Post on 08-Jul-2015
Enfermedades autoinmunes
Enfermedades del tejido conectivo
Sistemas y oacuterganos
Siacutentomas psiquiaacutetricos y neuroloacutegicos
Una de las causas mas comunes son tipo vascular (cambios inflamatorios tromboacuteticos) inmunoloacutegicos y ateroescleroacuteticos
Forma de siacutendrome ndash diferente presentacioacuten
Resultados de enfermedad o tratamiento (esteroides o agentes bioloacutegicos)
Manifestaciones psiquiaacutetricas Mas comunes
Cambios de comportamiento
Suentildeo
Inestabilidad emocional
Siacutentomas neuropsiquiaacutetricos son mas vistos en LES (hasta 80 ) sobre todo cuando coexiste con siacutendrome antifosfoliacutepidos
Autoanticuerpos
Problema cliacutenico separado
Au
toan
ticu
erp
os
Lupus inducido por drogas
Tra
tam
ien
toe
nfe
rmed
ad Primario
Secundario
La prevalencia de los siacutentomas psiquiaacutetricos depende y difiere del involucro del SNC SNP y autonoacutemico
Maacutes comunes disfuncioacuten cognitiva progresiva inestabilidad emocional trastornos del suentildeo y del afecto deacuteficits en memoria despersonalizacioacuten desrealizacioacuten depresioacuten ansiedad alucinaciones y delirios de referencia
Una de las principales afecciones primarias causales es de tipo vascular de patogeacutenesis multifactorial principalmente tromboinflamatoria e inmuneinflamatoria
Involucro vascular
bull Inflamacioacuten croacutenica (aa)
bull Lesiones subcliacutenicasateroescleroacuteticas
AutoanicuerposCitocinas
proinflamatorias
Ateroesclerosis acelerada
LES (30-40)
Stroke en 20a 30 de AI Complicacioacuten mas seria y una de las principales causas de muerteStroke isqueacutemicos raros silentes no especiacuteficos deterioro cognitivo progresivo
Siacutentomas neuropsiquiaacutetricos
ES (siacutentomas SNP)
AR (Disfuncioacuten)
LES (Criteriosimagen
cliacutenica)
Casi todas AI
Inmunosupresioacuten
Autoinmunizacioacuten
Articulaciones deformidades
05-1
AR
bull Muerte temprana
bull Disfuncioacuten progresiva
bull Manifestaciones extra-articulares y sisteacutemicas
bull 2x-3x en mujeres
bull 4 y 5 deacutecada
bull AIinflamatoria
bull Mas comuacuten de articulaciones
Cambios neuroloacutegicos
bull SNP
bull Compresioacuten
bull Inflamacioacuten
bull Paresia
Factores psicosociales
bull Adaptacioacuten negativa de cronicidad
bull Depresioacuten y ansiedad (14 a 42)
bull Estresores
bull Suentildeo
Depresioacuten
bull Fem AR con suicidio (90 depresioacuten)
bull AR mayor PG
bull Depresioacuten (dolor articulaciones pobre funcioacuten)
Estresores por AR croacutenica
Limitacioacuten actividadfuncional Econoacutemicos (peacuterdida $costos ) Cambios apariencia
Relaciones sociales alteradas (50) (comunicacioacutencomportamiento)
Relacioacuten pareja (empeore o module)
Incremento estresores (rigidez dolor global y respuesta AI alterada)
Eje HPA (estresores y actividad de AR)
Distorsiones cognitivas (impotencia aprendida)
Estrategias coping(educacioacutenhabilidades)
(lidiarprevenir)
Modificadores bioloacutegicos de la enfermedad ($$$ remisioacuten eficacia calidad problemas psicosociales)
LES
AI
bull Amplio espectro de manifestaciones cliacutenicas
bull Prevalencia 51 por 100000 en USA
Poblacioacuten
bull F 91 H
bull Ancianos serositis involucro pulmonar sicca manifestacionesmuacutesculo esqueleacuteticas
Muerte
bull 90 viven maacutes de 5 antildeos
bull Etapas tempranas infecciones
bull Etapas tardiacuteas complicaciones cardiovasculares por ateroesclerosis
American College of Rheumatology
19 de SNC y SNP
Trastornos psiquiaacutetricos agudos ocurren dentro de los 2 antildeos del diagoacutestico
SNC
Meningitis aseacuteptica enfermedad cerebrovascular siacutendrome desmielinizante
cefalea trastorno del movimiento mieloptiacutea epilepsia confuscioacuten ansiedad
cognitivo psicosis y afecto
Neuropsiquiaacutetricos LES (NPSLE)
LES criterios
Diagnoacutestico de exclusioacuten Otras causas de los siacutentomas infeccioacuten electroliacuteticas renales medicamentos masas embolia psiquiaacutetrico primaria
Cerebritis luacutepica
Base orgaacutenicaAnticuerpos antineurona
Anticuerpos antirribosoma
(psicosis y depresioacuten)
Siacutentomas neuropsiquiaacutetricos
Prevalencia de manifestaciones neuropsiquiaacutetricas
+-
bull Cognitiva cefalea afecto enfermedad cerebrovascular convulsiones polineuropatiacutea ansiedad y psicosis
Psicosis
bull Orgaacutenica 35-5 en LES en el primer antildeo
bull Pensamiento bizarro con alucinaciones y delirios y puede ser fluctuante sobre todo en PM
bull Otros sx atencioacuten agitacioacuten comportamiento agresivo
bull Pueden ser por esteroides (auditivas) o por LES SNC (taacutectiles y visuales)
bull Psicosis por LES reponde bien a esteroides 2-3 semanas citotoacutexicos
bull Mientras tx con antipsicoacuteticos
Procesos psicoloacutegicos funcionales
Disfuncioacuten cognitivabull Memoria a corto y largo plazo
bull Juicio abstraccioacuten afasia apraxia
bull Agnosia y cambios personalidad
Siacutendrome orgaacutenico mental
bull 21 al 80
bull Anticuerpos relacioacuten SNC
bull Condiciones asociadas hipertensioacuten o muacuteltiples infartos
bull Maacutes comuacuten e pacientes con LES activo en tx con esteroides
bull Asociada a historia de dantildeo en SNC
bull Asociada a actividad de enfermedad (efecto de SNC difuso y transitorio)
Memoria
Tratamiento cognitivo Basado en la etiologiacutea
Medicamentos disminuir o quitar
Ab antifosfoliacutepidos anticoagulantes
Ab antineurona esteroides pocas semanas
Reentrenamiento y soporte psicosocial
Aspirina en ancianos y riesgo casdiovascular
Demencia Memoria
Abstraccioacuten
Tareas diarias
Decisioacuten e impulsividad
Asocia a pequentildeos strokes muacuteltiples por anticueposantifosfoliacutepidos
Antipalpudicos pueden tener efecto protector
Pueden ser por lesiones vasculares isqueacutemicas por ateroesclerosis temprana
Parestesiascefalea
Cambios aacutenimo
Maniacutea
Ansiedaddepresioacuten
Agorafobiafobia social
Fobia
Cognitivo (memoriaafasiaorientacioacuten
espacial)
Manifestaciones psiquiaacutetricas secundarias
Depresioacuten
Ansiedad
Comportamiento maniacutea
like
Funcionales
Interaccioacuten px-meacutedicoFrustracioacuten por proceso dx largo
Depresioacuten Manifestacioacuten psiquiaacutetrica maacutes comuacuten
Usualmente comienzan de manera aguda como reaccioacuten a cronicidad y limitaciones en estilo de vida
Despueacutes de una exacerbacioacuten aguda algunos pacientes pueden presentar siacutentomas de ansiedad junto o en vez de los depresivos
Ansiedad Por las posibles consecuencias de la enfermedad
Manifestada como siacutentomas somaacuteticos
Puede deteriorar en comportamiento TOC like fobia hipocondriacutea insomnio y aislamiento
Raramente se desarrolla maniacutea o trastorno orgaacutenico de la personalidad (altas dosis)
Labilidad emocional desinhibicioacuten sexual verborrea religiosidad y agresividad
Siacutendrome antifosfoliacutepidos Siacutentomas neuropsiquiaacutetricos similares a LES
Ab antifosfoliacutepidos hasta 50 en LES
SAP primario trombofilia adquirida mas comuacuten trombosis arterial y venosa abortos espontaacuteneos y otras complicaciones embarazo
Ab antifosfoliacutepidos Anticoagulante luacutepico anticardiolipina y anti glicoproteiacutena I beta 2
SNC
bull Stroke
bull Corea
bull Mielitis transversa
bull Demencia progresiva
Psiquiaacutetricos
bull Cognitivos
bull Amnesia generalizada
bull Lesiones vasculares en sustancia blanca
bull Coexistir con liacutevedoreticularis
EM
bull Algunos pude haber AB AF
bull Difiacutecil diferenciar de EM lesiones
bull Sicca
bull Sx psiquiaacutetricos parecidos a EM
bull Anti-Ro
bull Ansiedad 48
bull Depresioacuten 23Sjoumlgren
bull Rara lesiones en piel tejido subcutaacuteneo u oacuterganos internos
bull Morfologiacutea de vasos (Raynaud hipertensioacuten pulmonar arterial)
bull Siacutentomas neuropsiquiaacutetricos son raros (SNP)(depresioacuten por cronicidad)
Esclerosis sisteacutemica
Vasculitis sisteacutemicas
bullSNP
bullVasculitis necroacutetica granulomatosa
bullAsma bronquial y eosinofilia perifeacuterica
bullPsicosis y orientacioacuten
bullDiversa
bullTamantildeo de vasos
bullGrupo heterogeacuteneo
bullRaras
bullPrimarias o secundarias
bullPsicosis en joacutevenes
bullSNC por hipertensioacuten arterial
bull70 sx neuroloacutegicos neuropatiacutea perifeacuterica
bullVasculitis av
bullPersonalidad depresioacuten y demencia
bull20 meningitis y encefalitis aseacuteptica Arteritis y trombosis senos venosos
BehccediletPoliarteritis
nodosa
Churg-StraussSintomatologiacutea
Complicaciones psiquiaacutetricas debido al tratamiento
bull Prolongado altas dosis
bull Reversibles y moderadas al disminuir o quitar
Esteroides
bull Maniacutea hipomaniacutea
bull Labilidaddepresioacuten
bull Psicosisdelirium
bull Confusioacutendesorientacion
bull Cognitivosmemoria
Psiquiaacutetricasbull Suentildeo (dosis divididas)
bull Acatisia
bull Ancianos (riesgo)
bull Inicio (agitacioacuten euforia hipomaniacutea)
Depresioacuten despueacutes de terapia larga sobre todo en historia familiar de esta y OHMayor severidad a pocos diacuteas con dosis superiores a 20mg de prednisona10 necesidad de reduccioacuten y antipsicoacuteticosPsicosis aumenta en LES con hipoalbuminemia
Esteroides Psicosis diferenciar de glucocorticoide vs LES en altas
dosis
Bajas dosis memoria riesgo elevado ancianos
1 alteraciones cognitivas persistentes
Riesgo suicida elevado
Pseudotumor cerebri raro
Antipaluacutedicos
Cloroquina e hidroxicloroquina
Moderados y transitorios
Cefalea mareo
Raros labilidad agitacioacuten insomnio pesadillas ansiedad fatiga delirios y alucinaciones
Faacutermacos Siacutentesis de autoanticuerpos por faacutermacos
Mayor parte no desarrolla enfermedad autoinmune
Lupus inducido por faacutermacos sujetos sin historia de LES que desarrollan ab antinucleares + sintomas de LES despues de exposicioacuten adecuada a medicamento sintomas se resuelven al descontinuar
Fiebre Rash
Artritis Mialgias
SerositisHematoloacutegicasrenalesSNC
raras
An antihistonas en 95Hipocomplementenemia y ab anti-DNA son poco comunes
Medicamentos
bull Riesgo bajo
bull Clorpromazina
bull Perfenazina
bull Litio
Tratamiento
bull Descontinuar
bull Antipaluacutedicos
bull Glucocorticoides
bull Aines
Hipertiroiddismo Graveacutes AI
Causa mas comuacuten de hipertiroidismo
Oftalmopatiacutea psiquiaacutetricos
Hiperactividad del sistema adreneacutergico
Antagonistas beta adreneacutergicos y antitiroideos
Faacutermacos psicotroacutepicos Necesarios = eutiroideos
Manifestaciones psiquiaacutetricas del hipertiroidismo
Robert Graves
1835
Bocio palpitaciones disfuncioacuten nerviosa y siacutentomas oculares
Discretos trastornos psiquiaacutetricos no psicoacuteticos
SecundarioTP antes de Graveacutes
(comoacuterbido)
Hipertiroidismo y siacutentomas psiquiaacutetricos Depresioacuten
Ansiedad
Hipertiroidismo subcliacutenico (similar escalas)
The presence of antithyroid antibodies in patientswith affective and nonaffective psychiatricdisorders
John J Haggerty Jr 1 Dwight L Evans1 2 Robert N Golden1 Cort A Pedersen1 Jeffrey S Simon3 Charles B Nemeroff4
Biological Psychiatry
Volume 27 Issue 1 1 January 1990 Pages 51ndash60
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
Manifestaciones psiquiaacutetricas Mas comunes
Cambios de comportamiento
Suentildeo
Inestabilidad emocional
Siacutentomas neuropsiquiaacutetricos son mas vistos en LES (hasta 80 ) sobre todo cuando coexiste con siacutendrome antifosfoliacutepidos
Autoanticuerpos
Problema cliacutenico separado
Au
toan
ticu
erp
os
Lupus inducido por drogas
Tra
tam
ien
toe
nfe
rmed
ad Primario
Secundario
La prevalencia de los siacutentomas psiquiaacutetricos depende y difiere del involucro del SNC SNP y autonoacutemico
Maacutes comunes disfuncioacuten cognitiva progresiva inestabilidad emocional trastornos del suentildeo y del afecto deacuteficits en memoria despersonalizacioacuten desrealizacioacuten depresioacuten ansiedad alucinaciones y delirios de referencia
Una de las principales afecciones primarias causales es de tipo vascular de patogeacutenesis multifactorial principalmente tromboinflamatoria e inmuneinflamatoria
Involucro vascular
bull Inflamacioacuten croacutenica (aa)
bull Lesiones subcliacutenicasateroescleroacuteticas
AutoanicuerposCitocinas
proinflamatorias
Ateroesclerosis acelerada
LES (30-40)
Stroke en 20a 30 de AI Complicacioacuten mas seria y una de las principales causas de muerteStroke isqueacutemicos raros silentes no especiacuteficos deterioro cognitivo progresivo
Siacutentomas neuropsiquiaacutetricos
ES (siacutentomas SNP)
AR (Disfuncioacuten)
LES (Criteriosimagen
cliacutenica)
Casi todas AI
Inmunosupresioacuten
Autoinmunizacioacuten
Articulaciones deformidades
05-1
AR
bull Muerte temprana
bull Disfuncioacuten progresiva
bull Manifestaciones extra-articulares y sisteacutemicas
bull 2x-3x en mujeres
bull 4 y 5 deacutecada
bull AIinflamatoria
bull Mas comuacuten de articulaciones
Cambios neuroloacutegicos
bull SNP
bull Compresioacuten
bull Inflamacioacuten
bull Paresia
Factores psicosociales
bull Adaptacioacuten negativa de cronicidad
bull Depresioacuten y ansiedad (14 a 42)
bull Estresores
bull Suentildeo
Depresioacuten
bull Fem AR con suicidio (90 depresioacuten)
bull AR mayor PG
bull Depresioacuten (dolor articulaciones pobre funcioacuten)
Estresores por AR croacutenica
Limitacioacuten actividadfuncional Econoacutemicos (peacuterdida $costos ) Cambios apariencia
Relaciones sociales alteradas (50) (comunicacioacutencomportamiento)
Relacioacuten pareja (empeore o module)
Incremento estresores (rigidez dolor global y respuesta AI alterada)
Eje HPA (estresores y actividad de AR)
Distorsiones cognitivas (impotencia aprendida)
Estrategias coping(educacioacutenhabilidades)
(lidiarprevenir)
Modificadores bioloacutegicos de la enfermedad ($$$ remisioacuten eficacia calidad problemas psicosociales)
LES
AI
bull Amplio espectro de manifestaciones cliacutenicas
bull Prevalencia 51 por 100000 en USA
Poblacioacuten
bull F 91 H
bull Ancianos serositis involucro pulmonar sicca manifestacionesmuacutesculo esqueleacuteticas
Muerte
bull 90 viven maacutes de 5 antildeos
bull Etapas tempranas infecciones
bull Etapas tardiacuteas complicaciones cardiovasculares por ateroesclerosis
American College of Rheumatology
19 de SNC y SNP
Trastornos psiquiaacutetricos agudos ocurren dentro de los 2 antildeos del diagoacutestico
SNC
Meningitis aseacuteptica enfermedad cerebrovascular siacutendrome desmielinizante
cefalea trastorno del movimiento mieloptiacutea epilepsia confuscioacuten ansiedad
cognitivo psicosis y afecto
Neuropsiquiaacutetricos LES (NPSLE)
LES criterios
Diagnoacutestico de exclusioacuten Otras causas de los siacutentomas infeccioacuten electroliacuteticas renales medicamentos masas embolia psiquiaacutetrico primaria
Cerebritis luacutepica
Base orgaacutenicaAnticuerpos antineurona
Anticuerpos antirribosoma
(psicosis y depresioacuten)
Siacutentomas neuropsiquiaacutetricos
Prevalencia de manifestaciones neuropsiquiaacutetricas
+-
bull Cognitiva cefalea afecto enfermedad cerebrovascular convulsiones polineuropatiacutea ansiedad y psicosis
Psicosis
bull Orgaacutenica 35-5 en LES en el primer antildeo
bull Pensamiento bizarro con alucinaciones y delirios y puede ser fluctuante sobre todo en PM
bull Otros sx atencioacuten agitacioacuten comportamiento agresivo
bull Pueden ser por esteroides (auditivas) o por LES SNC (taacutectiles y visuales)
bull Psicosis por LES reponde bien a esteroides 2-3 semanas citotoacutexicos
bull Mientras tx con antipsicoacuteticos
Procesos psicoloacutegicos funcionales
Disfuncioacuten cognitivabull Memoria a corto y largo plazo
bull Juicio abstraccioacuten afasia apraxia
bull Agnosia y cambios personalidad
Siacutendrome orgaacutenico mental
bull 21 al 80
bull Anticuerpos relacioacuten SNC
bull Condiciones asociadas hipertensioacuten o muacuteltiples infartos
bull Maacutes comuacuten e pacientes con LES activo en tx con esteroides
bull Asociada a historia de dantildeo en SNC
bull Asociada a actividad de enfermedad (efecto de SNC difuso y transitorio)
Memoria
Tratamiento cognitivo Basado en la etiologiacutea
Medicamentos disminuir o quitar
Ab antifosfoliacutepidos anticoagulantes
Ab antineurona esteroides pocas semanas
Reentrenamiento y soporte psicosocial
Aspirina en ancianos y riesgo casdiovascular
Demencia Memoria
Abstraccioacuten
Tareas diarias
Decisioacuten e impulsividad
Asocia a pequentildeos strokes muacuteltiples por anticueposantifosfoliacutepidos
Antipalpudicos pueden tener efecto protector
Pueden ser por lesiones vasculares isqueacutemicas por ateroesclerosis temprana
Parestesiascefalea
Cambios aacutenimo
Maniacutea
Ansiedaddepresioacuten
Agorafobiafobia social
Fobia
Cognitivo (memoriaafasiaorientacioacuten
espacial)
Manifestaciones psiquiaacutetricas secundarias
Depresioacuten
Ansiedad
Comportamiento maniacutea
like
Funcionales
Interaccioacuten px-meacutedicoFrustracioacuten por proceso dx largo
Depresioacuten Manifestacioacuten psiquiaacutetrica maacutes comuacuten
Usualmente comienzan de manera aguda como reaccioacuten a cronicidad y limitaciones en estilo de vida
