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

Selected Recommendations

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

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• 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.

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• 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.

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• 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.

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• 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.

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• 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.

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