Pediatric Acute-onset Neuropsychiatric Syndrome and Mycoplasma Pneumoniae Infection: A Case Report Analysis with a Metabolomics Approach

: Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) is a clinical condition characterized by a sudden and dramatic obsessive-compulsive disorder with a suggested post-infectious immune-mediated etiology. This condition is accompanied by an extensive series of relatively serious neuropsychiatric symptoms. The diagnosis of PANS is made by "exclusion", as the individual PANS symptoms overlap with a multiplicity of psychiatric disorders with the onset in childhood. A number of researchers accumulated evidence to support the hypothesis that PANS was closely associated with a number of infections. : In the last decade, metabolomics played an essential role in improving the knowledge of complex biological systems and identifying potential new biomarkers as indicators of pathological progressions or pharmacologic responses to therapy. The metabolome is considered the most predictive phenotype, capable of recognizing epigenetic differences, reflecting more closely the clinical reality at any given moment and thus providing extremely dynamic data. In the present work, the most recent hypothesis and suggested mechanisms of this condition are reviewed and the case of a 10 - year-old girl with PANS is described, before and after clarithromycin treatment. The main results of this case report are discussed from a metabolomics point of view. The alteration of several metabolic pathways concerning the microbial activity highlights the possible role of the microbiome in the development of PANS. Furthermore, different metabolic perturbations at the level of protein biosynthesis, energy and amino acid metabolisms are observed and discussed. Based on our observations, it is believed that metabolomics is a promising technology to unravel the mysteries of PANS in the near future.

Download Full-text

No Neurochemical Evidence of Neuronal Injury or Glial Activation in Children with Paediatric Acute-onset Neuropsychiatric Syndrome

10.21203/rs.3.rs-66815/v1 ◽

2020 ◽

Author(s):

Mats Johnson ◽

Elisabeth Fernell ◽

Christopher Gillberg ◽

Anders Fasth ◽

Kaj Blennow ◽

...

Keyword(s):

Diagnostic Criteria ◽

Neuropsychiatric Symptoms ◽

Neuronal Injury ◽

Acute Onset ◽

University Hospital ◽

Serum Concentrations ◽

Obsessive Compulsive ◽

Neurofilament Light ◽

Compulsive Disorder ◽

Autoimmune Aetiology

Abstract Background Paediatric Acute-onset Neuropsychiatric Syndrome (PANS) is characterized by an acute onset of obsessive compulsive disorder, combined with at least two other neuropsychiatric symptoms with similarly acute onset. Diagnostic criteria also require that no specific medical aetiology is identified. Although there are no verified aetiological biomarkers, PANS is assumed to be a neuroinflammatory disorder with a possible autoimmune aetiology. Neurochemical markers such as neurofilament light (NfL, a neuronal injury marker) and glial fibrillary acidic protein (GFAP, an astrocytic activation marker) have not been published for this patient group.Methods Blood samples from 17 children meeting diagnostic criteria for PANS, after assessment at the Child Neuropsychiatry Centre, Sahlgrenska University Hospital, Gothenburg, Sweden, were analysed for serum concentrations of NfL and GFAP. Ten age-matched children without any neurological or psychiatric disorder served as a comparison group. Results No difference was found in mean NfL and mean GFAP serum concentrations between children with PANS and controls. NfL and GFAP concentrations did not correlate with disease duration between PANS onset and time of blood tests. Conclusion Neuronal injury and astrocyte activation do not seem to be a major event in PANS. The study group was small, and even if findings may be reassuring for parents and patients, they should be interpreted with caution and verified in larger cohort and possibly with other markers in both serum and CSF.

Download Full-text

Diagnostic Approach to Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (PANDAS): A Narrative Review of Literature Data

Frontiers in Pediatrics ◽

10.3389/fped.2021.746639 ◽

2021 ◽

Vol 9 ◽

Author(s):

Adriana Prato ◽

Mariangela Gulisano ◽

Miriam Scerbo ◽

Rita Barone ◽

Carmelo M. Vicario ◽

...