Despueacutes de una exacerbacioacuten aguda algunos pacientes pueden presentar siacutentomas de ansiedad junto o en vez de los depresivos
Ansiedad Por las posibles consecuencias de la enfermedad
Manifestada como siacutentomas somaacuteticos
Puede deteriorar en comportamiento TOC like fobia hipocondriacutea insomnio y aislamiento
Raramente se desarrolla maniacutea o trastorno orgaacutenico de la personalidad (altas dosis)
Labilidad emocional desinhibicioacuten sexual verborrea religiosidad y agresividad
Siacutendrome antifosfoliacutepidos Siacutentomas neuropsiquiaacutetricos similares a LES
Ab antifosfoliacutepidos hasta 50 en LES
SAP primario trombofilia adquirida mas comuacuten trombosis arterial y venosa abortos espontaacuteneos y otras complicaciones embarazo
Ab antifosfoliacutepidos Anticoagulante luacutepico anticardiolipina y anti glicoproteiacutena I beta 2
SNC
bull Stroke
bull Corea
bull Mielitis transversa
bull Demencia progresiva
Psiquiaacutetricos
bull Cognitivos
bull Amnesia generalizada
bull Lesiones vasculares en sustancia blanca
bull Coexistir con liacutevedoreticularis
EM
bull Algunos pude haber AB AF
bull Difiacutecil diferenciar de EM lesiones
bull Sicca
bull Sx psiquiaacutetricos parecidos a EM
bull Anti-Ro
bull Ansiedad 48
bull Depresioacuten 23Sjoumlgren
bull Rara lesiones en piel tejido subcutaacuteneo u oacuterganos internos
bull Morfologiacutea de vasos (Raynaud hipertensioacuten pulmonar arterial)
bull Siacutentomas neuropsiquiaacutetricos son raros (SNP)(depresioacuten por cronicidad)
Esclerosis sisteacutemica
Vasculitis sisteacutemicas
bullSNP
bullVasculitis necroacutetica granulomatosa
bullAsma bronquial y eosinofilia perifeacuterica
bullPsicosis y orientacioacuten
bullDiversa
bullTamantildeo de vasos
bullGrupo heterogeacuteneo
bullRaras
bullPrimarias o secundarias
bullPsicosis en joacutevenes
bullSNC por hipertensioacuten arterial
bull70 sx neuroloacutegicos neuropatiacutea perifeacuterica
bullVasculitis av
bullPersonalidad depresioacuten y demencia
bull20 meningitis y encefalitis aseacuteptica Arteritis y trombosis senos venosos
BehccediletPoliarteritis
nodosa
Churg-StraussSintomatologiacutea
Complicaciones psiquiaacutetricas debido al tratamiento
bull Prolongado altas dosis
bull Reversibles y moderadas al disminuir o quitar
Esteroides
bull Maniacutea hipomaniacutea
bull Labilidaddepresioacuten
bull Psicosisdelirium
bull Confusioacutendesorientacion
bull Cognitivosmemoria
Psiquiaacutetricasbull Suentildeo (dosis divididas)
bull Acatisia
bull Ancianos (riesgo)
bull Inicio (agitacioacuten euforia hipomaniacutea)
Depresioacuten despueacutes de terapia larga sobre todo en historia familiar de esta y OHMayor severidad a pocos diacuteas con dosis superiores a 20mg de prednisona10 necesidad de reduccioacuten y antipsicoacuteticosPsicosis aumenta en LES con hipoalbuminemia
Esteroides Psicosis diferenciar de glucocorticoide vs LES en altas
dosis
Bajas dosis memoria riesgo elevado ancianos
1 alteraciones cognitivas persistentes
Riesgo suicida elevado
Pseudotumor cerebri raro
Antipaluacutedicos
Cloroquina e hidroxicloroquina
Moderados y transitorios
Cefalea mareo
Raros labilidad agitacioacuten insomnio pesadillas ansiedad fatiga delirios y alucinaciones
Faacutermacos Siacutentesis de autoanticuerpos por faacutermacos
Mayor parte no desarrolla enfermedad autoinmune
Lupus inducido por faacutermacos sujetos sin historia de LES que desarrollan ab antinucleares + sintomas de LES despues de exposicioacuten adecuada a medicamento sintomas se resuelven al descontinuar
Fiebre Rash
Artritis Mialgias
SerositisHematoloacutegicasrenalesSNC
raras
An antihistonas en 95Hipocomplementenemia y ab anti-DNA son poco comunes
Medicamentos
bull Riesgo bajo
bull Clorpromazina
bull Perfenazina
bull Litio
Tratamiento
bull Descontinuar
bull Antipaluacutedicos
bull Glucocorticoides
bull Aines
Hipertiroiddismo Graveacutes AI
Causa mas comuacuten de hipertiroidismo
Oftalmopatiacutea psiquiaacutetricos
Hiperactividad del sistema adreneacutergico
Antagonistas beta adreneacutergicos y antitiroideos
Faacutermacos psicotroacutepicos Necesarios = eutiroideos
Manifestaciones psiquiaacutetricas del hipertiroidismo
Robert Graves
1835
Bocio palpitaciones disfuncioacuten nerviosa y siacutentomas oculares
Discretos trastornos psiquiaacutetricos no psicoacuteticos
SecundarioTP antes de Graveacutes
(comoacuterbido)
Hipertiroidismo y siacutentomas psiquiaacutetricos Depresioacuten
Ansiedad
Hipertiroidismo subcliacutenico (similar escalas)
The presence of antithyroid antibodies in patientswith affective and nonaffective psychiatricdisorders
John J Haggerty Jr 1 Dwight L Evans1 2 Robert N Golden1 Cort A Pedersen1 Jeffrey S Simon3 Charles B Nemeroff4
Biological Psychiatry
Volume 27 Issue 1 1 January 1990 Pages 51ndash60
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
Autoanticuerpos
Problema cliacutenico separado
Au
toan
ticu
erp
os
Lupus inducido por drogas
Tra
tam
ien
toe
nfe
rmed
ad Primario
Secundario
La prevalencia de los siacutentomas psiquiaacutetricos depende y difiere del involucro del SNC SNP y autonoacutemico
Maacutes comunes disfuncioacuten cognitiva progresiva inestabilidad emocional trastornos del suentildeo y del afecto deacuteficits en memoria despersonalizacioacuten desrealizacioacuten depresioacuten ansiedad alucinaciones y delirios de referencia
Una de las principales afecciones primarias causales es de tipo vascular de patogeacutenesis multifactorial principalmente tromboinflamatoria e inmuneinflamatoria
Involucro vascular
bull Inflamacioacuten croacutenica (aa)
bull Lesiones subcliacutenicasateroescleroacuteticas
AutoanicuerposCitocinas
proinflamatorias
Ateroesclerosis acelerada
LES (30-40)
Stroke en 20a 30 de AI Complicacioacuten mas seria y una de las principales causas de muerteStroke isqueacutemicos raros silentes no especiacuteficos deterioro cognitivo progresivo
Siacutentomas neuropsiquiaacutetricos
ES (siacutentomas SNP)
AR (Disfuncioacuten)
LES (Criteriosimagen
cliacutenica)
Casi todas AI
Inmunosupresioacuten
Autoinmunizacioacuten
Articulaciones deformidades
05-1
AR
bull Muerte temprana
bull Disfuncioacuten progresiva
bull Manifestaciones extra-articulares y sisteacutemicas
bull 2x-3x en mujeres
bull 4 y 5 deacutecada
bull AIinflamatoria
bull Mas comuacuten de articulaciones
Cambios neuroloacutegicos
bull SNP
bull Compresioacuten
bull Inflamacioacuten
bull Paresia
Factores psicosociales
bull Adaptacioacuten negativa de cronicidad
bull Depresioacuten y ansiedad (14 a 42)
bull Estresores
bull Suentildeo
Depresioacuten
bull Fem AR con suicidio (90 depresioacuten)
bull AR mayor PG
bull Depresioacuten (dolor articulaciones pobre funcioacuten)
Estresores por AR croacutenica
Limitacioacuten actividadfuncional Econoacutemicos (peacuterdida $costos ) Cambios apariencia
Relaciones sociales alteradas (50) (comunicacioacutencomportamiento)
Relacioacuten pareja (empeore o module)
Incremento estresores (rigidez dolor global y respuesta AI alterada)
Eje HPA (estresores y actividad de AR)
Distorsiones cognitivas (impotencia aprendida)
Estrategias coping(educacioacutenhabilidades)
(lidiarprevenir)
Modificadores bioloacutegicos de la enfermedad ($$$ remisioacuten eficacia calidad problemas psicosociales)
LES
AI
bull Amplio espectro de manifestaciones cliacutenicas
bull Prevalencia 51 por 100000 en USA
Poblacioacuten
bull F 91 H
bull Ancianos serositis involucro pulmonar sicca manifestacionesmuacutesculo esqueleacuteticas
Muerte
bull 90 viven maacutes de 5 antildeos
bull Etapas tempranas infecciones
bull Etapas tardiacuteas complicaciones cardiovasculares por ateroesclerosis
American College of Rheumatology
19 de SNC y SNP
Trastornos psiquiaacutetricos agudos ocurren dentro de los 2 antildeos del diagoacutestico
SNC
Meningitis aseacuteptica enfermedad cerebrovascular siacutendrome desmielinizante
cefalea trastorno del movimiento mieloptiacutea epilepsia confuscioacuten ansiedad
cognitivo psicosis y afecto
Neuropsiquiaacutetricos LES (NPSLE)
LES criterios
Diagnoacutestico de exclusioacuten Otras causas de los siacutentomas infeccioacuten electroliacuteticas renales medicamentos masas embolia psiquiaacutetrico primaria
Cerebritis luacutepica
Base orgaacutenicaAnticuerpos antineurona
Anticuerpos antirribosoma
(psicosis y depresioacuten)
Siacutentomas neuropsiquiaacutetricos
Prevalencia de manifestaciones neuropsiquiaacutetricas
+-
bull Cognitiva cefalea afecto enfermedad cerebrovascular convulsiones polineuropatiacutea ansiedad y psicosis
Psicosis
bull Orgaacutenica 35-5 en LES en el primer antildeo
bull Pensamiento bizarro con alucinaciones y delirios y puede ser fluctuante sobre todo en PM
bull Otros sx atencioacuten agitacioacuten comportamiento agresivo
bull Pueden ser por esteroides (auditivas) o por LES SNC (taacutectiles y visuales)
bull Psicosis por LES reponde bien a esteroides 2-3 semanas citotoacutexicos
bull Mientras tx con antipsicoacuteticos
Procesos psicoloacutegicos funcionales
Disfuncioacuten cognitivabull Memoria a corto y largo plazo
bull Juicio abstraccioacuten afasia apraxia
bull Agnosia y cambios personalidad
Siacutendrome orgaacutenico mental
bull 21 al 80
bull Anticuerpos relacioacuten SNC
bull Condiciones asociadas hipertensioacuten o muacuteltiples infartos
bull Maacutes comuacuten e pacientes con LES activo en tx con esteroides
bull Asociada a historia de dantildeo en SNC
bull Asociada a actividad de enfermedad (efecto de SNC difuso y transitorio)
Memoria
Tratamiento cognitivo Basado en la etiologiacutea
Medicamentos disminuir o quitar
Ab antifosfoliacutepidos anticoagulantes
Ab antineurona esteroides pocas semanas
Reentrenamiento y soporte psicosocial
Aspirina en ancianos y riesgo casdiovascular
Demencia Memoria
Abstraccioacuten
Tareas diarias
Decisioacuten e impulsividad
Asocia a pequentildeos strokes muacuteltiples por anticueposantifosfoliacutepidos
Antipalpudicos pueden tener efecto protector
Pueden ser por lesiones vasculares isqueacutemicas por ateroesclerosis temprana
Parestesiascefalea
Cambios aacutenimo
Maniacutea
Ansiedaddepresioacuten
Agorafobiafobia social
Fobia
Cognitivo (memoriaafasiaorientacioacuten
espacial)
Manifestaciones psiquiaacutetricas secundarias
Depresioacuten
Ansiedad
Comportamiento maniacutea
like
Funcionales
Interaccioacuten px-meacutedicoFrustracioacuten por proceso dx largo
Depresioacuten Manifestacioacuten psiquiaacutetrica maacutes comuacuten
Usualmente comienzan de manera aguda como reaccioacuten a cronicidad y limitaciones en estilo de vida
Despueacutes de una exacerbacioacuten aguda algunos pacientes pueden presentar siacutentomas de ansiedad junto o en vez de los depresivos
Ansiedad Por las posibles consecuencias de la enfermedad
Manifestada como siacutentomas somaacuteticos
Puede deteriorar en comportamiento TOC like fobia hipocondriacutea insomnio y aislamiento
Raramente se desarrolla maniacutea o trastorno orgaacutenico de la personalidad (altas dosis)
Labilidad emocional desinhibicioacuten sexual verborrea religiosidad y agresividad
Siacutendrome antifosfoliacutepidos Siacutentomas neuropsiquiaacutetricos similares a LES
Ab antifosfoliacutepidos hasta 50 en LES
SAP primario trombofilia adquirida mas comuacuten trombosis arterial y venosa abortos espontaacuteneos y otras complicaciones embarazo
Ab antifosfoliacutepidos Anticoagulante luacutepico anticardiolipina y anti glicoproteiacutena I beta 2
SNC
bull Stroke
bull Corea
bull Mielitis transversa
bull Demencia progresiva
Psiquiaacutetricos
bull Cognitivos
bull Amnesia generalizada
bull Lesiones vasculares en sustancia blanca
bull Coexistir con liacutevedoreticularis
EM
bull Algunos pude haber AB AF
bull Difiacutecil diferenciar de EM lesiones
bull Sicca
bull Sx psiquiaacutetricos parecidos a EM
bull Anti-Ro
bull Ansiedad 48
bull Depresioacuten 23Sjoumlgren
bull Rara lesiones en piel tejido subcutaacuteneo u oacuterganos internos
bull Morfologiacutea de vasos (Raynaud hipertensioacuten pulmonar arterial)
bull Siacutentomas neuropsiquiaacutetricos son raros (SNP)(depresioacuten por cronicidad)
Esclerosis sisteacutemica
Vasculitis sisteacutemicas
bullSNP
bullVasculitis necroacutetica granulomatosa
bullAsma bronquial y eosinofilia perifeacuterica
bullPsicosis y orientacioacuten
bullDiversa
bullTamantildeo de vasos
bullGrupo heterogeacuteneo
bullRaras
bullPrimarias o secundarias
bullPsicosis en joacutevenes
bullSNC por hipertensioacuten arterial
bull70 sx neuroloacutegicos neuropatiacutea perifeacuterica
bullVasculitis av
bullPersonalidad depresioacuten y demencia
bull20 meningitis y encefalitis aseacuteptica Arteritis y trombosis senos venosos
BehccediletPoliarteritis
nodosa
Churg-StraussSintomatologiacutea
Complicaciones psiquiaacutetricas debido al tratamiento
bull Prolongado altas dosis
bull Reversibles y moderadas al disminuir o quitar
Esteroides
bull Maniacutea hipomaniacutea
bull Labilidaddepresioacuten
bull Psicosisdelirium
bull Confusioacutendesorientacion
bull Cognitivosmemoria
Psiquiaacutetricasbull Suentildeo (dosis divididas)
bull Acatisia
bull Ancianos (riesgo)
bull Inicio (agitacioacuten euforia hipomaniacutea)
Depresioacuten despueacutes de terapia larga sobre todo en historia familiar de esta y OHMayor severidad a pocos diacuteas con dosis superiores a 20mg de prednisona10 necesidad de reduccioacuten y antipsicoacuteticosPsicosis aumenta en LES con hipoalbuminemia
Esteroides Psicosis diferenciar de glucocorticoide vs LES en altas
dosis
Bajas dosis memoria riesgo elevado ancianos
1 alteraciones cognitivas persistentes
Riesgo suicida elevado
Pseudotumor cerebri raro
Antipaluacutedicos
Cloroquina e hidroxicloroquina
Moderados y transitorios
Cefalea mareo
Raros labilidad agitacioacuten insomnio pesadillas ansiedad fatiga delirios y alucinaciones
Faacutermacos Siacutentesis de autoanticuerpos por faacutermacos
Mayor parte no desarrolla enfermedad autoinmune
Lupus inducido por faacutermacos sujetos sin historia de LES que desarrollan ab antinucleares + sintomas de LES despues de exposicioacuten adecuada a medicamento sintomas se resuelven al descontinuar
Fiebre Rash
Artritis Mialgias
SerositisHematoloacutegicasrenalesSNC
raras
An antihistonas en 95Hipocomplementenemia y ab anti-DNA son poco comunes
Medicamentos
bull Riesgo bajo
bull Clorpromazina
bull Perfenazina
bull Litio
Tratamiento
bull Descontinuar
bull Antipaluacutedicos
bull Glucocorticoides
bull Aines
Hipertiroiddismo Graveacutes AI
Causa mas comuacuten de hipertiroidismo
Oftalmopatiacutea psiquiaacutetricos
Hiperactividad del sistema adreneacutergico
Antagonistas beta adreneacutergicos y antitiroideos
Faacutermacos psicotroacutepicos Necesarios = eutiroideos
Manifestaciones psiquiaacutetricas del hipertiroidismo
Robert Graves
1835
Bocio palpitaciones disfuncioacuten nerviosa y siacutentomas oculares
Discretos trastornos psiquiaacutetricos no psicoacuteticos
SecundarioTP antes de Graveacutes
(comoacuterbido)
Hipertiroidismo y siacutentomas psiquiaacutetricos Depresioacuten
Ansiedad
Hipertiroidismo subcliacutenico (similar escalas)
The presence of antithyroid antibodies in patientswith affective and nonaffective psychiatricdisorders
John J Haggerty Jr 1 Dwight L Evans1 2 Robert N Golden1 Cort A Pedersen1 Jeffrey S Simon3 Charles B Nemeroff4
Biological Psychiatry
Volume 27 Issue 1 1 January 1990 Pages 51ndash60
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
La prevalencia de los siacutentomas psiquiaacutetricos depende y difiere del involucro del SNC SNP y autonoacutemico
Maacutes comunes disfuncioacuten cognitiva progresiva inestabilidad emocional trastornos del suentildeo y del afecto deacuteficits en memoria despersonalizacioacuten desrealizacioacuten depresioacuten ansiedad alucinaciones y delirios de referencia
Una de las principales afecciones primarias causales es de tipo vascular de patogeacutenesis multifactorial principalmente tromboinflamatoria e inmuneinflamatoria
Involucro vascular
bull Inflamacioacuten croacutenica (aa)
bull Lesiones subcliacutenicasateroescleroacuteticas
AutoanicuerposCitocinas
proinflamatorias
Ateroesclerosis acelerada
LES (30-40)
Stroke en 20a 30 de AI Complicacioacuten mas seria y una de las principales causas de muerteStroke isqueacutemicos raros silentes no especiacuteficos deterioro cognitivo progresivo
Siacutentomas neuropsiquiaacutetricos
ES (siacutentomas SNP)
AR (Disfuncioacuten)
LES (Criteriosimagen
cliacutenica)
Casi todas AI
Inmunosupresioacuten
Autoinmunizacioacuten
Articulaciones deformidades
05-1
AR
bull Muerte temprana
bull Disfuncioacuten progresiva
bull Manifestaciones extra-articulares y sisteacutemicas
bull 2x-3x en mujeres
bull 4 y 5 deacutecada
bull AIinflamatoria
bull Mas comuacuten de articulaciones
Cambios neuroloacutegicos
bull SNP
bull Compresioacuten
bull Inflamacioacuten
bull Paresia
Factores psicosociales
bull Adaptacioacuten negativa de cronicidad
bull Depresioacuten y ansiedad (14 a 42)
bull Estresores
bull Suentildeo
Depresioacuten
bull Fem AR con suicidio (90 depresioacuten)
bull AR mayor PG
bull Depresioacuten (dolor articulaciones pobre funcioacuten)
Estresores por AR croacutenica
