1.Neuropsychiatric Symptoms of Multiple Sclerosis: State of the Art
Celeste SILVEIRA ; Renato GUEDES ; Diana MAIA ; Rosário CURRAL ; Rui COELHO
Psychiatry Investigation 2019;16(12):877-888
Multiple Sclerosis (MS) is a chronic disabling neuroinflammatory disease. Psychiatric manifestations have a high prevalence in MS patients and may worsen the illness progression and the patients’ quality of life (QoL). Depression is a highly prevalent condition in MS patients, associated with poorer adherence to treatment, decreased functional status and QoL, and increased suicide risk. Diagnosis and treatment of this disorder is challenging because of symptom overlap. Other prevalent psychiatric comorbidities are anxiety disorders, bipolar disorder, psychotic disorders, substance misuse and personality disorders. As the illness progresses, personality changes can happen, as well as affect abnormalities. Cognitive changes occur frequently in MS patients, and affect features like processing speed, attention, learning, memory, visual spatial capabilities, and some language deficits. Disease-modifying treatments may reduce cognitive impairment because of their container action on the brain’s lesion burden. Other QoL determinants such as fatigue, pain, sexual dysfunction, exercise, resilience and social support should be taken into account, in order to promote the individuals’ well-being. Further studies are needed in order to elucidate the effectiveness of pharmacotherapy and more neuroimaging studies are required to clarify the relationship between structural changes and psychiatric comorbidities.
Anxiety Disorders
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Bipolar Disorder
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Cognition
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Cognition Disorders
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Comorbidity
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Depression
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Diagnosis
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Drug Therapy
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Fatigue
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Humans
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Learning
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Memory
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Multiple Sclerosis
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Neuroimaging
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Personality Disorders
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Prevalence
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Psychotic Disorders
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Quality of Life
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Suicide
2.Peripheral Biomarkers for First-Episode Psychosis—Opportunities from the Neuroinflammatory Hypothesis of Schizophrenia
Nuno TROVÃO ; Joana PRATA ; Orlando VONDOELLINGER ; Susana SANTOS ; Mário BARBOSA ; Rui COELHO
Psychiatry Investigation 2019;16(3):177-184
OBJECTIVE: Schizophrenia is a disabling disorder of unknown aetiology, lacking definite diagnostic method and cure. A reliable biological marker of schizophrenia is highly demanded, for which traceable immune mediators in blood could be promising candidates. We aimed to gather the best findings of neuroinflammatory markers for first-episode psychosis (FEP). METHODS: We performed an extensive narrative review of online literature on inflammation-related markers found in human FEP patients only. RESULTS: Changes to cytokine levels have been increasingly reported in schizophrenia. The peripheral levels of IL-1 (or its receptor antagonist), soluble IL-2 receptor, IL-4, IL-6, IL-8, and TNF-α have been frequently reported as increased in FEP, in a suggestive continuum from high-risk stages for psychosis. Microglia and astrocytes establish the link between this immune signalling and the synthesis of noxious tryptophan catabolism products, that cause structural damage and directly hamper normal neurotransmission. Amongst these, only 3-hydroxykynurenine has been consistently described in the blood of FEP patients. CONCLUSION: Peripheral molecules stemming from brain inflammation might provide insightful biomarkers of schizophrenia, as early as FEP or even prodromal phases, although more time- and clinically-adjusted studies are essential for their validation.
Astrocytes
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Biomarkers
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Encephalitis
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Humans
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Interleukin-1
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Interleukin-4
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Interleukin-6
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Interleukin-8
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Metabolism
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Methods
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Microglia
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Polytetrafluoroethylene
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Psychotic Disorders
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Receptors, Interleukin-2
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Schizophrenia
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Synaptic Transmission
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Tryptophan