRONMENTAL and EPIGENETIC FACTORS.

Lessons learned from twins in autoimmune and chronic inflammatory diseases (2017)

Affiliations

1Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, Rozzano, Milan, Italy.
2Italian Twin Registry, Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy.
3Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, Rozzano, Milan, Italy; BIOMETRA Department, University of Milan, Milan, Italy.

Further, concordance rates in monozygotic twins should be compared to those in dizygotic twins, which share 50% of their genes, as in regular siblings, but also young-age environmental factors. ...These observations are necessary to interpret data gathered by genome …

The Epigenetics of Lupus Erythematosus (2020)

Affiliations

1Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
2Division of Pediatric Immunology and Allergy, Joe DiMaggio Children's Hospital, Hollywood, FL, 33021, USA.
3Division of Rheumatology, Allergy and Clinical Immunology, University of California Davis, Davis, CA, 95616, USA.
4Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, Second Xiangya Hospital, Central South University, Changsha, Hunan, China.

However, increasing evidence has shown that environment factors, genetic susceptibilities, and epigenetic regulation contribute to abnormalities in the immune system. ...However, genetics cannot explain the high discordance of lupus incidence in homozygous twins …

Therefore, this chapter will summarize the up-to-date progress on epigenetics regulation in lupus, in order to broaden our understanding of lupus and discuss the potential roles of epigenetic regulations for clinical applications.

Epigenetics of Autism Spectrum Disorder. (2017)

Affiliations

1Program in Genetics and Genome Biology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
2Program in Genetics and Genome Biology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
3Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
4Department of Paediatrics, University of Toronto, Toronto, ON, M5S 1A1, Canada.
5Institute of Medical Science, University of Toronto, Toronto, ON, M5S 1A8, Canada.

The etiopathogenesis of ASD is known to be complex, including genetic, environmental and epigenetic factors.

Normal epigenetic marks modifiable by both genetics and environmental exposures can result in epigenetic alterations that disrupt the regulation of gene expression, negatively impacting biological pathways important for brain development.

2019 Editorial in Frontiers In Immunology regarding advances in Psycho-Neuro-Immunology Research

7/31/2021

Selected Recommendations

Incorporate cerebrospinal fluid (CSF) analysis in the standard diagnostic workup.

Consider early auto-antibody screening for diagnosing SNAps (Synaptic and Neuronal Auto-Antibody Associated Syndromes), potentially permitting early diagnosis and management of these rare forms of autoimmune encephalitis that can mimic intractable severe mental disorders.

Move to a newer theoretical conceptualization of schizophrenia from an incurable psychiatric illness to a chronic but treatable NEUROLOGICAL DISEASE.

Research justifies the need for a more frequent assessment of serum vitamin D levels in these disorders, and advocate for additional randomized clinical trials investigating the effectiveness of vitamin D supplementation in ameliorating psychiatric and behavioral symptoms.

Krause et al. showed significantly lower serum kynurenine level, and higher quinolinic acid/kynurenine (Qui/Kyn) ratio in a cohort of 32 individuals with major depression, compared to 20 healthy controls.

Higher baseline kynurenine/tryptophan (KYN/TRP) ratio at baseline was predictive of remission and lower Qui/Kyn ratio

following an add- on treatment
with celecoxib correlated
positively with remission.

This study suggests that the measurements of above

biomarkers might be useful in selecting individuals with major
depression who are more likely to respond to anti-inflammatory
agents.

Consider autoimmune psychosis in the differential diagnosis of secondary (organic) psychosis and to complete the relevant diagnostic workup to early identify this subgroup of immune-responsive psychosis.

The authors suggest that the clinical approach to the management of psychotropic–resistant obsessive-compulsive disorder should also include a careful search for biomarkers of inflammation and autoimmunity.

HSV-1 infection of specific limbic brain regions such as hippocampal dentate gyrus among other factors is potentially mechanistically linked to psychosis in a subset of individuals with schizophrenia.

The mechanisms potentially linking viral infections to the neurobiology of schizophrenia were highlighted.

The author suggests that silencing the viral elements such as HSV-1, via either administering antiviral treatment or suppressing environmental factors that can influence viral expression such as stress can thereby potentially be curative in a subgroup of individuals with schizophrenia.

Critical to obtain a detailed history, perform a thorough examination, recognize clinical features (red flags) suggestive of organic causes, and complete a relevant diagnostic workup to include screening for relevant neuronal antibodies in serum and CSF to exclude other organic causes, in order not to overlook immunological causes of new-onset secondary (organic) neuropsychiatric syndromes.

Additional research studies investigating the prevalence of autoimmune psychosis among individuals with new-onset psychosis are needed. Further, development of an expert consensus on the evidence-based clinical practice guidelines addressing the diagnostic challenges and therapeutic dilemmas of new-onset psychosis of suspected immune origin is warranted.

RECENT ADVANCES IN PSYCHIATRY FROM PSYCHO-NEURO-IMMUNOLOGY RESEARCH: AUTOIMMUNE ENCEPHALITIS, AUTOIMMUNE ENCEPHALOPATHY, AND MILD ENCEPHALITIS

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