Limitacioacuten actividadfuncional Econoacutemicos (peacuterdida $costos ) Cambios apariencia
Relaciones sociales alteradas (50) (comunicacioacutencomportamiento)
Relacioacuten pareja (empeore o module)
Incremento estresores (rigidez dolor global y respuesta AI alterada)
Eje HPA (estresores y actividad de AR)
Distorsiones cognitivas (impotencia aprendida)
Estrategias coping(educacioacutenhabilidades)
(lidiarprevenir)
Modificadores bioloacutegicos de la enfermedad ($$$ remisioacuten eficacia calidad problemas psicosociales)
LES
AI
bull Amplio espectro de manifestaciones cliacutenicas
bull Prevalencia 51 por 100000 en USA
Poblacioacuten
bull F 91 H
bull Ancianos serositis involucro pulmonar sicca manifestacionesmuacutesculo esqueleacuteticas
Muerte
bull 90 viven maacutes de 5 antildeos
bull Etapas tempranas infecciones
bull Etapas tardiacuteas complicaciones cardiovasculares por ateroesclerosis
American College of Rheumatology
19 de SNC y SNP
Trastornos psiquiaacutetricos agudos ocurren dentro de los 2 antildeos del diagoacutestico
SNC
Meningitis aseacuteptica enfermedad cerebrovascular siacutendrome desmielinizante
cefalea trastorno del movimiento mieloptiacutea epilepsia confuscioacuten ansiedad
cognitivo psicosis y afecto
Neuropsiquiaacutetricos LES (NPSLE)
LES criterios
Diagnoacutestico de exclusioacuten Otras causas de los siacutentomas infeccioacuten electroliacuteticas renales medicamentos masas embolia psiquiaacutetrico primaria
Cerebritis luacutepica
Base orgaacutenicaAnticuerpos antineurona
Anticuerpos antirribosoma
(psicosis y depresioacuten)
Siacutentomas neuropsiquiaacutetricos
Prevalencia de manifestaciones neuropsiquiaacutetricas
+-
bull Cognitiva cefalea afecto enfermedad cerebrovascular convulsiones polineuropatiacutea ansiedad y psicosis
Psicosis
bull Orgaacutenica 35-5 en LES en el primer antildeo
bull Pensamiento bizarro con alucinaciones y delirios y puede ser fluctuante sobre todo en PM
bull Otros sx atencioacuten agitacioacuten comportamiento agresivo
bull Pueden ser por esteroides (auditivas) o por LES SNC (taacutectiles y visuales)
bull Psicosis por LES reponde bien a esteroides 2-3 semanas citotoacutexicos
bull Mientras tx con antipsicoacuteticos
Procesos psicoloacutegicos funcionales
Disfuncioacuten cognitivabull Memoria a corto y largo plazo
bull Juicio abstraccioacuten afasia apraxia
bull Agnosia y cambios personalidad
Siacutendrome orgaacutenico mental
bull 21 al 80
bull Anticuerpos relacioacuten SNC
bull Condiciones asociadas hipertensioacuten o muacuteltiples infartos
bull Maacutes comuacuten e pacientes con LES activo en tx con esteroides
bull Asociada a historia de dantildeo en SNC
bull Asociada a actividad de enfermedad (efecto de SNC difuso y transitorio)
Memoria
Tratamiento cognitivo Basado en la etiologiacutea
Medicamentos disminuir o quitar
Ab antifosfoliacutepidos anticoagulantes
Ab antineurona esteroides pocas semanas
Reentrenamiento y soporte psicosocial
Aspirina en ancianos y riesgo casdiovascular
Demencia Memoria
Abstraccioacuten
Tareas diarias
Decisioacuten e impulsividad
Asocia a pequentildeos strokes muacuteltiples por anticueposantifosfoliacutepidos
Antipalpudicos pueden tener efecto protector
Pueden ser por lesiones vasculares isqueacutemicas por ateroesclerosis temprana
Parestesiascefalea
Cambios aacutenimo
Maniacutea
Ansiedaddepresioacuten
Agorafobiafobia social
Fobia
Cognitivo (memoriaafasiaorientacioacuten
espacial)
Manifestaciones psiquiaacutetricas secundarias
Depresioacuten
Ansiedad
Comportamiento maniacutea
like
Funcionales
Interaccioacuten px-meacutedicoFrustracioacuten por proceso dx largo
Depresioacuten Manifestacioacuten psiquiaacutetrica maacutes comuacuten
Usualmente comienzan de manera aguda como reaccioacuten a cronicidad y limitaciones en estilo de vida
Despueacutes de una exacerbacioacuten aguda algunos pacientes pueden presentar siacutentomas de ansiedad junto o en vez de los depresivos
Ansiedad Por las posibles consecuencias de la enfermedad
Manifestada como siacutentomas somaacuteticos
Puede deteriorar en comportamiento TOC like fobia hipocondriacutea insomnio y aislamiento
Raramente se desarrolla maniacutea o trastorno orgaacutenico de la personalidad (altas dosis)
Labilidad emocional desinhibicioacuten sexual verborrea religiosidad y agresividad
Siacutendrome antifosfoliacutepidos Siacutentomas neuropsiquiaacutetricos similares a LES
Ab antifosfoliacutepidos hasta 50 en LES
SAP primario trombofilia adquirida mas comuacuten trombosis arterial y venosa abortos espontaacuteneos y otras complicaciones embarazo
Ab antifosfoliacutepidos Anticoagulante luacutepico anticardiolipina y anti glicoproteiacutena I beta 2
SNC
bull Stroke
bull Corea
bull Mielitis transversa
bull Demencia progresiva
Psiquiaacutetricos
bull Cognitivos
bull Amnesia generalizada
bull Lesiones vasculares en sustancia blanca
bull Coexistir con liacutevedoreticularis
EM
bull Algunos pude haber AB AF
bull Difiacutecil diferenciar de EM lesiones
bull Sicca
bull Sx psiquiaacutetricos parecidos a EM
bull Anti-Ro
bull Ansiedad 48
bull Depresioacuten 23Sjoumlgren
bull Rara lesiones en piel tejido subcutaacuteneo u oacuterganos internos
bull Morfologiacutea de vasos (Raynaud hipertensioacuten pulmonar arterial)
bull Siacutentomas neuropsiquiaacutetricos son raros (SNP)(depresioacuten por cronicidad)
Esclerosis sisteacutemica
Vasculitis sisteacutemicas
bullSNP
bullVasculitis necroacutetica granulomatosa
bullAsma bronquial y eosinofilia perifeacuterica
bullPsicosis y orientacioacuten
bullDiversa
bullTamantildeo de vasos
bullGrupo heterogeacuteneo
bullRaras
bullPrimarias o secundarias
bullPsicosis en joacutevenes
bullSNC por hipertensioacuten arterial
bull70 sx neuroloacutegicos neuropatiacutea perifeacuterica
bullVasculitis av
bullPersonalidad depresioacuten y demencia
bull20 meningitis y encefalitis aseacuteptica Arteritis y trombosis senos venosos
BehccediletPoliarteritis
nodosa
Churg-StraussSintomatologiacutea
Complicaciones psiquiaacutetricas debido al tratamiento
bull Prolongado altas dosis
bull Reversibles y moderadas al disminuir o quitar
Esteroides
bull Maniacutea hipomaniacutea
bull Labilidaddepresioacuten
bull Psicosisdelirium
bull Confusioacutendesorientacion
bull Cognitivosmemoria
Psiquiaacutetricasbull Suentildeo (dosis divididas)
bull Acatisia
bull Ancianos (riesgo)
bull Inicio (agitacioacuten euforia hipomaniacutea)
Depresioacuten despueacutes de terapia larga sobre todo en historia familiar de esta y OHMayor severidad a pocos diacuteas con dosis superiores a 20mg de prednisona10 necesidad de reduccioacuten y antipsicoacuteticosPsicosis aumenta en LES con hipoalbuminemia
Esteroides Psicosis diferenciar de glucocorticoide vs LES en altas
dosis
Bajas dosis memoria riesgo elevado ancianos
1 alteraciones cognitivas persistentes
Riesgo suicida elevado
Pseudotumor cerebri raro
Antipaluacutedicos
Cloroquina e hidroxicloroquina
Moderados y transitorios
Cefalea mareo
Raros labilidad agitacioacuten insomnio pesadillas ansiedad fatiga delirios y alucinaciones
Faacutermacos Siacutentesis de autoanticuerpos por faacutermacos
Mayor parte no desarrolla enfermedad autoinmune
Lupus inducido por faacutermacos sujetos sin historia de LES que desarrollan ab antinucleares + sintomas de LES despues de exposicioacuten adecuada a medicamento sintomas se resuelven al descontinuar
Fiebre Rash
Artritis Mialgias
SerositisHematoloacutegicasrenalesSNC
raras
An antihistonas en 95Hipocomplementenemia y ab anti-DNA son poco comunes
Medicamentos
bull Riesgo bajo
bull Clorpromazina
bull Perfenazina
bull Litio
Tratamiento
bull Descontinuar
bull Antipaluacutedicos
bull Glucocorticoides
bull Aines
Hipertiroiddismo Graveacutes AI
Causa mas comuacuten de hipertiroidismo
Oftalmopatiacutea psiquiaacutetricos
Hiperactividad del sistema adreneacutergico
Antagonistas beta adreneacutergicos y antitiroideos
Faacutermacos psicotroacutepicos Necesarios = eutiroideos
Manifestaciones psiquiaacutetricas del hipertiroidismo
Robert Graves
1835
Bocio palpitaciones disfuncioacuten nerviosa y siacutentomas oculares
Discretos trastornos psiquiaacutetricos no psicoacuteticos
SecundarioTP antes de Graveacutes
(comoacuterbido)
Hipertiroidismo y siacutentomas psiquiaacutetricos Depresioacuten
Ansiedad
Hipertiroidismo subcliacutenico (similar escalas)
The presence of antithyroid antibodies in patientswith affective and nonaffective psychiatricdisorders
John J Haggerty Jr 1 Dwight L Evans1 2 Robert N Golden1 Cort A Pedersen1 Jeffrey S Simon3 Charles B Nemeroff4
Biological Psychiatry
Volume 27 Issue 1 1 January 1990 Pages 51ndash60
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
Involucro vascular
bull Inflamacioacuten croacutenica (aa)
bull Lesiones subcliacutenicasateroescleroacuteticas
AutoanicuerposCitocinas
proinflamatorias
Ateroesclerosis acelerada
LES (30-40)
Stroke en 20a 30 de AI Complicacioacuten mas seria y una de las principales causas de muerteStroke isqueacutemicos raros silentes no especiacuteficos deterioro cognitivo progresivo
Siacutentomas neuropsiquiaacutetricos
ES (siacutentomas SNP)
AR (Disfuncioacuten)
LES (Criteriosimagen
cliacutenica)
Casi todas AI
Inmunosupresioacuten
Autoinmunizacioacuten
Articulaciones deformidades
05-1
AR
bull Muerte temprana
bull Disfuncioacuten progresiva
bull Manifestaciones extra-articulares y sisteacutemicas
bull 2x-3x en mujeres
bull 4 y 5 deacutecada
bull AIinflamatoria
bull Mas comuacuten de articulaciones
Cambios neuroloacutegicos
bull SNP
bull Compresioacuten
bull Inflamacioacuten
bull Paresia
Factores psicosociales
bull Adaptacioacuten negativa de cronicidad
bull Depresioacuten y ansiedad (14 a 42)
bull Estresores
bull Suentildeo
Depresioacuten
bull Fem AR con suicidio (90 depresioacuten)
bull AR mayor PG
bull Depresioacuten (dolor articulaciones pobre funcioacuten)
Estresores por AR croacutenica
Limitacioacuten actividadfuncional Econoacutemicos (peacuterdida $costos ) Cambios apariencia
Relaciones sociales alteradas (50) (comunicacioacutencomportamiento)
Relacioacuten pareja (empeore o module)
Incremento estresores (rigidez dolor global y respuesta AI alterada)
Eje HPA (estresores y actividad de AR)
Distorsiones cognitivas (impotencia aprendida)
Estrategias coping(educacioacutenhabilidades)
(lidiarprevenir)
Modificadores bioloacutegicos de la enfermedad ($$$ remisioacuten eficacia calidad problemas psicosociales)
LES
AI
bull Amplio espectro de manifestaciones cliacutenicas
bull Prevalencia 51 por 100000 en USA
Poblacioacuten
bull F 91 H
bull Ancianos serositis involucro pulmonar sicca manifestacionesmuacutesculo esqueleacuteticas
Muerte
bull 90 viven maacutes de 5 antildeos
bull Etapas tempranas infecciones
bull Etapas tardiacuteas complicaciones cardiovasculares por ateroesclerosis
American College of Rheumatology
19 de SNC y SNP
Trastornos psiquiaacutetricos agudos ocurren dentro de los 2 antildeos del diagoacutestico
SNC
Meningitis aseacuteptica enfermedad cerebrovascular siacutendrome desmielinizante
cefalea trastorno del movimiento mieloptiacutea epilepsia confuscioacuten ansiedad
cognitivo psicosis y afecto
Neuropsiquiaacutetricos LES (NPSLE)
LES criterios
Diagnoacutestico de exclusioacuten Otras causas de los siacutentomas infeccioacuten electroliacuteticas renales medicamentos masas embolia psiquiaacutetrico primaria
Cerebritis luacutepica
Base orgaacutenicaAnticuerpos antineurona
Anticuerpos antirribosoma
(psicosis y depresioacuten)
Siacutentomas neuropsiquiaacutetricos
Prevalencia de manifestaciones neuropsiquiaacutetricas
+-
bull Cognitiva cefalea afecto enfermedad cerebrovascular convulsiones polineuropatiacutea ansiedad y psicosis
Psicosis
bull Orgaacutenica 35-5 en LES en el primer antildeo
bull Pensamiento bizarro con alucinaciones y delirios y puede ser fluctuante sobre todo en PM
bull Otros sx atencioacuten agitacioacuten comportamiento agresivo
bull Pueden ser por esteroides (auditivas) o por LES SNC (taacutectiles y visuales)
bull Psicosis por LES reponde bien a esteroides 2-3 semanas citotoacutexicos
bull Mientras tx con antipsicoacuteticos
Procesos psicoloacutegicos funcionales
Disfuncioacuten cognitivabull Memoria a corto y largo plazo
bull Juicio abstraccioacuten afasia apraxia
bull Agnosia y cambios personalidad
Siacutendrome orgaacutenico mental
bull 21 al 80
bull Anticuerpos relacioacuten SNC
bull Condiciones asociadas hipertensioacuten o muacuteltiples infartos
bull Maacutes comuacuten e pacientes con LES activo en tx con esteroides
bull Asociada a historia de dantildeo en SNC
bull Asociada a actividad de enfermedad (efecto de SNC difuso y transitorio)
Memoria
Tratamiento cognitivo Basado en la etiologiacutea
Medicamentos disminuir o quitar
Ab antifosfoliacutepidos anticoagulantes
Ab antineurona esteroides pocas semanas
Reentrenamiento y soporte psicosocial
Aspirina en ancianos y riesgo casdiovascular
Demencia Memoria
Abstraccioacuten
Tareas diarias
Decisioacuten e impulsividad
Asocia a pequentildeos strokes muacuteltiples por anticueposantifosfoliacutepidos
Antipalpudicos pueden tener efecto protector
Pueden ser por lesiones vasculares isqueacutemicas por ateroesclerosis temprana
Parestesiascefalea
Cambios aacutenimo
Maniacutea
Ansiedaddepresioacuten
Agorafobiafobia social
Fobia
Cognitivo (memoriaafasiaorientacioacuten
espacial)
Manifestaciones psiquiaacutetricas secundarias
Depresioacuten
Ansiedad
Comportamiento maniacutea
like
Funcionales
Interaccioacuten px-meacutedicoFrustracioacuten por proceso dx largo
Depresioacuten Manifestacioacuten psiquiaacutetrica maacutes comuacuten
Usualmente comienzan de manera aguda como reaccioacuten a cronicidad y limitaciones en estilo de vida
Despueacutes de una exacerbacioacuten aguda algunos pacientes pueden presentar siacutentomas de ansiedad junto o en vez de los depresivos
Ansiedad Por las posibles consecuencias de la enfermedad
Manifestada como siacutentomas somaacuteticos
Puede deteriorar en comportamiento TOC like fobia hipocondriacutea insomnio y aislamiento
Raramente se desarrolla maniacutea o trastorno orgaacutenico de la personalidad (altas dosis)
Labilidad emocional desinhibicioacuten sexual verborrea religiosidad y agresividad
Siacutendrome antifosfoliacutepidos Siacutentomas neuropsiquiaacutetricos similares a LES
Ab antifosfoliacutepidos hasta 50 en LES
SAP primario trombofilia adquirida mas comuacuten trombosis arterial y venosa abortos espontaacuteneos y otras complicaciones embarazo
Ab antifosfoliacutepidos Anticoagulante luacutepico anticardiolipina y anti glicoproteiacutena I beta 2
SNC
bull Stroke
bull Corea
bull Mielitis transversa
bull Demencia progresiva
Psiquiaacutetricos
bull Cognitivos
bull Amnesia generalizada
bull Lesiones vasculares en sustancia blanca
bull Coexistir con liacutevedoreticularis
EM
bull Algunos pude haber AB AF
bull Difiacutecil diferenciar de EM lesiones
bull Sicca
bull Sx psiquiaacutetricos parecidos a EM
bull Anti-Ro
bull Ansiedad 48
bull Depresioacuten 23Sjoumlgren
bull Rara lesiones en piel tejido subcutaacuteneo u oacuterganos internos
bull Morfologiacutea de vasos (Raynaud hipertensioacuten pulmonar arterial)
bull Siacutentomas neuropsiquiaacutetricos son raros (SNP)(depresioacuten por cronicidad)
Esclerosis sisteacutemica
Vasculitis sisteacutemicas
bullSNP
bullVasculitis necroacutetica granulomatosa
bullAsma bronquial y eosinofilia perifeacuterica
bullPsicosis y orientacioacuten
bullDiversa
bullTamantildeo de vasos
bullGrupo heterogeacuteneo
bullRaras
bullPrimarias o secundarias
bullPsicosis en joacutevenes
bullSNC por hipertensioacuten arterial
bull70 sx neuroloacutegicos neuropatiacutea perifeacuterica
bullVasculitis av
bullPersonalidad depresioacuten y demencia
bull20 meningitis y encefalitis aseacuteptica Arteritis y trombosis senos venosos
BehccediletPoliarteritis
nodosa
Churg-StraussSintomatologiacutea
Complicaciones psiquiaacutetricas debido al tratamiento
bull Prolongado altas dosis
bull Reversibles y moderadas al disminuir o quitar
Esteroides
bull Maniacutea hipomaniacutea
bull Labilidaddepresioacuten
bull Psicosisdelirium
bull Confusioacutendesorientacion
bull Cognitivosmemoria
Psiquiaacutetricasbull Suentildeo (dosis divididas)
bull Acatisia
bull Ancianos (riesgo)
bull Inicio (agitacioacuten euforia hipomaniacutea)
Depresioacuten despueacutes de terapia larga sobre todo en historia familiar de esta y OHMayor severidad a pocos diacuteas con dosis superiores a 20mg de prednisona10 necesidad de reduccioacuten y antipsicoacuteticosPsicosis aumenta en LES con hipoalbuminemia
Esteroides Psicosis diferenciar de glucocorticoide vs LES en altas
dosis
Bajas dosis memoria riesgo elevado ancianos
1 alteraciones cognitivas persistentes
Riesgo suicida elevado
Pseudotumor cerebri raro
Antipaluacutedicos
Cloroquina e hidroxicloroquina
Moderados y transitorios
Cefalea mareo
Raros labilidad agitacioacuten insomnio pesadillas ansiedad fatiga delirios y alucinaciones
Faacutermacos Siacutentesis de autoanticuerpos por faacutermacos
Mayor parte no desarrolla enfermedad autoinmune