Keyword(s):

Neuropsychiatric Symptoms ◽

Diagnostic Procedures ◽

Neuropsychiatric Disorders ◽

Sudden Onset ◽

Acute Onset ◽

Streptococcal Infections ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Appropriate Treatment ◽

Clinical Conditions

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) are clinical conditions characterized by the sudden onset of obsessive–compulsive disorder and/or tics, often accompanied by other behavioral symptoms in a group of children with streptococcal infection. PANDAS-related disorders, including pediatric acute-onset neuropsychiatric syndrome (PANS), childhood acute neuropsychiatric symptoms (CANS), and pediatric infection triggered autoimmune neuropsychiatric disorders (PITANDs), have also been described. Since first defined in 1998, PANDAS has been considered a controversial diagnosis. A comprehensive review of the literature was performed on PubMed and Scopus databases, searching for diagnostic criteria and diagnostic procedures of PANDAS and related disorders. We propose a test panel to support clinicians in the workout of PANDAS/PANS patients establishing an appropriate treatment. However, further studies are needed to improve our knowledge on these acute-onset neuropsychiatric conditions.

Download Full-text

Session-specific effects of the Metacognitive Group Training for Obsessive–Compulsive Disorder: significant results for thought control

Scientific Reports ◽

10.1038/s41598-020-73122-z ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Franziska Miegel ◽

Barbara Cludius ◽

Birgit Hottenrott ◽

Cüneyt Demiralay ◽

Lena Jelinek

Keyword(s):

Pilot Study ◽

Obsessive Compulsive Disorder ◽

Specific Effect ◽

Group Training ◽

Obsessive Compulsive ◽

Thought Control ◽

Compulsive Disorder ◽

Specific Effects ◽

Before And After ◽

The Individual

Abstract The investigation of the session-specific effects is central for the understanding of psychological interventions. For the present study, we investigated the session-specific effects of the Metacognitive Group Training for Obsessive–Compulsive Disorder (MCT-OCD), which was revised based on data of a pilot study. Thirty-four outpatients with OCD participated in the MCT-OCD once a week over 8 weeks. Different metacognitive beliefs (e.g., thought control) and cognitive beliefs (e.g., intolerance of uncertainty), OC symptoms, as well as associated comorbid symptoms were assessed before and after each session. Linear mixed effects models showed that patients’ obsessions and compulsions, thought control, the belief of being well informed about the disorder, and action fusion improved over the course of the training. The only session-specific effect emerged for thought control, which improved immediately after the respective module. We were able to replicate the findings of the pilot study and thus corroborate the session-specific effect of the module targeting thought control. Moreover, we generated information on the mode of action of the individual modules of the MCT-OCD that allows a more in-depth evaluation of the intervention. Notably, we were able to eliminate the adverse effects of the pilot version of the MCT-OCD. Trial Registration: German Clinical Trials Register (Deutsches Register Klinischer Studien [DRKS]; DRKS-ID: DRKS00013539; registration date: 22/02/2018).

Download Full-text

A review about comorbidity between obsessive-compulsive symptoms and huntintong disease and a case report

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1247 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S702-S703

Author(s):

L. Sánchez Blanco ◽

M. Juncal Ruíz ◽

G. Pardo de Santayana Jenaro ◽

M. Goméz Revuelta ◽

R. Landera Rodríguez ◽

...