Lupus inducido por faacutermacos sujetos sin historia de LES que desarrollan ab antinucleares + sintomas de LES despues de exposicioacuten adecuada a medicamento sintomas se resuelven al descontinuar
Fiebre Rash
Artritis Mialgias
SerositisHematoloacutegicasrenalesSNC
raras
An antihistonas en 95Hipocomplementenemia y ab anti-DNA son poco comunes
Medicamentos
bull Riesgo bajo
bull Clorpromazina
bull Perfenazina
bull Litio
Tratamiento
bull Descontinuar
bull Antipaluacutedicos
bull Glucocorticoides
bull Aines
Hipertiroiddismo Graveacutes AI
Causa mas comuacuten de hipertiroidismo
Oftalmopatiacutea psiquiaacutetricos
Hiperactividad del sistema adreneacutergico
Antagonistas beta adreneacutergicos y antitiroideos
Faacutermacos psicotroacutepicos Necesarios = eutiroideos
Manifestaciones psiquiaacutetricas del hipertiroidismo
Robert Graves
1835
Bocio palpitaciones disfuncioacuten nerviosa y siacutentomas oculares
Discretos trastornos psiquiaacutetricos no psicoacuteticos
SecundarioTP antes de Graveacutes
(comoacuterbido)
Hipertiroidismo y siacutentomas psiquiaacutetricos Depresioacuten
Ansiedad
Hipertiroidismo subcliacutenico (similar escalas)
The presence of antithyroid antibodies in patientswith affective and nonaffective psychiatricdisorders
John J Haggerty Jr 1 Dwight L Evans1 2 Robert N Golden1 Cort A Pedersen1 Jeffrey S Simon3 Charles B Nemeroff4
Biological Psychiatry
Volume 27 Issue 1 1 January 1990 Pages 51ndash60
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
Siacutentomas neuropsiquiaacutetricos
ES (siacutentomas SNP)
AR (Disfuncioacuten)
LES (Criteriosimagen
cliacutenica)
Casi todas AI
Inmunosupresioacuten
Autoinmunizacioacuten
Articulaciones deformidades
05-1
AR
bull Muerte temprana
bull Disfuncioacuten progresiva
bull Manifestaciones extra-articulares y sisteacutemicas
bull 2x-3x en mujeres
bull 4 y 5 deacutecada
bull AIinflamatoria
bull Mas comuacuten de articulaciones
Cambios neuroloacutegicos
bull SNP
bull Compresioacuten
bull Inflamacioacuten
bull Paresia
Factores psicosociales
bull Adaptacioacuten negativa de cronicidad
bull Depresioacuten y ansiedad (14 a 42)
bull Estresores
bull Suentildeo
Depresioacuten
bull Fem AR con suicidio (90 depresioacuten)
bull AR mayor PG
bull Depresioacuten (dolor articulaciones pobre funcioacuten)
Estresores por AR croacutenica
Limitacioacuten actividadfuncional Econoacutemicos (peacuterdida $costos ) Cambios apariencia
Relaciones sociales alteradas (50) (comunicacioacutencomportamiento)
Relacioacuten pareja (empeore o module)
Incremento estresores (rigidez dolor global y respuesta AI alterada)
Eje HPA (estresores y actividad de AR)
Distorsiones cognitivas (impotencia aprendida)
Estrategias coping(educacioacutenhabilidades)
(lidiarprevenir)
Modificadores bioloacutegicos de la enfermedad ($$$ remisioacuten eficacia calidad problemas psicosociales)
LES
AI
bull Amplio espectro de manifestaciones cliacutenicas
bull Prevalencia 51 por 100000 en USA
Poblacioacuten
bull F 91 H
bull Ancianos serositis involucro pulmonar sicca manifestacionesmuacutesculo esqueleacuteticas
Muerte
bull 90 viven maacutes de 5 antildeos
bull Etapas tempranas infecciones
bull Etapas tardiacuteas complicaciones cardiovasculares por ateroesclerosis
American College of Rheumatology
19 de SNC y SNP
Trastornos psiquiaacutetricos agudos ocurren dentro de los 2 antildeos del diagoacutestico
SNC
Meningitis aseacuteptica enfermedad cerebrovascular siacutendrome desmielinizante
cefalea trastorno del movimiento mieloptiacutea epilepsia confuscioacuten ansiedad
cognitivo psicosis y afecto
Neuropsiquiaacutetricos LES (NPSLE)
LES criterios
Diagnoacutestico de exclusioacuten Otras causas de los siacutentomas infeccioacuten electroliacuteticas renales medicamentos masas embolia psiquiaacutetrico primaria
Cerebritis luacutepica
Base orgaacutenicaAnticuerpos antineurona
Anticuerpos antirribosoma
(psicosis y depresioacuten)
Siacutentomas neuropsiquiaacutetricos
Prevalencia de manifestaciones neuropsiquiaacutetricas
+-
bull Cognitiva cefalea afecto enfermedad cerebrovascular convulsiones polineuropatiacutea ansiedad y psicosis
Psicosis
bull Orgaacutenica 35-5 en LES en el primer antildeo
bull Pensamiento bizarro con alucinaciones y delirios y puede ser fluctuante sobre todo en PM
bull Otros sx atencioacuten agitacioacuten comportamiento agresivo
bull Pueden ser por esteroides (auditivas) o por LES SNC (taacutectiles y visuales)
bull Psicosis por LES reponde bien a esteroides 2-3 semanas citotoacutexicos
bull Mientras tx con antipsicoacuteticos
Procesos psicoloacutegicos funcionales
Disfuncioacuten cognitivabull Memoria a corto y largo plazo
bull Juicio abstraccioacuten afasia apraxia
bull Agnosia y cambios personalidad
Siacutendrome orgaacutenico mental
bull 21 al 80
bull Anticuerpos relacioacuten SNC
bull Condiciones asociadas hipertensioacuten o muacuteltiples infartos
bull Maacutes comuacuten e pacientes con LES activo en tx con esteroides
bull Asociada a historia de dantildeo en SNC
bull Asociada a actividad de enfermedad (efecto de SNC difuso y transitorio)
Memoria
Tratamiento cognitivo Basado en la etiologiacutea
Medicamentos disminuir o quitar
Ab antifosfoliacutepidos anticoagulantes
Ab antineurona esteroides pocas semanas
Reentrenamiento y soporte psicosocial
Aspirina en ancianos y riesgo casdiovascular
Demencia Memoria
Abstraccioacuten
Tareas diarias
Decisioacuten e impulsividad
Asocia a pequentildeos strokes muacuteltiples por anticueposantifosfoliacutepidos
Antipalpudicos pueden tener efecto protector
Pueden ser por lesiones vasculares isqueacutemicas por ateroesclerosis temprana
Parestesiascefalea
Cambios aacutenimo
Maniacutea
Ansiedaddepresioacuten
Agorafobiafobia social
Fobia
Cognitivo (memoriaafasiaorientacioacuten
espacial)
Manifestaciones psiquiaacutetricas secundarias
Depresioacuten
Ansiedad
Comportamiento maniacutea
like
Funcionales
Interaccioacuten px-meacutedicoFrustracioacuten por proceso dx largo
Depresioacuten Manifestacioacuten psiquiaacutetrica maacutes comuacuten
Usualmente comienzan de manera aguda como reaccioacuten a cronicidad y limitaciones en estilo de vida
Despueacutes de una exacerbacioacuten aguda algunos pacientes pueden presentar siacutentomas de ansiedad junto o en vez de los depresivos
Ansiedad Por las posibles consecuencias de la enfermedad
Manifestada como siacutentomas somaacuteticos
Puede deteriorar en comportamiento TOC like fobia hipocondriacutea insomnio y aislamiento
Raramente se desarrolla maniacutea o trastorno orgaacutenico de la personalidad (altas dosis)
Labilidad emocional desinhibicioacuten sexual verborrea religiosidad y agresividad
Siacutendrome antifosfoliacutepidos Siacutentomas neuropsiquiaacutetricos similares a LES
Ab antifosfoliacutepidos hasta 50 en LES
SAP primario trombofilia adquirida mas comuacuten trombosis arterial y venosa abortos espontaacuteneos y otras complicaciones embarazo
Ab antifosfoliacutepidos Anticoagulante luacutepico anticardiolipina y anti glicoproteiacutena I beta 2
SNC
bull Stroke
bull Corea
bull Mielitis transversa
bull Demencia progresiva
Psiquiaacutetricos
bull Cognitivos
bull Amnesia generalizada
bull Lesiones vasculares en sustancia blanca
bull Coexistir con liacutevedoreticularis
EM
bull Algunos pude haber AB AF
bull Difiacutecil diferenciar de EM lesiones
bull Sicca
bull Sx psiquiaacutetricos parecidos a EM
bull Anti-Ro
bull Ansiedad 48
bull Depresioacuten 23Sjoumlgren
bull Rara lesiones en piel tejido subcutaacuteneo u oacuterganos internos
bull Morfologiacutea de vasos (Raynaud hipertensioacuten pulmonar arterial)
bull Siacutentomas neuropsiquiaacutetricos son raros (SNP)(depresioacuten por cronicidad)
Esclerosis sisteacutemica
Vasculitis sisteacutemicas
bullSNP
bullVasculitis necroacutetica granulomatosa
bullAsma bronquial y eosinofilia perifeacuterica
bullPsicosis y orientacioacuten
bullDiversa
bullTamantildeo de vasos
bullGrupo heterogeacuteneo
bullRaras
bullPrimarias o secundarias
bullPsicosis en joacutevenes
bullSNC por hipertensioacuten arterial
bull70 sx neuroloacutegicos neuropatiacutea perifeacuterica
bullVasculitis av
bullPersonalidad depresioacuten y demencia
bull20 meningitis y encefalitis aseacuteptica Arteritis y trombosis senos venosos
BehccediletPoliarteritis
nodosa
Churg-StraussSintomatologiacutea
Complicaciones psiquiaacutetricas debido al tratamiento
bull Prolongado altas dosis
bull Reversibles y moderadas al disminuir o quitar
Esteroides
bull Maniacutea hipomaniacutea
bull Labilidaddepresioacuten
bull Psicosisdelirium
bull Confusioacutendesorientacion
bull Cognitivosmemoria
Psiquiaacutetricasbull Suentildeo (dosis divididas)
bull Acatisia
bull Ancianos (riesgo)
bull Inicio (agitacioacuten euforia hipomaniacutea)
Depresioacuten despueacutes de terapia larga sobre todo en historia familiar de esta y OHMayor severidad a pocos diacuteas con dosis superiores a 20mg de prednisona10 necesidad de reduccioacuten y antipsicoacuteticosPsicosis aumenta en LES con hipoalbuminemia
Esteroides Psicosis diferenciar de glucocorticoide vs LES en altas
dosis
Bajas dosis memoria riesgo elevado ancianos
1 alteraciones cognitivas persistentes
Riesgo suicida elevado
Pseudotumor cerebri raro
Antipaluacutedicos
Cloroquina e hidroxicloroquina
Moderados y transitorios
Cefalea mareo
Raros labilidad agitacioacuten insomnio pesadillas ansiedad fatiga delirios y alucinaciones
Faacutermacos Siacutentesis de autoanticuerpos por faacutermacos
Mayor parte no desarrolla enfermedad autoinmune
Lupus inducido por faacutermacos sujetos sin historia de LES que desarrollan ab antinucleares + sintomas de LES despues de exposicioacuten adecuada a medicamento sintomas se resuelven al descontinuar
Fiebre Rash
Artritis Mialgias
SerositisHematoloacutegicasrenalesSNC
raras
An antihistonas en 95Hipocomplementenemia y ab anti-DNA son poco comunes
Medicamentos
bull Riesgo bajo
bull Clorpromazina
bull Perfenazina
bull Litio
Tratamiento
bull Descontinuar
bull Antipaluacutedicos
bull Glucocorticoides
bull Aines
Hipertiroiddismo Graveacutes AI
Causa mas comuacuten de hipertiroidismo
Oftalmopatiacutea psiquiaacutetricos
Hiperactividad del sistema adreneacutergico
Antagonistas beta adreneacutergicos y antitiroideos
Faacutermacos psicotroacutepicos Necesarios = eutiroideos
Manifestaciones psiquiaacutetricas del hipertiroidismo
Robert Graves
1835
Bocio palpitaciones disfuncioacuten nerviosa y siacutentomas oculares
Discretos trastornos psiquiaacutetricos no psicoacuteticos
SecundarioTP antes de Graveacutes
(comoacuterbido)
Hipertiroidismo y siacutentomas psiquiaacutetricos Depresioacuten
Ansiedad
Hipertiroidismo subcliacutenico (similar escalas)
The presence of antithyroid antibodies in patientswith affective and nonaffective psychiatricdisorders
John J Haggerty Jr 1 Dwight L Evans1 2 Robert N Golden1 Cort A Pedersen1 Jeffrey S Simon3 Charles B Nemeroff4
Biological Psychiatry
Volume 27 Issue 1 1 January 1990 Pages 51ndash60
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
Articulaciones deformidades
05-1
AR
bull Muerte temprana
bull Disfuncioacuten progresiva
bull Manifestaciones extra-articulares y sisteacutemicas
bull 2x-3x en mujeres
bull 4 y 5 deacutecada
bull AIinflamatoria
bull Mas comuacuten de articulaciones
Cambios neuroloacutegicos
bull SNP
bull Compresioacuten
bull Inflamacioacuten
bull Paresia
Factores psicosociales
bull Adaptacioacuten negativa de cronicidad
bull Depresioacuten y ansiedad (14 a 42)
bull Estresores
bull Suentildeo
Depresioacuten
bull Fem AR con suicidio (90 depresioacuten)
bull AR mayor PG
bull Depresioacuten (dolor articulaciones pobre funcioacuten)
Estresores por AR croacutenica
Limitacioacuten actividadfuncional Econoacutemicos (peacuterdida $costos ) Cambios apariencia
Relaciones sociales alteradas (50) (comunicacioacutencomportamiento)
Relacioacuten pareja (empeore o module)
Incremento estresores (rigidez dolor global y respuesta AI alterada)
Eje HPA (estresores y actividad de AR)
Distorsiones cognitivas (impotencia aprendida)
Estrategias coping(educacioacutenhabilidades)
(lidiarprevenir)
Modificadores bioloacutegicos de la enfermedad ($$$ remisioacuten eficacia calidad problemas psicosociales)
LES
AI
bull Amplio espectro de manifestaciones cliacutenicas
bull Prevalencia 51 por 100000 en USA
Poblacioacuten
bull F 91 H
bull Ancianos serositis involucro pulmonar sicca manifestacionesmuacutesculo esqueleacuteticas
Muerte
bull 90 viven maacutes de 5 antildeos
bull Etapas tempranas infecciones
bull Etapas tardiacuteas complicaciones cardiovasculares por ateroesclerosis
American College of Rheumatology
19 de SNC y SNP
Trastornos psiquiaacutetricos agudos ocurren dentro de los 2 antildeos del diagoacutestico
SNC
Meningitis aseacuteptica enfermedad cerebrovascular siacutendrome desmielinizante
cefalea trastorno del movimiento mieloptiacutea epilepsia confuscioacuten ansiedad
cognitivo psicosis y afecto
Neuropsiquiaacutetricos LES (NPSLE)
LES criterios
Diagnoacutestico de exclusioacuten Otras causas de los siacutentomas infeccioacuten electroliacuteticas renales medicamentos masas embolia psiquiaacutetrico primaria
Cerebritis luacutepica
Base orgaacutenicaAnticuerpos antineurona
Anticuerpos antirribosoma
(psicosis y depresioacuten)
Siacutentomas neuropsiquiaacutetricos
Prevalencia de manifestaciones neuropsiquiaacutetricas
+-
bull Cognitiva cefalea afecto enfermedad cerebrovascular convulsiones polineuropatiacutea ansiedad y psicosis
Psicosis
bull Orgaacutenica 35-5 en LES en el primer antildeo
bull Pensamiento bizarro con alucinaciones y delirios y puede ser fluctuante sobre todo en PM
bull Otros sx atencioacuten agitacioacuten comportamiento agresivo
bull Pueden ser por esteroides (auditivas) o por LES SNC (taacutectiles y visuales)
bull Psicosis por LES reponde bien a esteroides 2-3 semanas citotoacutexicos
bull Mientras tx con antipsicoacuteticos
Procesos psicoloacutegicos funcionales
Disfuncioacuten cognitivabull Memoria a corto y largo plazo
bull Juicio abstraccioacuten afasia apraxia
bull Agnosia y cambios personalidad
Siacutendrome orgaacutenico mental
bull 21 al 80
bull Anticuerpos relacioacuten SNC
bull Condiciones asociadas hipertensioacuten o muacuteltiples infartos
bull Maacutes comuacuten e pacientes con LES activo en tx con esteroides
bull Asociada a historia de dantildeo en SNC
bull Asociada a actividad de enfermedad (efecto de SNC difuso y transitorio)
Memoria
Tratamiento cognitivo Basado en la etiologiacutea
Medicamentos disminuir o quitar
Ab antifosfoliacutepidos anticoagulantes
Ab antineurona esteroides pocas semanas
Reentrenamiento y soporte psicosocial
Aspirina en ancianos y riesgo casdiovascular
Demencia Memoria
Abstraccioacuten
Tareas diarias
Decisioacuten e impulsividad
Asocia a pequentildeos strokes muacuteltiples por anticueposantifosfoliacutepidos
Antipalpudicos pueden tener efecto protector
Pueden ser por lesiones vasculares isqueacutemicas por ateroesclerosis temprana
Parestesiascefalea
Cambios aacutenimo
Maniacutea
Ansiedaddepresioacuten
Agorafobiafobia social
Fobia
Cognitivo (memoriaafasiaorientacioacuten
espacial)
Manifestaciones psiquiaacutetricas secundarias
Depresioacuten
Ansiedad
Comportamiento maniacutea
like
Funcionales
Interaccioacuten px-meacutedicoFrustracioacuten por proceso dx largo
Depresioacuten Manifestacioacuten psiquiaacutetrica maacutes comuacuten
Usualmente comienzan de manera aguda como reaccioacuten a cronicidad y limitaciones en estilo de vida
Despueacutes de una exacerbacioacuten aguda algunos pacientes pueden presentar siacutentomas de ansiedad junto o en vez de los depresivos
Ansiedad Por las posibles consecuencias de la enfermedad
Manifestada como siacutentomas somaacuteticos
Puede deteriorar en comportamiento TOC like fobia hipocondriacutea insomnio y aislamiento
Raramente se desarrolla maniacutea o trastorno orgaacutenico de la personalidad (altas dosis)
Labilidad emocional desinhibicioacuten sexual verborrea religiosidad y agresividad
Siacutendrome antifosfoliacutepidos Siacutentomas neuropsiquiaacutetricos similares a LES
Ab antifosfoliacutepidos hasta 50 en LES
SAP primario trombofilia adquirida mas comuacuten trombosis arterial y venosa abortos espontaacuteneos y otras complicaciones embarazo
Ab antifosfoliacutepidos Anticoagulante luacutepico anticardiolipina y anti glicoproteiacutena I beta 2
SNC
bull Stroke
bull Corea
bull Mielitis transversa
bull Demencia progresiva
Psiquiaacutetricos
bull Cognitivos
bull Amnesia generalizada
bull Lesiones vasculares en sustancia blanca
bull Coexistir con liacutevedoreticularis
EM
bull Algunos pude haber AB AF
bull Difiacutecil diferenciar de EM lesiones
bull Sicca
bull Sx psiquiaacutetricos parecidos a EM
bull Anti-Ro
bull Ansiedad 48
bull Depresioacuten 23Sjoumlgren
bull Rara lesiones en piel tejido subcutaacuteneo u oacuterganos internos
bull Morfologiacutea de vasos (Raynaud hipertensioacuten pulmonar arterial)
bull Siacutentomas neuropsiquiaacutetricos son raros (SNP)(depresioacuten por cronicidad)
Esclerosis sisteacutemica
Vasculitis sisteacutemicas
bullSNP
bullVasculitis necroacutetica granulomatosa
bullAsma bronquial y eosinofilia perifeacuterica
bullPsicosis y orientacioacuten
bullDiversa
bullTamantildeo de vasos
bullGrupo heterogeacuteneo
bullRaras
bullPrimarias o secundarias
bullPsicosis en joacutevenes
bullSNC por hipertensioacuten arterial
bull70 sx neuroloacutegicos neuropatiacutea perifeacuterica
bullVasculitis av
bullPersonalidad depresioacuten y demencia
bull20 meningitis y encefalitis aseacuteptica Arteritis y trombosis senos venosos
BehccediletPoliarteritis
nodosa
Churg-StraussSintomatologiacutea
Complicaciones psiquiaacutetricas debido al tratamiento
bull Prolongado altas dosis
bull Reversibles y moderadas al disminuir o quitar
Esteroides
bull Maniacutea hipomaniacutea
bull Labilidaddepresioacuten
bull Psicosisdelirium
bull Confusioacutendesorientacion
bull Cognitivosmemoria
Psiquiaacutetricasbull Suentildeo (dosis divididas)
bull Acatisia
bull Ancianos (riesgo)
bull Inicio (agitacioacuten euforia hipomaniacutea)
Depresioacuten despueacutes de terapia larga sobre todo en historia familiar de esta y OHMayor severidad a pocos diacuteas con dosis superiores a 20mg de prednisona10 necesidad de reduccioacuten y antipsicoacuteticosPsicosis aumenta en LES con hipoalbuminemia
Esteroides Psicosis diferenciar de glucocorticoide vs LES en altas
dosis
Bajas dosis memoria riesgo elevado ancianos
1 alteraciones cognitivas persistentes
Riesgo suicida elevado
Pseudotumor cerebri raro
Antipaluacutedicos
Cloroquina e hidroxicloroquina
Moderados y transitorios
Cefalea mareo
Raros labilidad agitacioacuten insomnio pesadillas ansiedad fatiga delirios y alucinaciones
Faacutermacos Siacutentesis de autoanticuerpos por faacutermacos
Mayor parte no desarrolla enfermedad autoinmune
Lupus inducido por faacutermacos sujetos sin historia de LES que desarrollan ab antinucleares + sintomas de LES despues de exposicioacuten adecuada a medicamento sintomas se resuelven al descontinuar
Fiebre Rash
Artritis Mialgias
SerositisHematoloacutegicasrenalesSNC
raras
An antihistonas en 95Hipocomplementenemia y ab anti-DNA son poco comunes
Medicamentos
bull Riesgo bajo
bull Clorpromazina
bull Perfenazina
bull Litio
Tratamiento
bull Descontinuar
bull Antipaluacutedicos
bull Glucocorticoides
bull Aines
Hipertiroiddismo Graveacutes AI
Causa mas comuacuten de hipertiroidismo
Oftalmopatiacutea psiquiaacutetricos
Hiperactividad del sistema adreneacutergico
Antagonistas beta adreneacutergicos y antitiroideos
Faacutermacos psicotroacutepicos Necesarios = eutiroideos
Manifestaciones psiquiaacutetricas del hipertiroidismo
Robert Graves
1835
Bocio palpitaciones disfuncioacuten nerviosa y siacutentomas oculares
Discretos trastornos psiquiaacutetricos no psicoacuteticos
SecundarioTP antes de Graveacutes
(comoacuterbido)
Hipertiroidismo y siacutentomas psiquiaacutetricos Depresioacuten
Ansiedad
Hipertiroidismo subcliacutenico (similar escalas)
The presence of antithyroid antibodies in patientswith affective and nonaffective psychiatricdisorders
John J Haggerty Jr 1 Dwight L Evans1 2 Robert N Golden1 Cort A Pedersen1 Jeffrey S Simon3 Charles B Nemeroff4
Biological Psychiatry
Volume 27 Issue 1 1 January 1990 Pages 51ndash60
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
Cambios neuroloacutegicos
bull SNP
bull Compresioacuten
bull Inflamacioacuten
bull Paresia
Factores psicosociales
bull Adaptacioacuten negativa de cronicidad
bull Depresioacuten y ansiedad (14 a 42)
bull Estresores
bull Suentildeo
Depresioacuten
bull Fem AR con suicidio (90 depresioacuten)
bull AR mayor PG
bull Depresioacuten (dolor articulaciones pobre funcioacuten)
Estresores por AR croacutenica
Limitacioacuten actividadfuncional Econoacutemicos (peacuterdida $costos ) Cambios apariencia
Relaciones sociales alteradas (50) (comunicacioacutencomportamiento)
Relacioacuten pareja (empeore o module)
Incremento estresores (rigidez dolor global y respuesta AI alterada)
Eje HPA (estresores y actividad de AR)
Distorsiones cognitivas (impotencia aprendida)
Estrategias coping(educacioacutenhabilidades)
(lidiarprevenir)
Modificadores bioloacutegicos de la enfermedad ($$$ remisioacuten eficacia calidad problemas psicosociales)
LES
AI
bull Amplio espectro de manifestaciones cliacutenicas
bull Prevalencia 51 por 100000 en USA
Poblacioacuten
bull F 91 H
bull Ancianos serositis involucro pulmonar sicca manifestacionesmuacutesculo esqueleacuteticas
Muerte
bull 90 viven maacutes de 5 antildeos
bull Etapas tempranas infecciones
bull Etapas tardiacuteas complicaciones cardiovasculares por ateroesclerosis
American College of Rheumatology
19 de SNC y SNP
Trastornos psiquiaacutetricos agudos ocurren dentro de los 2 antildeos del diagoacutestico
SNC
Meningitis aseacuteptica enfermedad cerebrovascular siacutendrome desmielinizante
cefalea trastorno del movimiento mieloptiacutea epilepsia confuscioacuten ansiedad
cognitivo psicosis y afecto
Neuropsiquiaacutetricos LES (NPSLE)
LES criterios
Diagnoacutestico de exclusioacuten Otras causas de los siacutentomas infeccioacuten electroliacuteticas renales medicamentos masas embolia psiquiaacutetrico primaria
Cerebritis luacutepica
Base orgaacutenicaAnticuerpos antineurona
Anticuerpos antirribosoma
(psicosis y depresioacuten)
Siacutentomas neuropsiquiaacutetricos
Prevalencia de manifestaciones neuropsiquiaacutetricas
+-
bull Cognitiva cefalea afecto enfermedad cerebrovascular convulsiones polineuropatiacutea ansiedad y psicosis
Psicosis
bull Orgaacutenica 35-5 en LES en el primer antildeo
bull Pensamiento bizarro con alucinaciones y delirios y puede ser fluctuante sobre todo en PM
bull Otros sx atencioacuten agitacioacuten comportamiento agresivo
bull Pueden ser por esteroides (auditivas) o por LES SNC (taacutectiles y visuales)
bull Psicosis por LES reponde bien a esteroides 2-3 semanas citotoacutexicos
bull Mientras tx con antipsicoacuteticos
Procesos psicoloacutegicos funcionales
Disfuncioacuten cognitivabull Memoria a corto y largo plazo
bull Juicio abstraccioacuten afasia apraxia
bull Agnosia y cambios personalidad
Siacutendrome orgaacutenico mental
bull 21 al 80
bull Anticuerpos relacioacuten SNC
bull Condiciones asociadas hipertensioacuten o muacuteltiples infartos
bull Maacutes comuacuten e pacientes con LES activo en tx con esteroides
bull Asociada a historia de dantildeo en SNC
bull Asociada a actividad de enfermedad (efecto de SNC difuso y transitorio)
Memoria
Tratamiento cognitivo Basado en la etiologiacutea
Medicamentos disminuir o quitar
Ab antifosfoliacutepidos anticoagulantes
Ab antineurona esteroides pocas semanas
Reentrenamiento y soporte psicosocial
Aspirina en ancianos y riesgo casdiovascular
Demencia Memoria
Abstraccioacuten
Tareas diarias
Decisioacuten e impulsividad
Asocia a pequentildeos strokes muacuteltiples por anticueposantifosfoliacutepidos
Antipalpudicos pueden tener efecto protector
Pueden ser por lesiones vasculares isqueacutemicas por ateroesclerosis temprana
Parestesiascefalea
Cambios aacutenimo
Maniacutea
Ansiedaddepresioacuten
Agorafobiafobia social
Fobia
Cognitivo (memoriaafasiaorientacioacuten
espacial)
Manifestaciones psiquiaacutetricas secundarias
Depresioacuten
Ansiedad
Comportamiento maniacutea
like
Funcionales
Interaccioacuten px-meacutedicoFrustracioacuten por proceso dx largo
Depresioacuten Manifestacioacuten psiquiaacutetrica maacutes comuacuten
Usualmente comienzan de manera aguda como reaccioacuten a cronicidad y limitaciones en estilo de vida
Despueacutes de una exacerbacioacuten aguda algunos pacientes pueden presentar siacutentomas de ansiedad junto o en vez de los depresivos
Ansiedad Por las posibles consecuencias de la enfermedad
Manifestada como siacutentomas somaacuteticos
Puede deteriorar en comportamiento TOC like fobia hipocondriacutea insomnio y aislamiento
Raramente se desarrolla maniacutea o trastorno orgaacutenico de la personalidad (altas dosis)
Labilidad emocional desinhibicioacuten sexual verborrea religiosidad y agresividad
Siacutendrome antifosfoliacutepidos Siacutentomas neuropsiquiaacutetricos similares a LES
Ab antifosfoliacutepidos hasta 50 en LES
SAP primario trombofilia adquirida mas comuacuten trombosis arterial y venosa abortos espontaacuteneos y otras complicaciones embarazo
Ab antifosfoliacutepidos Anticoagulante luacutepico anticardiolipina y anti glicoproteiacutena I beta 2
SNC
bull Stroke
bull Corea
bull Mielitis transversa
bull Demencia progresiva
Psiquiaacutetricos
bull Cognitivos
bull Amnesia generalizada
bull Lesiones vasculares en sustancia blanca
bull Coexistir con liacutevedoreticularis
EM
bull Algunos pude haber AB AF
bull Difiacutecil diferenciar de EM lesiones
bull Sicca
bull Sx psiquiaacutetricos parecidos a EM
bull Anti-Ro
bull Ansiedad 48
bull Depresioacuten 23Sjoumlgren
bull Rara lesiones en piel tejido subcutaacuteneo u oacuterganos internos
bull Morfologiacutea de vasos (Raynaud hipertensioacuten pulmonar arterial)
bull Siacutentomas neuropsiquiaacutetricos son raros (SNP)(depresioacuten por cronicidad)
Esclerosis sisteacutemica
Vasculitis sisteacutemicas
bullSNP
bullVasculitis necroacutetica granulomatosa
bullAsma bronquial y eosinofilia perifeacuterica
bullPsicosis y orientacioacuten
bullDiversa
bullTamantildeo de vasos
bullGrupo heterogeacuteneo
bullRaras
bullPrimarias o secundarias
bullPsicosis en joacutevenes
bullSNC por hipertensioacuten arterial
bull70 sx neuroloacutegicos neuropatiacutea perifeacuterica
bullVasculitis av
bullPersonalidad depresioacuten y demencia
bull20 meningitis y encefalitis aseacuteptica Arteritis y trombosis senos venosos
BehccediletPoliarteritis
nodosa
Churg-StraussSintomatologiacutea
Complicaciones psiquiaacutetricas debido al tratamiento
bull Prolongado altas dosis
bull Reversibles y moderadas al disminuir o quitar
Esteroides
bull Maniacutea hipomaniacutea
bull Labilidaddepresioacuten
bull Psicosisdelirium
bull Confusioacutendesorientacion
bull Cognitivosmemoria
Psiquiaacutetricasbull Suentildeo (dosis divididas)
bull Acatisia
bull Ancianos (riesgo)
bull Inicio (agitacioacuten euforia hipomaniacutea)
Depresioacuten despueacutes de terapia larga sobre todo en historia familiar de esta y OHMayor severidad a pocos diacuteas con dosis superiores a 20mg de prednisona10 necesidad de reduccioacuten y antipsicoacuteticosPsicosis aumenta en LES con hipoalbuminemia
Esteroides Psicosis diferenciar de glucocorticoide vs LES en altas
dosis
Bajas dosis memoria riesgo elevado ancianos
1 alteraciones cognitivas persistentes
Riesgo suicida elevado
Pseudotumor cerebri raro
Antipaluacutedicos
Cloroquina e hidroxicloroquina
Moderados y transitorios
Cefalea mareo
Raros labilidad agitacioacuten insomnio pesadillas ansiedad fatiga delirios y alucinaciones
Faacutermacos Siacutentesis de autoanticuerpos por faacutermacos
Mayor parte no desarrolla enfermedad autoinmune
Lupus inducido por faacutermacos sujetos sin historia de LES que desarrollan ab antinucleares + sintomas de LES despues de exposicioacuten adecuada a medicamento sintomas se resuelven al descontinuar
Fiebre Rash
Artritis Mialgias
SerositisHematoloacutegicasrenalesSNC
raras
An antihistonas en 95Hipocomplementenemia y ab anti-DNA son poco comunes
Medicamentos
bull Riesgo bajo
bull Clorpromazina
bull Perfenazina
bull Litio
Tratamiento
bull Descontinuar
bull Antipaluacutedicos
bull Glucocorticoides
bull Aines
Hipertiroiddismo Graveacutes AI
Causa mas comuacuten de hipertiroidismo
Oftalmopatiacutea psiquiaacutetricos
Hiperactividad del sistema adreneacutergico
Antagonistas beta adreneacutergicos y antitiroideos
Faacutermacos psicotroacutepicos Necesarios = eutiroideos
Manifestaciones psiquiaacutetricas del hipertiroidismo
Robert Graves
1835
Bocio palpitaciones disfuncioacuten nerviosa y siacutentomas oculares
Discretos trastornos psiquiaacutetricos no psicoacuteticos
SecundarioTP antes de Graveacutes
(comoacuterbido)
Hipertiroidismo y siacutentomas psiquiaacutetricos Depresioacuten
Ansiedad
Hipertiroidismo subcliacutenico (similar escalas)
The presence of antithyroid antibodies in patientswith affective and nonaffective psychiatricdisorders
John J Haggerty Jr 1 Dwight L Evans1 2 Robert N Golden1 Cort A Pedersen1 Jeffrey S Simon3 Charles B Nemeroff4
Biological Psychiatry
Volume 27 Issue 1 1 January 1990 Pages 51ndash60
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
Estresores por AR croacutenica
Limitacioacuten actividadfuncional Econoacutemicos (peacuterdida $costos ) Cambios apariencia
Relaciones sociales alteradas (50) (comunicacioacutencomportamiento)
Relacioacuten pareja (empeore o module)
Incremento estresores (rigidez dolor global y respuesta AI alterada)
Eje HPA (estresores y actividad de AR)
Distorsiones cognitivas (impotencia aprendida)
Estrategias coping(educacioacutenhabilidades)
(lidiarprevenir)
Modificadores bioloacutegicos de la enfermedad ($$$ remisioacuten eficacia calidad problemas psicosociales)
LES
AI
bull Amplio espectro de manifestaciones cliacutenicas
bull Prevalencia 51 por 100000 en USA
Poblacioacuten
bull F 91 H
bull Ancianos serositis involucro pulmonar sicca manifestacionesmuacutesculo esqueleacuteticas
Muerte
bull 90 viven maacutes de 5 antildeos
bull Etapas tempranas infecciones
bull Etapas tardiacuteas complicaciones cardiovasculares por ateroesclerosis
American College of Rheumatology
19 de SNC y SNP
Trastornos psiquiaacutetricos agudos ocurren dentro de los 2 antildeos del diagoacutestico
SNC
Meningitis aseacuteptica enfermedad cerebrovascular siacutendrome desmielinizante
cefalea trastorno del movimiento mieloptiacutea epilepsia confuscioacuten ansiedad
cognitivo psicosis y afecto
Neuropsiquiaacutetricos LES (NPSLE)
LES criterios
Diagnoacutestico de exclusioacuten Otras causas de los siacutentomas infeccioacuten electroliacuteticas renales medicamentos masas embolia psiquiaacutetrico primaria
Cerebritis luacutepica
Base orgaacutenicaAnticuerpos antineurona
Anticuerpos antirribosoma
(psicosis y depresioacuten)
Siacutentomas neuropsiquiaacutetricos
Prevalencia de manifestaciones neuropsiquiaacutetricas
+-
bull Cognitiva cefalea afecto enfermedad cerebrovascular convulsiones polineuropatiacutea ansiedad y psicosis
Psicosis
bull Orgaacutenica 35-5 en LES en el primer antildeo
bull Pensamiento bizarro con alucinaciones y delirios y puede ser fluctuante sobre todo en PM
bull Otros sx atencioacuten agitacioacuten comportamiento agresivo
bull Pueden ser por esteroides (auditivas) o por LES SNC (taacutectiles y visuales)
bull Psicosis por LES reponde bien a esteroides 2-3 semanas citotoacutexicos
bull Mientras tx con antipsicoacuteticos
Procesos psicoloacutegicos funcionales
Disfuncioacuten cognitivabull Memoria a corto y largo plazo
bull Juicio abstraccioacuten afasia apraxia
bull Agnosia y cambios personalidad
Siacutendrome orgaacutenico mental
bull 21 al 80
bull Anticuerpos relacioacuten SNC
bull Condiciones asociadas hipertensioacuten o muacuteltiples infartos
bull Maacutes comuacuten e pacientes con LES activo en tx con esteroides
bull Asociada a historia de dantildeo en SNC
bull Asociada a actividad de enfermedad (efecto de SNC difuso y transitorio)
Memoria
Tratamiento cognitivo Basado en la etiologiacutea
Medicamentos disminuir o quitar
Ab antifosfoliacutepidos anticoagulantes
Ab antineurona esteroides pocas semanas
Reentrenamiento y soporte psicosocial
Aspirina en ancianos y riesgo casdiovascular
Demencia Memoria
Abstraccioacuten
Tareas diarias
Decisioacuten e impulsividad
Asocia a pequentildeos strokes muacuteltiples por anticueposantifosfoliacutepidos
Antipalpudicos pueden tener efecto protector
Pueden ser por lesiones vasculares isqueacutemicas por ateroesclerosis temprana
Parestesiascefalea
Cambios aacutenimo
Maniacutea
Ansiedaddepresioacuten
Agorafobiafobia social
Fobia
Cognitivo (memoriaafasiaorientacioacuten
espacial)
Manifestaciones psiquiaacutetricas secundarias
Depresioacuten
Ansiedad
Comportamiento maniacutea
like
Funcionales
Interaccioacuten px-meacutedicoFrustracioacuten por proceso dx largo
Depresioacuten Manifestacioacuten psiquiaacutetrica maacutes comuacuten
Usualmente comienzan de manera aguda como reaccioacuten a cronicidad y limitaciones en estilo de vida
Despueacutes de una exacerbacioacuten aguda algunos pacientes pueden presentar siacutentomas de ansiedad junto o en vez de los depresivos
Ansiedad Por las posibles consecuencias de la enfermedad
Manifestada como siacutentomas somaacuteticos
Puede deteriorar en comportamiento TOC like fobia hipocondriacutea insomnio y aislamiento
Raramente se desarrolla maniacutea o trastorno orgaacutenico de la personalidad (altas dosis)
Labilidad emocional desinhibicioacuten sexual verborrea religiosidad y agresividad
Siacutendrome antifosfoliacutepidos Siacutentomas neuropsiquiaacutetricos similares a LES
Ab antifosfoliacutepidos hasta 50 en LES
SAP primario trombofilia adquirida mas comuacuten trombosis arterial y venosa abortos espontaacuteneos y otras complicaciones embarazo
Ab antifosfoliacutepidos Anticoagulante luacutepico anticardiolipina y anti glicoproteiacutena I beta 2
SNC
bull Stroke
bull Corea
bull Mielitis transversa
bull Demencia progresiva
Psiquiaacutetricos
bull Cognitivos
bull Amnesia generalizada
bull Lesiones vasculares en sustancia blanca
bull Coexistir con liacutevedoreticularis
EM
bull Algunos pude haber AB AF