Keyword(s):

Case Report ◽

Basal Ganglia ◽

Psychiatric Symptoms ◽

Therapeutic Option ◽

Neuropsychiatric Symptoms ◽

Previous History ◽

Depressive Mood ◽

Obsessive Compulsive ◽

Obsessive Compulsive Symptoms ◽

Compulsive Disorder

IntroductionThe concept of obsessive-compulsive disorder (OCD) as a disorder that affects the basal ganglia arising to the phenomenological similarities found between idiopathic OCD and other conditions associated with basal ganglia disease such as Huntington's disease (HD) and Sydenham's chorea. Huntintong's disease is characterized by cognitive, motor and neuropsychiatric symptoms.AimsA review of articles published from 1989 to 2016 in Pub-Med and UpToDate about relationship between HD and obsessive-compulsive symptoms.MethodsCase report of a 56-year-old male who was admitted at the acute unit of psychiatry with obsessive-compulsive symptoms marked by hypochondriac obsessive thoughts. He also had cleaning rituals in relation with meals and we observed an important functional impairment and depressive mood. No previous history except family chorea without cognitive impairment in study by neurology department.ResultsAffective disorders are the most common psychiatric disorders in HD. Less frequently it can be found other psychiatric symptoms as obsessive-compulsive behaviour with prevalences between 10% to 52%. Psychiatric symptoms do not correlate with duration of disease or presence of dementia or motor symptoms.ConclusionsIt is necessary to complete the study of the patient to provide a more appropriate therapeutic option. The neurological signs of basal ganglia disorder should be evaluated when considering OCD diagnosis, especially in atypical presentation ages. Longitudinal studies are needed to determine the pathogenesis, disease progression and future therapeutic options.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

Neuroleptic-induced Parkinsonism in Patient with Obsessive Compulsive Disorder: a Case Report

10.26226/morressier.58a41cf6d462b8028d89153e ◽

2017 ◽

Author(s):

Juliana Nunes

Keyword(s):

Case Report ◽

Obsessive Compulsive Disorder ◽

Obsessive Compulsive ◽

Compulsive Disorder

Download Full-text

Obsessive Compulsive Disorder with Obsessive Compulsive Personality Disorder - A Case Report

10.26226/morressier.5a6ef3e9d462b80290b57c04 ◽

2018 ◽

Author(s):

Alakananda Gudi

Keyword(s):

Case Report ◽

Personality Disorder ◽

Obsessive Compulsive Disorder ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Obsessive Compulsive Personality Disorder

Download Full-text

Stopping a Response When You Really Care about the Action: Considerations from a Clinical Perspective

Brain Sciences ◽

10.3390/brainsci11080979 ◽

2021 ◽

Vol 11 (8) ◽

pp. 979

Author(s):

Sharon Morein-Zamir ◽

Gideon Anholt

Keyword(s):

Response Inhibition ◽

Action Control ◽

Common Denominator ◽

Obsessive Compulsive ◽

Apparent Paradox ◽

Compulsive Disorder ◽

Reward Seeking ◽

Threat Avoidance ◽

The Individual ◽

Action Tendencies

Response inhibition, whether reactive or proactive, is mostly investigated in a narrow cognitive framework. We argue that it be viewed within a broader frame than the action being inhibited, i.e., in the context of emotion and motivation of the individual at large. This is particularly important in the clinical domain, where the motivational strength of an action can be driven by threat avoidance or reward seeking. The cognitive response inhibition literature has focused on stopping reactively with responses in anticipation of clearly delineated external signals, or proactively in limited contexts, largely independent of clinical phenomena. Moreover, the focus has often been on stopping efficiency and its correlates rather than on inhibition failures. Currently, the cognitive and clinical perspectives are incommensurable. A broader context may explain the apparent paradox where individuals with disorders characterised by maladaptive action control have difficulty inhibiting their actions only in specific circumstances. Using Obsessive Compulsive Disorder as a case study, clinical theorising has focused largely on compulsions as failures of inhibition in relation to specific internal or external triggers. We propose that the concept of action tendencies may constitute a useful common denominator bridging research into motor, emotional, motivational, and contextual aspects of action control failure. The success of action control may depend on the interaction between the strength of action tendencies, the ability to withhold urges, and contextual factors.

Download Full-text