bull Difiacutecil diferenciar de EM lesiones
bull Sicca
bull Sx psiquiaacutetricos parecidos a EM
bull Anti-Ro
bull Ansiedad 48
bull Depresioacuten 23Sjoumlgren
bull Rara lesiones en piel tejido subcutaacuteneo u oacuterganos internos
bull Morfologiacutea de vasos (Raynaud hipertensioacuten pulmonar arterial)
bull Siacutentomas neuropsiquiaacutetricos son raros (SNP)(depresioacuten por cronicidad)
Esclerosis sisteacutemica
Vasculitis sisteacutemicas
bullSNP
bullVasculitis necroacutetica granulomatosa
bullAsma bronquial y eosinofilia perifeacuterica
bullPsicosis y orientacioacuten
bullDiversa
bullTamantildeo de vasos
bullGrupo heterogeacuteneo
bullRaras
bullPrimarias o secundarias
bullPsicosis en joacutevenes
bullSNC por hipertensioacuten arterial
bull70 sx neuroloacutegicos neuropatiacutea perifeacuterica
bullVasculitis av
bullPersonalidad depresioacuten y demencia
bull20 meningitis y encefalitis aseacuteptica Arteritis y trombosis senos venosos
BehccediletPoliarteritis
nodosa
Churg-StraussSintomatologiacutea
Complicaciones psiquiaacutetricas debido al tratamiento
bull Prolongado altas dosis
bull Reversibles y moderadas al disminuir o quitar
Esteroides
bull Maniacutea hipomaniacutea
bull Labilidaddepresioacuten
bull Psicosisdelirium
bull Confusioacutendesorientacion
bull Cognitivosmemoria
Psiquiaacutetricasbull Suentildeo (dosis divididas)
bull Acatisia
bull Ancianos (riesgo)
bull Inicio (agitacioacuten euforia hipomaniacutea)
Depresioacuten despueacutes de terapia larga sobre todo en historia familiar de esta y OHMayor severidad a pocos diacuteas con dosis superiores a 20mg de prednisona10 necesidad de reduccioacuten y antipsicoacuteticosPsicosis aumenta en LES con hipoalbuminemia
Esteroides Psicosis diferenciar de glucocorticoide vs LES en altas
dosis
Bajas dosis memoria riesgo elevado ancianos
1 alteraciones cognitivas persistentes
Riesgo suicida elevado
Pseudotumor cerebri raro
Antipaluacutedicos
Cloroquina e hidroxicloroquina
Moderados y transitorios
Cefalea mareo
Raros labilidad agitacioacuten insomnio pesadillas ansiedad fatiga delirios y alucinaciones
Faacutermacos Siacutentesis de autoanticuerpos por faacutermacos
Mayor parte no desarrolla enfermedad autoinmune
Lupus inducido por faacutermacos sujetos sin historia de LES que desarrollan ab antinucleares + sintomas de LES despues de exposicioacuten adecuada a medicamento sintomas se resuelven al descontinuar
Fiebre Rash
Artritis Mialgias
SerositisHematoloacutegicasrenalesSNC
raras
An antihistonas en 95Hipocomplementenemia y ab anti-DNA son poco comunes
Medicamentos
bull Riesgo bajo
bull Clorpromazina
bull Perfenazina
bull Litio
Tratamiento
bull Descontinuar
bull Antipaluacutedicos
bull Glucocorticoides
bull Aines
Hipertiroiddismo Graveacutes AI
Causa mas comuacuten de hipertiroidismo
Oftalmopatiacutea psiquiaacutetricos
Hiperactividad del sistema adreneacutergico
Antagonistas beta adreneacutergicos y antitiroideos
Faacutermacos psicotroacutepicos Necesarios = eutiroideos
Manifestaciones psiquiaacutetricas del hipertiroidismo
Robert Graves
1835
Bocio palpitaciones disfuncioacuten nerviosa y siacutentomas oculares
Discretos trastornos psiquiaacutetricos no psicoacuteticos
SecundarioTP antes de Graveacutes
(comoacuterbido)
Hipertiroidismo y siacutentomas psiquiaacutetricos Depresioacuten
Ansiedad
Hipertiroidismo subcliacutenico (similar escalas)
The presence of antithyroid antibodies in patientswith affective and nonaffective psychiatricdisorders
John J Haggerty Jr 1 Dwight L Evans1 2 Robert N Golden1 Cort A Pedersen1 Jeffrey S Simon3 Charles B Nemeroff4
Biological Psychiatry
Volume 27 Issue 1 1 January 1990 Pages 51ndash60
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
LES
AI
bull Amplio espectro de manifestaciones cliacutenicas
bull Prevalencia 51 por 100000 en USA
Poblacioacuten
bull F 91 H
bull Ancianos serositis involucro pulmonar sicca manifestacionesmuacutesculo esqueleacuteticas
Muerte
bull 90 viven maacutes de 5 antildeos
bull Etapas tempranas infecciones
bull Etapas tardiacuteas complicaciones cardiovasculares por ateroesclerosis
American College of Rheumatology
19 de SNC y SNP
Trastornos psiquiaacutetricos agudos ocurren dentro de los 2 antildeos del diagoacutestico
SNC
Meningitis aseacuteptica enfermedad cerebrovascular siacutendrome desmielinizante
cefalea trastorno del movimiento mieloptiacutea epilepsia confuscioacuten ansiedad
cognitivo psicosis y afecto
Neuropsiquiaacutetricos LES (NPSLE)
LES criterios
Diagnoacutestico de exclusioacuten Otras causas de los siacutentomas infeccioacuten electroliacuteticas renales medicamentos masas embolia psiquiaacutetrico primaria
Cerebritis luacutepica
Base orgaacutenicaAnticuerpos antineurona
Anticuerpos antirribosoma
(psicosis y depresioacuten)
Siacutentomas neuropsiquiaacutetricos
Prevalencia de manifestaciones neuropsiquiaacutetricas
+-
bull Cognitiva cefalea afecto enfermedad cerebrovascular convulsiones polineuropatiacutea ansiedad y psicosis
Psicosis
bull Orgaacutenica 35-5 en LES en el primer antildeo
bull Pensamiento bizarro con alucinaciones y delirios y puede ser fluctuante sobre todo en PM
bull Otros sx atencioacuten agitacioacuten comportamiento agresivo
bull Pueden ser por esteroides (auditivas) o por LES SNC (taacutectiles y visuales)
bull Psicosis por LES reponde bien a esteroides 2-3 semanas citotoacutexicos
bull Mientras tx con antipsicoacuteticos
Procesos psicoloacutegicos funcionales
Disfuncioacuten cognitivabull Memoria a corto y largo plazo
bull Juicio abstraccioacuten afasia apraxia
bull Agnosia y cambios personalidad
Siacutendrome orgaacutenico mental
bull 21 al 80
bull Anticuerpos relacioacuten SNC
bull Condiciones asociadas hipertensioacuten o muacuteltiples infartos
bull Maacutes comuacuten e pacientes con LES activo en tx con esteroides
bull Asociada a historia de dantildeo en SNC
bull Asociada a actividad de enfermedad (efecto de SNC difuso y transitorio)
Memoria
Tratamiento cognitivo Basado en la etiologiacutea
Medicamentos disminuir o quitar
Ab antifosfoliacutepidos anticoagulantes
Ab antineurona esteroides pocas semanas
Reentrenamiento y soporte psicosocial
Aspirina en ancianos y riesgo casdiovascular
Demencia Memoria
Abstraccioacuten
Tareas diarias
Decisioacuten e impulsividad
Asocia a pequentildeos strokes muacuteltiples por anticueposantifosfoliacutepidos
Antipalpudicos pueden tener efecto protector
Pueden ser por lesiones vasculares isqueacutemicas por ateroesclerosis temprana
Parestesiascefalea
Cambios aacutenimo
Maniacutea
Ansiedaddepresioacuten
Agorafobiafobia social
Fobia
Cognitivo (memoriaafasiaorientacioacuten
espacial)
Manifestaciones psiquiaacutetricas secundarias
Depresioacuten
Ansiedad
Comportamiento maniacutea
like
Funcionales
Interaccioacuten px-meacutedicoFrustracioacuten por proceso dx largo
Depresioacuten Manifestacioacuten psiquiaacutetrica maacutes comuacuten
Usualmente comienzan de manera aguda como reaccioacuten a cronicidad y limitaciones en estilo de vida
Despueacutes de una exacerbacioacuten aguda algunos pacientes pueden presentar siacutentomas de ansiedad junto o en vez de los depresivos
Ansiedad Por las posibles consecuencias de la enfermedad
Manifestada como siacutentomas somaacuteticos
Puede deteriorar en comportamiento TOC like fobia hipocondriacutea insomnio y aislamiento
Raramente se desarrolla maniacutea o trastorno orgaacutenico de la personalidad (altas dosis)
Labilidad emocional desinhibicioacuten sexual verborrea religiosidad y agresividad
Siacutendrome antifosfoliacutepidos Siacutentomas neuropsiquiaacutetricos similares a LES
Ab antifosfoliacutepidos hasta 50 en LES
SAP primario trombofilia adquirida mas comuacuten trombosis arterial y venosa abortos espontaacuteneos y otras complicaciones embarazo
Ab antifosfoliacutepidos Anticoagulante luacutepico anticardiolipina y anti glicoproteiacutena I beta 2
SNC
bull Stroke
bull Corea
bull Mielitis transversa
bull Demencia progresiva
Psiquiaacutetricos
bull Cognitivos
bull Amnesia generalizada
bull Lesiones vasculares en sustancia blanca
bull Coexistir con liacutevedoreticularis
EM
bull Algunos pude haber AB AF
bull Difiacutecil diferenciar de EM lesiones
bull Sicca
bull Sx psiquiaacutetricos parecidos a EM
bull Anti-Ro
bull Ansiedad 48
bull Depresioacuten 23Sjoumlgren
bull Rara lesiones en piel tejido subcutaacuteneo u oacuterganos internos
bull Morfologiacutea de vasos (Raynaud hipertensioacuten pulmonar arterial)
bull Siacutentomas neuropsiquiaacutetricos son raros (SNP)(depresioacuten por cronicidad)
Esclerosis sisteacutemica
Vasculitis sisteacutemicas
bullSNP
bullVasculitis necroacutetica granulomatosa
bullAsma bronquial y eosinofilia perifeacuterica
bullPsicosis y orientacioacuten
bullDiversa
bullTamantildeo de vasos
bullGrupo heterogeacuteneo
bullRaras
bullPrimarias o secundarias
bullPsicosis en joacutevenes
bullSNC por hipertensioacuten arterial
bull70 sx neuroloacutegicos neuropatiacutea perifeacuterica
bullVasculitis av
bullPersonalidad depresioacuten y demencia
bull20 meningitis y encefalitis aseacuteptica Arteritis y trombosis senos venosos
BehccediletPoliarteritis
nodosa
Churg-StraussSintomatologiacutea
Complicaciones psiquiaacutetricas debido al tratamiento
bull Prolongado altas dosis
bull Reversibles y moderadas al disminuir o quitar
Esteroides
bull Maniacutea hipomaniacutea
bull Labilidaddepresioacuten
bull Psicosisdelirium
bull Confusioacutendesorientacion
bull Cognitivosmemoria
Psiquiaacutetricasbull Suentildeo (dosis divididas)
bull Acatisia
bull Ancianos (riesgo)
bull Inicio (agitacioacuten euforia hipomaniacutea)
Depresioacuten despueacutes de terapia larga sobre todo en historia familiar de esta y OHMayor severidad a pocos diacuteas con dosis superiores a 20mg de prednisona10 necesidad de reduccioacuten y antipsicoacuteticosPsicosis aumenta en LES con hipoalbuminemia
Esteroides Psicosis diferenciar de glucocorticoide vs LES en altas
dosis
Bajas dosis memoria riesgo elevado ancianos
1 alteraciones cognitivas persistentes
Riesgo suicida elevado
Pseudotumor cerebri raro
Antipaluacutedicos
Cloroquina e hidroxicloroquina
Moderados y transitorios
Cefalea mareo
Raros labilidad agitacioacuten insomnio pesadillas ansiedad fatiga delirios y alucinaciones
Faacutermacos Siacutentesis de autoanticuerpos por faacutermacos
Mayor parte no desarrolla enfermedad autoinmune
Lupus inducido por faacutermacos sujetos sin historia de LES que desarrollan ab antinucleares + sintomas de LES despues de exposicioacuten adecuada a medicamento sintomas se resuelven al descontinuar
Fiebre Rash
Artritis Mialgias
SerositisHematoloacutegicasrenalesSNC
raras
An antihistonas en 95Hipocomplementenemia y ab anti-DNA son poco comunes
Medicamentos
bull Riesgo bajo
bull Clorpromazina
bull Perfenazina
bull Litio
Tratamiento
bull Descontinuar
bull Antipaluacutedicos
bull Glucocorticoides
bull Aines
Hipertiroiddismo Graveacutes AI
Causa mas comuacuten de hipertiroidismo
Oftalmopatiacutea psiquiaacutetricos
Hiperactividad del sistema adreneacutergico
Antagonistas beta adreneacutergicos y antitiroideos
Faacutermacos psicotroacutepicos Necesarios = eutiroideos
Manifestaciones psiquiaacutetricas del hipertiroidismo
Robert Graves
1835
Bocio palpitaciones disfuncioacuten nerviosa y siacutentomas oculares
Discretos trastornos psiquiaacutetricos no psicoacuteticos
SecundarioTP antes de Graveacutes
(comoacuterbido)
Hipertiroidismo y siacutentomas psiquiaacutetricos Depresioacuten
Ansiedad
Hipertiroidismo subcliacutenico (similar escalas)
The presence of antithyroid antibodies in patientswith affective and nonaffective psychiatricdisorders
John J Haggerty Jr 1 Dwight L Evans1 2 Robert N Golden1 Cort A Pedersen1 Jeffrey S Simon3 Charles B Nemeroff4
Biological Psychiatry
Volume 27 Issue 1 1 January 1990 Pages 51ndash60
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
American College of Rheumatology
19 de SNC y SNP
Trastornos psiquiaacutetricos agudos ocurren dentro de los 2 antildeos del diagoacutestico
SNC
Meningitis aseacuteptica enfermedad cerebrovascular siacutendrome desmielinizante
cefalea trastorno del movimiento mieloptiacutea epilepsia confuscioacuten ansiedad
cognitivo psicosis y afecto
Neuropsiquiaacutetricos LES (NPSLE)
LES criterios
Diagnoacutestico de exclusioacuten Otras causas de los siacutentomas infeccioacuten electroliacuteticas renales medicamentos masas embolia psiquiaacutetrico primaria
Cerebritis luacutepica
Base orgaacutenicaAnticuerpos antineurona
Anticuerpos antirribosoma
(psicosis y depresioacuten)
Siacutentomas neuropsiquiaacutetricos
Prevalencia de manifestaciones neuropsiquiaacutetricas
+-
bull Cognitiva cefalea afecto enfermedad cerebrovascular convulsiones polineuropatiacutea ansiedad y psicosis
Psicosis
bull Orgaacutenica 35-5 en LES en el primer antildeo
bull Pensamiento bizarro con alucinaciones y delirios y puede ser fluctuante sobre todo en PM
bull Otros sx atencioacuten agitacioacuten comportamiento agresivo
bull Pueden ser por esteroides (auditivas) o por LES SNC (taacutectiles y visuales)
bull Psicosis por LES reponde bien a esteroides 2-3 semanas citotoacutexicos
bull Mientras tx con antipsicoacuteticos
Procesos psicoloacutegicos funcionales
Disfuncioacuten cognitivabull Memoria a corto y largo plazo
bull Juicio abstraccioacuten afasia apraxia
bull Agnosia y cambios personalidad
Siacutendrome orgaacutenico mental
bull 21 al 80
bull Anticuerpos relacioacuten SNC
bull Condiciones asociadas hipertensioacuten o muacuteltiples infartos
bull Maacutes comuacuten e pacientes con LES activo en tx con esteroides
bull Asociada a historia de dantildeo en SNC
bull Asociada a actividad de enfermedad (efecto de SNC difuso y transitorio)
Memoria
Tratamiento cognitivo Basado en la etiologiacutea
Medicamentos disminuir o quitar
Ab antifosfoliacutepidos anticoagulantes
Ab antineurona esteroides pocas semanas
Reentrenamiento y soporte psicosocial
Aspirina en ancianos y riesgo casdiovascular
Demencia Memoria
Abstraccioacuten
Tareas diarias
Decisioacuten e impulsividad
Asocia a pequentildeos strokes muacuteltiples por anticueposantifosfoliacutepidos
Antipalpudicos pueden tener efecto protector
Pueden ser por lesiones vasculares isqueacutemicas por ateroesclerosis temprana
Parestesiascefalea
Cambios aacutenimo
Maniacutea
Ansiedaddepresioacuten
Agorafobiafobia social
Fobia
Cognitivo (memoriaafasiaorientacioacuten
espacial)
Manifestaciones psiquiaacutetricas secundarias
Depresioacuten
Ansiedad
Comportamiento maniacutea
like
Funcionales
Interaccioacuten px-meacutedicoFrustracioacuten por proceso dx largo
Depresioacuten Manifestacioacuten psiquiaacutetrica maacutes comuacuten
Usualmente comienzan de manera aguda como reaccioacuten a cronicidad y limitaciones en estilo de vida
Despueacutes de una exacerbacioacuten aguda algunos pacientes pueden presentar siacutentomas de ansiedad junto o en vez de los depresivos
Ansiedad Por las posibles consecuencias de la enfermedad
Manifestada como siacutentomas somaacuteticos
Puede deteriorar en comportamiento TOC like fobia hipocondriacutea insomnio y aislamiento
Raramente se desarrolla maniacutea o trastorno orgaacutenico de la personalidad (altas dosis)
Labilidad emocional desinhibicioacuten sexual verborrea religiosidad y agresividad
Siacutendrome antifosfoliacutepidos Siacutentomas neuropsiquiaacutetricos similares a LES
Ab antifosfoliacutepidos hasta 50 en LES
SAP primario trombofilia adquirida mas comuacuten trombosis arterial y venosa abortos espontaacuteneos y otras complicaciones embarazo
Ab antifosfoliacutepidos Anticoagulante luacutepico anticardiolipina y anti glicoproteiacutena I beta 2
SNC
bull Stroke
bull Corea
bull Mielitis transversa
bull Demencia progresiva
Psiquiaacutetricos
bull Cognitivos
bull Amnesia generalizada
bull Lesiones vasculares en sustancia blanca
bull Coexistir con liacutevedoreticularis
EM
bull Algunos pude haber AB AF
bull Difiacutecil diferenciar de EM lesiones
bull Sicca
bull Sx psiquiaacutetricos parecidos a EM
bull Anti-Ro
bull Ansiedad 48
bull Depresioacuten 23Sjoumlgren
bull Rara lesiones en piel tejido subcutaacuteneo u oacuterganos internos
bull Morfologiacutea de vasos (Raynaud hipertensioacuten pulmonar arterial)
bull Siacutentomas neuropsiquiaacutetricos son raros (SNP)(depresioacuten por cronicidad)
Esclerosis sisteacutemica
Vasculitis sisteacutemicas
bullSNP
bullVasculitis necroacutetica granulomatosa
bullAsma bronquial y eosinofilia perifeacuterica
bullPsicosis y orientacioacuten
bullDiversa
bullTamantildeo de vasos
bullGrupo heterogeacuteneo
bullRaras
bullPrimarias o secundarias
bullPsicosis en joacutevenes
bullSNC por hipertensioacuten arterial
bull70 sx neuroloacutegicos neuropatiacutea perifeacuterica
bullVasculitis av
bullPersonalidad depresioacuten y demencia
bull20 meningitis y encefalitis aseacuteptica Arteritis y trombosis senos venosos
BehccediletPoliarteritis
nodosa
Churg-StraussSintomatologiacutea
Complicaciones psiquiaacutetricas debido al tratamiento
bull Prolongado altas dosis
bull Reversibles y moderadas al disminuir o quitar
Esteroides
bull Maniacutea hipomaniacutea
bull Labilidaddepresioacuten
bull Psicosisdelirium
bull Confusioacutendesorientacion
bull Cognitivosmemoria
Psiquiaacutetricasbull Suentildeo (dosis divididas)
bull Acatisia
bull Ancianos (riesgo)
bull Inicio (agitacioacuten euforia hipomaniacutea)
Depresioacuten despueacutes de terapia larga sobre todo en historia familiar de esta y OHMayor severidad a pocos diacuteas con dosis superiores a 20mg de prednisona10 necesidad de reduccioacuten y antipsicoacuteticosPsicosis aumenta en LES con hipoalbuminemia
Esteroides Psicosis diferenciar de glucocorticoide vs LES en altas
dosis
Bajas dosis memoria riesgo elevado ancianos
1 alteraciones cognitivas persistentes
Riesgo suicida elevado
Pseudotumor cerebri raro
Antipaluacutedicos
Cloroquina e hidroxicloroquina
Moderados y transitorios
Cefalea mareo
Raros labilidad agitacioacuten insomnio pesadillas ansiedad fatiga delirios y alucinaciones
Faacutermacos Siacutentesis de autoanticuerpos por faacutermacos
Mayor parte no desarrolla enfermedad autoinmune
Lupus inducido por faacutermacos sujetos sin historia de LES que desarrollan ab antinucleares + sintomas de LES despues de exposicioacuten adecuada a medicamento sintomas se resuelven al descontinuar
Fiebre Rash
Artritis Mialgias
SerositisHematoloacutegicasrenalesSNC
raras
An antihistonas en 95Hipocomplementenemia y ab anti-DNA son poco comunes
Medicamentos
bull Riesgo bajo
bull Clorpromazina
bull Perfenazina
bull Litio
Tratamiento
bull Descontinuar
bull Antipaluacutedicos
bull Glucocorticoides
bull Aines
Hipertiroiddismo Graveacutes AI
Causa mas comuacuten de hipertiroidismo
Oftalmopatiacutea psiquiaacutetricos
Hiperactividad del sistema adreneacutergico
Antagonistas beta adreneacutergicos y antitiroideos
Faacutermacos psicotroacutepicos Necesarios = eutiroideos
Manifestaciones psiquiaacutetricas del hipertiroidismo
Robert Graves
1835
Bocio palpitaciones disfuncioacuten nerviosa y siacutentomas oculares
Discretos trastornos psiquiaacutetricos no psicoacuteticos
SecundarioTP antes de Graveacutes
(comoacuterbido)
Hipertiroidismo y siacutentomas psiquiaacutetricos Depresioacuten
Ansiedad
Hipertiroidismo subcliacutenico (similar escalas)
The presence of antithyroid antibodies in patientswith affective and nonaffective psychiatricdisorders
John J Haggerty Jr 1 Dwight L Evans1 2 Robert N Golden1 Cort A Pedersen1 Jeffrey S Simon3 Charles B Nemeroff4
Biological Psychiatry
Volume 27 Issue 1 1 January 1990 Pages 51ndash60
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
Cerebritis luacutepica
Base orgaacutenicaAnticuerpos antineurona
Anticuerpos antirribosoma
(psicosis y depresioacuten)
Siacutentomas neuropsiquiaacutetricos
Prevalencia de manifestaciones neuropsiquiaacutetricas
+-
bull Cognitiva cefalea afecto enfermedad cerebrovascular convulsiones polineuropatiacutea ansiedad y psicosis
Psicosis
bull Orgaacutenica 35-5 en LES en el primer antildeo
bull Pensamiento bizarro con alucinaciones y delirios y puede ser fluctuante sobre todo en PM
bull Otros sx atencioacuten agitacioacuten comportamiento agresivo
bull Pueden ser por esteroides (auditivas) o por LES SNC (taacutectiles y visuales)
bull Psicosis por LES reponde bien a esteroides 2-3 semanas citotoacutexicos
bull Mientras tx con antipsicoacuteticos
Procesos psicoloacutegicos funcionales
Disfuncioacuten cognitivabull Memoria a corto y largo plazo
bull Juicio abstraccioacuten afasia apraxia
bull Agnosia y cambios personalidad
Siacutendrome orgaacutenico mental
bull 21 al 80
bull Anticuerpos relacioacuten SNC
bull Condiciones asociadas hipertensioacuten o muacuteltiples infartos
bull Maacutes comuacuten e pacientes con LES activo en tx con esteroides
bull Asociada a historia de dantildeo en SNC
bull Asociada a actividad de enfermedad (efecto de SNC difuso y transitorio)
Memoria
Tratamiento cognitivo Basado en la etiologiacutea
Medicamentos disminuir o quitar
Ab antifosfoliacutepidos anticoagulantes
Ab antineurona esteroides pocas semanas
Reentrenamiento y soporte psicosocial
Aspirina en ancianos y riesgo casdiovascular
Demencia Memoria
Abstraccioacuten
Tareas diarias
Decisioacuten e impulsividad
Asocia a pequentildeos strokes muacuteltiples por anticueposantifosfoliacutepidos
Antipalpudicos pueden tener efecto protector
Pueden ser por lesiones vasculares isqueacutemicas por ateroesclerosis temprana
Parestesiascefalea
Cambios aacutenimo
Maniacutea
Ansiedaddepresioacuten
Agorafobiafobia social
Fobia
Cognitivo (memoriaafasiaorientacioacuten
espacial)
Manifestaciones psiquiaacutetricas secundarias
Depresioacuten
Ansiedad
Comportamiento maniacutea
like
Funcionales
Interaccioacuten px-meacutedicoFrustracioacuten por proceso dx largo
Depresioacuten Manifestacioacuten psiquiaacutetrica maacutes comuacuten
Usualmente comienzan de manera aguda como reaccioacuten a cronicidad y limitaciones en estilo de vida
Despueacutes de una exacerbacioacuten aguda algunos pacientes pueden presentar siacutentomas de ansiedad junto o en vez de los depresivos
Ansiedad Por las posibles consecuencias de la enfermedad
Manifestada como siacutentomas somaacuteticos
Puede deteriorar en comportamiento TOC like fobia hipocondriacutea insomnio y aislamiento
Raramente se desarrolla maniacutea o trastorno orgaacutenico de la personalidad (altas dosis)
Labilidad emocional desinhibicioacuten sexual verborrea religiosidad y agresividad
Siacutendrome antifosfoliacutepidos Siacutentomas neuropsiquiaacutetricos similares a LES
Ab antifosfoliacutepidos hasta 50 en LES
SAP primario trombofilia adquirida mas comuacuten trombosis arterial y venosa abortos espontaacuteneos y otras complicaciones embarazo
Ab antifosfoliacutepidos Anticoagulante luacutepico anticardiolipina y anti glicoproteiacutena I beta 2
SNC
bull Stroke
bull Corea
bull Mielitis transversa
bull Demencia progresiva
Psiquiaacutetricos
bull Cognitivos
bull Amnesia generalizada
bull Lesiones vasculares en sustancia blanca
bull Coexistir con liacutevedoreticularis
EM
bull Algunos pude haber AB AF
bull Difiacutecil diferenciar de EM lesiones
bull Sicca
bull Sx psiquiaacutetricos parecidos a EM
bull Anti-Ro
bull Ansiedad 48
bull Depresioacuten 23Sjoumlgren
bull Rara lesiones en piel tejido subcutaacuteneo u oacuterganos internos
bull Morfologiacutea de vasos (Raynaud hipertensioacuten pulmonar arterial)
bull Siacutentomas neuropsiquiaacutetricos son raros (SNP)(depresioacuten por cronicidad)
Esclerosis sisteacutemica
Vasculitis sisteacutemicas
bullSNP
bullVasculitis necroacutetica granulomatosa
bullAsma bronquial y eosinofilia perifeacuterica
bullPsicosis y orientacioacuten
bullDiversa
bullTamantildeo de vasos
bullGrupo heterogeacuteneo
bullRaras
bullPrimarias o secundarias
bullPsicosis en joacutevenes
bullSNC por hipertensioacuten arterial
bull70 sx neuroloacutegicos neuropatiacutea perifeacuterica
bullVasculitis av
bullPersonalidad depresioacuten y demencia
bull20 meningitis y encefalitis aseacuteptica Arteritis y trombosis senos venosos
BehccediletPoliarteritis
nodosa
Churg-StraussSintomatologiacutea
Complicaciones psiquiaacutetricas debido al tratamiento
bull Prolongado altas dosis
bull Reversibles y moderadas al disminuir o quitar
Esteroides
bull Maniacutea hipomaniacutea
bull Labilidaddepresioacuten
bull Psicosisdelirium
bull Confusioacutendesorientacion
bull Cognitivosmemoria
Psiquiaacutetricasbull Suentildeo (dosis divididas)
bull Acatisia
bull Ancianos (riesgo)
bull Inicio (agitacioacuten euforia hipomaniacutea)
Depresioacuten despueacutes de terapia larga sobre todo en historia familiar de esta y OHMayor severidad a pocos diacuteas con dosis superiores a 20mg de prednisona10 necesidad de reduccioacuten y antipsicoacuteticosPsicosis aumenta en LES con hipoalbuminemia
Esteroides Psicosis diferenciar de glucocorticoide vs LES en altas
dosis
Bajas dosis memoria riesgo elevado ancianos
1 alteraciones cognitivas persistentes
Riesgo suicida elevado
Pseudotumor cerebri raro
Antipaluacutedicos
Cloroquina e hidroxicloroquina
Moderados y transitorios
Cefalea mareo
Raros labilidad agitacioacuten insomnio pesadillas ansiedad fatiga delirios y alucinaciones
Faacutermacos Siacutentesis de autoanticuerpos por faacutermacos
Mayor parte no desarrolla enfermedad autoinmune
Lupus inducido por faacutermacos sujetos sin historia de LES que desarrollan ab antinucleares + sintomas de LES despues de exposicioacuten adecuada a medicamento sintomas se resuelven al descontinuar
Fiebre Rash
Artritis Mialgias
SerositisHematoloacutegicasrenalesSNC
raras
An antihistonas en 95Hipocomplementenemia y ab anti-DNA son poco comunes
Medicamentos
bull Riesgo bajo
bull Clorpromazina
bull Perfenazina
bull Litio
Tratamiento
bull Descontinuar
bull Antipaluacutedicos
bull Glucocorticoides
bull Aines
Hipertiroiddismo Graveacutes AI
Causa mas comuacuten de hipertiroidismo
Oftalmopatiacutea psiquiaacutetricos
Hiperactividad del sistema adreneacutergico
Antagonistas beta adreneacutergicos y antitiroideos
Faacutermacos psicotroacutepicos Necesarios = eutiroideos
Manifestaciones psiquiaacutetricas del hipertiroidismo
Robert Graves
1835
Bocio palpitaciones disfuncioacuten nerviosa y siacutentomas oculares
Discretos trastornos psiquiaacutetricos no psicoacuteticos
SecundarioTP antes de Graveacutes
(comoacuterbido)
Hipertiroidismo y siacutentomas psiquiaacutetricos Depresioacuten
Ansiedad
Hipertiroidismo subcliacutenico (similar escalas)
The presence of antithyroid antibodies in patientswith affective and nonaffective psychiatricdisorders
John J Haggerty Jr 1 Dwight L Evans1 2 Robert N Golden1 Cort A Pedersen1 Jeffrey S Simon3 Charles B Nemeroff4
Biological Psychiatry
Volume 27 Issue 1 1 January 1990 Pages 51ndash60
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
Prevalencia de manifestaciones neuropsiquiaacutetricas
+-
bull Cognitiva cefalea afecto enfermedad cerebrovascular convulsiones polineuropatiacutea ansiedad y psicosis
Psicosis
bull Orgaacutenica 35-5 en LES en el primer antildeo
bull Pensamiento bizarro con alucinaciones y delirios y puede ser fluctuante sobre todo en PM
bull Otros sx atencioacuten agitacioacuten comportamiento agresivo
bull Pueden ser por esteroides (auditivas) o por LES SNC (taacutectiles y visuales)
bull Psicosis por LES reponde bien a esteroides 2-3 semanas citotoacutexicos
bull Mientras tx con antipsicoacuteticos
Procesos psicoloacutegicos funcionales
Disfuncioacuten cognitivabull Memoria a corto y largo plazo
bull Juicio abstraccioacuten afasia apraxia
bull Agnosia y cambios personalidad
Siacutendrome orgaacutenico mental
bull 21 al 80
bull Anticuerpos relacioacuten SNC
bull Condiciones asociadas hipertensioacuten o muacuteltiples infartos
bull Maacutes comuacuten e pacientes con LES activo en tx con esteroides
bull Asociada a historia de dantildeo en SNC
bull Asociada a actividad de enfermedad (efecto de SNC difuso y transitorio)
Memoria
Tratamiento cognitivo Basado en la etiologiacutea
Medicamentos disminuir o quitar
Ab antifosfoliacutepidos anticoagulantes
Ab antineurona esteroides pocas semanas
Reentrenamiento y soporte psicosocial
Aspirina en ancianos y riesgo casdiovascular
Demencia Memoria
Abstraccioacuten
Tareas diarias
Decisioacuten e impulsividad
Asocia a pequentildeos strokes muacuteltiples por anticueposantifosfoliacutepidos
Antipalpudicos pueden tener efecto protector
Pueden ser por lesiones vasculares isqueacutemicas por ateroesclerosis temprana
Parestesiascefalea
Cambios aacutenimo
Maniacutea
Ansiedaddepresioacuten
Agorafobiafobia social
Fobia
Cognitivo (memoriaafasiaorientacioacuten
espacial)
Manifestaciones psiquiaacutetricas secundarias
Depresioacuten
Ansiedad
Comportamiento maniacutea
like
Funcionales
Interaccioacuten px-meacutedicoFrustracioacuten por proceso dx largo
Depresioacuten Manifestacioacuten psiquiaacutetrica maacutes comuacuten
Usualmente comienzan de manera aguda como reaccioacuten a cronicidad y limitaciones en estilo de vida
Despueacutes de una exacerbacioacuten aguda algunos pacientes pueden presentar siacutentomas de ansiedad junto o en vez de los depresivos
Ansiedad Por las posibles consecuencias de la enfermedad
Manifestada como siacutentomas somaacuteticos
Puede deteriorar en comportamiento TOC like fobia hipocondriacutea insomnio y aislamiento
Raramente se desarrolla maniacutea o trastorno orgaacutenico de la personalidad (altas dosis)
Labilidad emocional desinhibicioacuten sexual verborrea religiosidad y agresividad
Siacutendrome antifosfoliacutepidos Siacutentomas neuropsiquiaacutetricos similares a LES
Ab antifosfoliacutepidos hasta 50 en LES
SAP primario trombofilia adquirida mas comuacuten trombosis arterial y venosa abortos espontaacuteneos y otras complicaciones embarazo
Ab antifosfoliacutepidos Anticoagulante luacutepico anticardiolipina y anti glicoproteiacutena I beta 2
SNC
bull Stroke
bull Corea
bull Mielitis transversa
bull Demencia progresiva
Psiquiaacutetricos
bull Cognitivos
bull Amnesia generalizada
bull Lesiones vasculares en sustancia blanca
bull Coexistir con liacutevedoreticularis
EM
bull Algunos pude haber AB AF
bull Difiacutecil diferenciar de EM lesiones
bull Sicca
bull Sx psiquiaacutetricos parecidos a EM
bull Anti-Ro
bull Ansiedad 48
bull Depresioacuten 23Sjoumlgren
bull Rara lesiones en piel tejido subcutaacuteneo u oacuterganos internos
bull Morfologiacutea de vasos (Raynaud hipertensioacuten pulmonar arterial)
bull Siacutentomas neuropsiquiaacutetricos son raros (SNP)(depresioacuten por cronicidad)
Esclerosis sisteacutemica
Vasculitis sisteacutemicas
bullSNP
bullVasculitis necroacutetica granulomatosa
bullAsma bronquial y eosinofilia perifeacuterica
bullPsicosis y orientacioacuten
bullDiversa
bullTamantildeo de vasos
bullGrupo heterogeacuteneo
bullRaras
bullPrimarias o secundarias
bullPsicosis en joacutevenes
bullSNC por hipertensioacuten arterial
bull70 sx neuroloacutegicos neuropatiacutea perifeacuterica
bullVasculitis av
bullPersonalidad depresioacuten y demencia
bull20 meningitis y encefalitis aseacuteptica Arteritis y trombosis senos venosos
BehccediletPoliarteritis
nodosa
Churg-StraussSintomatologiacutea
Complicaciones psiquiaacutetricas debido al tratamiento
bull Prolongado altas dosis
bull Reversibles y moderadas al disminuir o quitar
Esteroides
bull Maniacutea hipomaniacutea
bull Labilidaddepresioacuten
bull Psicosisdelirium
bull Confusioacutendesorientacion
bull Cognitivosmemoria
Psiquiaacutetricasbull Suentildeo (dosis divididas)
bull Acatisia
bull Ancianos (riesgo)
bull Inicio (agitacioacuten euforia hipomaniacutea)
Depresioacuten despueacutes de terapia larga sobre todo en historia familiar de esta y OHMayor severidad a pocos diacuteas con dosis superiores a 20mg de prednisona10 necesidad de reduccioacuten y antipsicoacuteticosPsicosis aumenta en LES con hipoalbuminemia
Esteroides Psicosis diferenciar de glucocorticoide vs LES en altas
dosis
Bajas dosis memoria riesgo elevado ancianos
1 alteraciones cognitivas persistentes
Riesgo suicida elevado
Pseudotumor cerebri raro
Antipaluacutedicos
Cloroquina e hidroxicloroquina
Moderados y transitorios
Cefalea mareo
Raros labilidad agitacioacuten insomnio pesadillas ansiedad fatiga delirios y alucinaciones
Faacutermacos Siacutentesis de autoanticuerpos por faacutermacos
Mayor parte no desarrolla enfermedad autoinmune
Lupus inducido por faacutermacos sujetos sin historia de LES que desarrollan ab antinucleares + sintomas de LES despues de exposicioacuten adecuada a medicamento sintomas se resuelven al descontinuar
Fiebre Rash
Artritis Mialgias
SerositisHematoloacutegicasrenalesSNC
raras
An antihistonas en 95Hipocomplementenemia y ab anti-DNA son poco comunes
Medicamentos
bull Riesgo bajo
bull Clorpromazina
bull Perfenazina
bull Litio
Tratamiento
bull Descontinuar
bull Antipaluacutedicos
bull Glucocorticoides
bull Aines
Hipertiroiddismo Graveacutes AI
Causa mas comuacuten de hipertiroidismo
Oftalmopatiacutea psiquiaacutetricos
Hiperactividad del sistema adreneacutergico
Antagonistas beta adreneacutergicos y antitiroideos
Faacutermacos psicotroacutepicos Necesarios = eutiroideos
Manifestaciones psiquiaacutetricas del hipertiroidismo
Robert Graves
1835
Bocio palpitaciones disfuncioacuten nerviosa y siacutentomas oculares
Discretos trastornos psiquiaacutetricos no psicoacuteticos
SecundarioTP antes de Graveacutes
(comoacuterbido)
Hipertiroidismo y siacutentomas psiquiaacutetricos Depresioacuten
Ansiedad
Hipertiroidismo subcliacutenico (similar escalas)
The presence of antithyroid antibodies in patientswith affective and nonaffective psychiatricdisorders
John J Haggerty Jr 1 Dwight L Evans1 2 Robert N Golden1 Cort A Pedersen1 Jeffrey S Simon3 Charles B Nemeroff4
Biological Psychiatry
Volume 27 Issue 1 1 January 1990 Pages 51ndash60
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
Disfuncioacuten cognitivabull Memoria a corto y largo plazo
bull Juicio abstraccioacuten afasia apraxia
bull Agnosia y cambios personalidad
Siacutendrome orgaacutenico mental
bull 21 al 80
bull Anticuerpos relacioacuten SNC
bull Condiciones asociadas hipertensioacuten o muacuteltiples infartos
bull Maacutes comuacuten e pacientes con LES activo en tx con esteroides
bull Asociada a historia de dantildeo en SNC
bull Asociada a actividad de enfermedad (efecto de SNC difuso y transitorio)
Memoria
Tratamiento cognitivo Basado en la etiologiacutea
Medicamentos disminuir o quitar
Ab antifosfoliacutepidos anticoagulantes
Ab antineurona esteroides pocas semanas
Reentrenamiento y soporte psicosocial
Aspirina en ancianos y riesgo casdiovascular
Demencia Memoria
Abstraccioacuten
Tareas diarias
Decisioacuten e impulsividad
Asocia a pequentildeos strokes muacuteltiples por anticueposantifosfoliacutepidos
Antipalpudicos pueden tener efecto protector
Pueden ser por lesiones vasculares isqueacutemicas por ateroesclerosis temprana
Parestesiascefalea
Cambios aacutenimo
Maniacutea
Ansiedaddepresioacuten
Agorafobiafobia social
Fobia
Cognitivo (memoriaafasiaorientacioacuten
espacial)
Manifestaciones psiquiaacutetricas secundarias
Depresioacuten
Ansiedad
Comportamiento maniacutea
like
Funcionales
Interaccioacuten px-meacutedicoFrustracioacuten por proceso dx largo
Depresioacuten Manifestacioacuten psiquiaacutetrica maacutes comuacuten
Usualmente comienzan de manera aguda como reaccioacuten a cronicidad y limitaciones en estilo de vida
Despueacutes de una exacerbacioacuten aguda algunos pacientes pueden presentar siacutentomas de ansiedad junto o en vez de los depresivos
Ansiedad Por las posibles consecuencias de la enfermedad
Manifestada como siacutentomas somaacuteticos
Puede deteriorar en comportamiento TOC like fobia hipocondriacutea insomnio y aislamiento
Raramente se desarrolla maniacutea o trastorno orgaacutenico de la personalidad (altas dosis)
Labilidad emocional desinhibicioacuten sexual verborrea religiosidad y agresividad
Siacutendrome antifosfoliacutepidos Siacutentomas neuropsiquiaacutetricos similares a LES
Ab antifosfoliacutepidos hasta 50 en LES
SAP primario trombofilia adquirida mas comuacuten trombosis arterial y venosa abortos espontaacuteneos y otras complicaciones embarazo
Ab antifosfoliacutepidos Anticoagulante luacutepico anticardiolipina y anti glicoproteiacutena I beta 2
SNC
bull Stroke
bull Corea
bull Mielitis transversa
bull Demencia progresiva
Psiquiaacutetricos
bull Cognitivos
bull Amnesia generalizada
bull Lesiones vasculares en sustancia blanca
bull Coexistir con liacutevedoreticularis
EM
bull Algunos pude haber AB AF
bull Difiacutecil diferenciar de EM lesiones
bull Sicca
bull Sx psiquiaacutetricos parecidos a EM
bull Anti-Ro
bull Ansiedad 48
bull Depresioacuten 23Sjoumlgren
bull Rara lesiones en piel tejido subcutaacuteneo u oacuterganos internos
bull Morfologiacutea de vasos (Raynaud hipertensioacuten pulmonar arterial)
bull Siacutentomas neuropsiquiaacutetricos son raros (SNP)(depresioacuten por cronicidad)
Esclerosis sisteacutemica
Vasculitis sisteacutemicas
bullSNP
bullVasculitis necroacutetica granulomatosa
bullAsma bronquial y eosinofilia perifeacuterica
bullPsicosis y orientacioacuten
bullDiversa
bullTamantildeo de vasos
bullGrupo heterogeacuteneo
bullRaras
bullPrimarias o secundarias
bullPsicosis en joacutevenes
bullSNC por hipertensioacuten arterial
bull70 sx neuroloacutegicos neuropatiacutea perifeacuterica
bullVasculitis av
bullPersonalidad depresioacuten y demencia
bull20 meningitis y encefalitis aseacuteptica Arteritis y trombosis senos venosos
BehccediletPoliarteritis
nodosa
Churg-StraussSintomatologiacutea
Complicaciones psiquiaacutetricas debido al tratamiento
bull Prolongado altas dosis
bull Reversibles y moderadas al disminuir o quitar
Esteroides
bull Maniacutea hipomaniacutea
bull Labilidaddepresioacuten
bull Psicosisdelirium
bull Confusioacutendesorientacion
bull Cognitivosmemoria
Psiquiaacutetricasbull Suentildeo (dosis divididas)
bull Acatisia
bull Ancianos (riesgo)
bull Inicio (agitacioacuten euforia hipomaniacutea)
Depresioacuten despueacutes de terapia larga sobre todo en historia familiar de esta y OHMayor severidad a pocos diacuteas con dosis superiores a 20mg de prednisona10 necesidad de reduccioacuten y antipsicoacuteticosPsicosis aumenta en LES con hipoalbuminemia
Esteroides Psicosis diferenciar de glucocorticoide vs LES en altas
dosis
Bajas dosis memoria riesgo elevado ancianos
1 alteraciones cognitivas persistentes
Riesgo suicida elevado
Pseudotumor cerebri raro
Antipaluacutedicos
Cloroquina e hidroxicloroquina
Moderados y transitorios
Cefalea mareo
Raros labilidad agitacioacuten insomnio pesadillas ansiedad fatiga delirios y alucinaciones
Faacutermacos Siacutentesis de autoanticuerpos por faacutermacos
Mayor parte no desarrolla enfermedad autoinmune
Lupus inducido por faacutermacos sujetos sin historia de LES que desarrollan ab antinucleares + sintomas de LES despues de exposicioacuten adecuada a medicamento sintomas se resuelven al descontinuar
Fiebre Rash
Artritis Mialgias
SerositisHematoloacutegicasrenalesSNC
raras
An antihistonas en 95Hipocomplementenemia y ab anti-DNA son poco comunes
Medicamentos
bull Riesgo bajo
bull Clorpromazina
bull Perfenazina
bull Litio
Tratamiento
bull Descontinuar
bull Antipaluacutedicos
bull Glucocorticoides
bull Aines
Hipertiroiddismo Graveacutes AI
Causa mas comuacuten de hipertiroidismo
Oftalmopatiacutea psiquiaacutetricos
Hiperactividad del sistema adreneacutergico
Antagonistas beta adreneacutergicos y antitiroideos
Faacutermacos psicotroacutepicos Necesarios = eutiroideos
Manifestaciones psiquiaacutetricas del hipertiroidismo
Robert Graves
1835
Bocio palpitaciones disfuncioacuten nerviosa y siacutentomas oculares
Discretos trastornos psiquiaacutetricos no psicoacuteticos
SecundarioTP antes de Graveacutes
(comoacuterbido)
Hipertiroidismo y siacutentomas psiquiaacutetricos Depresioacuten
Ansiedad
Hipertiroidismo subcliacutenico (similar escalas)
The presence of antithyroid antibodies in patientswith affective and nonaffective psychiatricdisorders
John J Haggerty Jr 1 Dwight L Evans1 2 Robert N Golden1 Cort A Pedersen1 Jeffrey S Simon3 Charles B Nemeroff4
Biological Psychiatry
Volume 27 Issue 1 1 January 1990 Pages 51ndash60
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
Tratamiento cognitivo Basado en la etiologiacutea
Medicamentos disminuir o quitar
Ab antifosfoliacutepidos anticoagulantes
Ab antineurona esteroides pocas semanas
Reentrenamiento y soporte psicosocial
Aspirina en ancianos y riesgo casdiovascular
Demencia Memoria
Abstraccioacuten
Tareas diarias
Decisioacuten e impulsividad
Asocia a pequentildeos strokes muacuteltiples por anticueposantifosfoliacutepidos
Antipalpudicos pueden tener efecto protector
Pueden ser por lesiones vasculares isqueacutemicas por ateroesclerosis temprana
Parestesiascefalea
Cambios aacutenimo
Maniacutea
Ansiedaddepresioacuten
Agorafobiafobia social
Fobia
Cognitivo (memoriaafasiaorientacioacuten
espacial)
Manifestaciones psiquiaacutetricas secundarias
Depresioacuten
Ansiedad
Comportamiento maniacutea
like
Funcionales
Interaccioacuten px-meacutedicoFrustracioacuten por proceso dx largo
Depresioacuten Manifestacioacuten psiquiaacutetrica maacutes comuacuten
Usualmente comienzan de manera aguda como reaccioacuten a cronicidad y limitaciones en estilo de vida
Despueacutes de una exacerbacioacuten aguda algunos pacientes pueden presentar siacutentomas de ansiedad junto o en vez de los depresivos
Ansiedad Por las posibles consecuencias de la enfermedad
Manifestada como siacutentomas somaacuteticos
Puede deteriorar en comportamiento TOC like fobia hipocondriacutea insomnio y aislamiento
Raramente se desarrolla maniacutea o trastorno orgaacutenico de la personalidad (altas dosis)
Labilidad emocional desinhibicioacuten sexual verborrea religiosidad y agresividad
Siacutendrome antifosfoliacutepidos Siacutentomas neuropsiquiaacutetricos similares a LES
Ab antifosfoliacutepidos hasta 50 en LES
SAP primario trombofilia adquirida mas comuacuten trombosis arterial y venosa abortos espontaacuteneos y otras complicaciones embarazo
Ab antifosfoliacutepidos Anticoagulante luacutepico anticardiolipina y anti glicoproteiacutena I beta 2
SNC
bull Stroke
bull Corea
bull Mielitis transversa
bull Demencia progresiva
Psiquiaacutetricos
bull Cognitivos
bull Amnesia generalizada
bull Lesiones vasculares en sustancia blanca
bull Coexistir con liacutevedoreticularis
EM
bull Algunos pude haber AB AF
bull Difiacutecil diferenciar de EM lesiones
bull Sicca
bull Sx psiquiaacutetricos parecidos a EM
bull Anti-Ro
bull Ansiedad 48
bull Depresioacuten 23Sjoumlgren
bull Rara lesiones en piel tejido subcutaacuteneo u oacuterganos internos
bull Morfologiacutea de vasos (Raynaud hipertensioacuten pulmonar arterial)
bull Siacutentomas neuropsiquiaacutetricos son raros (SNP)(depresioacuten por cronicidad)
Esclerosis sisteacutemica
Vasculitis sisteacutemicas
bullSNP
bullVasculitis necroacutetica granulomatosa
bullAsma bronquial y eosinofilia perifeacuterica
bullPsicosis y orientacioacuten
bullDiversa
bullTamantildeo de vasos
bullGrupo heterogeacuteneo
bullRaras
bullPrimarias o secundarias
bullPsicosis en joacutevenes
bullSNC por hipertensioacuten arterial
bull70 sx neuroloacutegicos neuropatiacutea perifeacuterica
bullVasculitis av
bullPersonalidad depresioacuten y demencia
bull20 meningitis y encefalitis aseacuteptica Arteritis y trombosis senos venosos
BehccediletPoliarteritis
nodosa
Churg-StraussSintomatologiacutea
Complicaciones psiquiaacutetricas debido al tratamiento
bull Prolongado altas dosis
bull Reversibles y moderadas al disminuir o quitar
Esteroides
bull Maniacutea hipomaniacutea
bull Labilidaddepresioacuten
bull Psicosisdelirium
bull Confusioacutendesorientacion
bull Cognitivosmemoria
Psiquiaacutetricasbull Suentildeo (dosis divididas)
bull Acatisia
bull Ancianos (riesgo)
bull Inicio (agitacioacuten euforia hipomaniacutea)
Depresioacuten despueacutes de terapia larga sobre todo en historia familiar de esta y OHMayor severidad a pocos diacuteas con dosis superiores a 20mg de prednisona10 necesidad de reduccioacuten y antipsicoacuteticosPsicosis aumenta en LES con hipoalbuminemia
Esteroides Psicosis diferenciar de glucocorticoide vs LES en altas
dosis
Bajas dosis memoria riesgo elevado ancianos
1 alteraciones cognitivas persistentes
Riesgo suicida elevado
Pseudotumor cerebri raro
Antipaluacutedicos
Cloroquina e hidroxicloroquina
Moderados y transitorios
Cefalea mareo
Raros labilidad agitacioacuten insomnio pesadillas ansiedad fatiga delirios y alucinaciones
Faacutermacos Siacutentesis de autoanticuerpos por faacutermacos
Mayor parte no desarrolla enfermedad autoinmune
Lupus inducido por faacutermacos sujetos sin historia de LES que desarrollan ab antinucleares + sintomas de LES despues de exposicioacuten adecuada a medicamento sintomas se resuelven al descontinuar
Fiebre Rash
Artritis Mialgias
SerositisHematoloacutegicasrenalesSNC
raras
An antihistonas en 95Hipocomplementenemia y ab anti-DNA son poco comunes
Medicamentos
bull Riesgo bajo
bull Clorpromazina
bull Perfenazina
bull Litio
Tratamiento
bull Descontinuar
bull Antipaluacutedicos
bull Glucocorticoides
bull Aines
Hipertiroiddismo Graveacutes AI
Causa mas comuacuten de hipertiroidismo
Oftalmopatiacutea psiquiaacutetricos
Hiperactividad del sistema adreneacutergico
Antagonistas beta adreneacutergicos y antitiroideos
Faacutermacos psicotroacutepicos Necesarios = eutiroideos
Manifestaciones psiquiaacutetricas del hipertiroidismo
Robert Graves
1835
Bocio palpitaciones disfuncioacuten nerviosa y siacutentomas oculares
Discretos trastornos psiquiaacutetricos no psicoacuteticos
SecundarioTP antes de Graveacutes
(comoacuterbido)
Hipertiroidismo y siacutentomas psiquiaacutetricos Depresioacuten
Ansiedad
Hipertiroidismo subcliacutenico (similar escalas)
The presence of antithyroid antibodies in patientswith affective and nonaffective psychiatricdisorders
John J Haggerty Jr 1 Dwight L Evans1 2 Robert N Golden1 Cort A Pedersen1 Jeffrey S Simon3 Charles B Nemeroff4
Biological Psychiatry
Volume 27 Issue 1 1 January 1990 Pages 51ndash60
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
Demencia Memoria
Abstraccioacuten
Tareas diarias
Decisioacuten e impulsividad
Asocia a pequentildeos strokes muacuteltiples por anticueposantifosfoliacutepidos
Antipalpudicos pueden tener efecto protector
Pueden ser por lesiones vasculares isqueacutemicas por ateroesclerosis temprana
Parestesiascefalea
Cambios aacutenimo
Maniacutea
Ansiedaddepresioacuten
Agorafobiafobia social
Fobia
Cognitivo (memoriaafasiaorientacioacuten
espacial)
Manifestaciones psiquiaacutetricas secundarias
Depresioacuten
Ansiedad
Comportamiento maniacutea
like
Funcionales
Interaccioacuten px-meacutedicoFrustracioacuten por proceso dx largo
Depresioacuten Manifestacioacuten psiquiaacutetrica maacutes comuacuten
Usualmente comienzan de manera aguda como reaccioacuten a cronicidad y limitaciones en estilo de vida
Despueacutes de una exacerbacioacuten aguda algunos pacientes pueden presentar siacutentomas de ansiedad junto o en vez de los depresivos
Ansiedad Por las posibles consecuencias de la enfermedad
Manifestada como siacutentomas somaacuteticos
Puede deteriorar en comportamiento TOC like fobia hipocondriacutea insomnio y aislamiento
Raramente se desarrolla maniacutea o trastorno orgaacutenico de la personalidad (altas dosis)
Labilidad emocional desinhibicioacuten sexual verborrea religiosidad y agresividad
Siacutendrome antifosfoliacutepidos Siacutentomas neuropsiquiaacutetricos similares a LES
Ab antifosfoliacutepidos hasta 50 en LES
SAP primario trombofilia adquirida mas comuacuten trombosis arterial y venosa abortos espontaacuteneos y otras complicaciones embarazo
Ab antifosfoliacutepidos Anticoagulante luacutepico anticardiolipina y anti glicoproteiacutena I beta 2
SNC
bull Stroke
bull Corea
bull Mielitis transversa
bull Demencia progresiva
Psiquiaacutetricos
bull Cognitivos
bull Amnesia generalizada
bull Lesiones vasculares en sustancia blanca
bull Coexistir con liacutevedoreticularis
EM
bull Algunos pude haber AB AF
bull Difiacutecil diferenciar de EM lesiones
bull Sicca
bull Sx psiquiaacutetricos parecidos a EM
bull Anti-Ro
bull Ansiedad 48
bull Depresioacuten 23Sjoumlgren
bull Rara lesiones en piel tejido subcutaacuteneo u oacuterganos internos
bull Morfologiacutea de vasos (Raynaud hipertensioacuten pulmonar arterial)
bull Siacutentomas neuropsiquiaacutetricos son raros (SNP)(depresioacuten por cronicidad)
Esclerosis sisteacutemica
Vasculitis sisteacutemicas
bullSNP
bullVasculitis necroacutetica granulomatosa
bullAsma bronquial y eosinofilia perifeacuterica
bullPsicosis y orientacioacuten
bullDiversa
bullTamantildeo de vasos
bullGrupo heterogeacuteneo
bullRaras
bullPrimarias o secundarias
bullPsicosis en joacutevenes
bullSNC por hipertensioacuten arterial
bull70 sx neuroloacutegicos neuropatiacutea perifeacuterica
bullVasculitis av
bullPersonalidad depresioacuten y demencia
bull20 meningitis y encefalitis aseacuteptica Arteritis y trombosis senos venosos
BehccediletPoliarteritis
nodosa
Churg-StraussSintomatologiacutea
Complicaciones psiquiaacutetricas debido al tratamiento
bull Prolongado altas dosis
bull Reversibles y moderadas al disminuir o quitar
Esteroides
bull Maniacutea hipomaniacutea
bull Labilidaddepresioacuten
bull Psicosisdelirium
bull Confusioacutendesorientacion
bull Cognitivosmemoria
Psiquiaacutetricasbull Suentildeo (dosis divididas)
bull Acatisia
bull Ancianos (riesgo)
bull Inicio (agitacioacuten euforia hipomaniacutea)
Depresioacuten despueacutes de terapia larga sobre todo en historia familiar de esta y OHMayor severidad a pocos diacuteas con dosis superiores a 20mg de prednisona10 necesidad de reduccioacuten y antipsicoacuteticosPsicosis aumenta en LES con hipoalbuminemia
Esteroides Psicosis diferenciar de glucocorticoide vs LES en altas
dosis
Bajas dosis memoria riesgo elevado ancianos
1 alteraciones cognitivas persistentes
Riesgo suicida elevado
Pseudotumor cerebri raro
Antipaluacutedicos
Cloroquina e hidroxicloroquina
Moderados y transitorios
Cefalea mareo
Raros labilidad agitacioacuten insomnio pesadillas ansiedad fatiga delirios y alucinaciones
Faacutermacos Siacutentesis de autoanticuerpos por faacutermacos
Mayor parte no desarrolla enfermedad autoinmune
Lupus inducido por faacutermacos sujetos sin historia de LES que desarrollan ab antinucleares + sintomas de LES despues de exposicioacuten adecuada a medicamento sintomas se resuelven al descontinuar
Fiebre Rash
Artritis Mialgias
SerositisHematoloacutegicasrenalesSNC
raras
An antihistonas en 95Hipocomplementenemia y ab anti-DNA son poco comunes
Medicamentos
bull Riesgo bajo
bull Clorpromazina
bull Perfenazina
bull Litio
Tratamiento
bull Descontinuar
bull Antipaluacutedicos
bull Glucocorticoides
bull Aines
Hipertiroiddismo Graveacutes AI
Causa mas comuacuten de hipertiroidismo
Oftalmopatiacutea psiquiaacutetricos
Hiperactividad del sistema adreneacutergico
Antagonistas beta adreneacutergicos y antitiroideos
Faacutermacos psicotroacutepicos Necesarios = eutiroideos
Manifestaciones psiquiaacutetricas del hipertiroidismo
Robert Graves
1835
Bocio palpitaciones disfuncioacuten nerviosa y siacutentomas oculares
Discretos trastornos psiquiaacutetricos no psicoacuteticos
SecundarioTP antes de Graveacutes
(comoacuterbido)
Hipertiroidismo y siacutentomas psiquiaacutetricos Depresioacuten
Ansiedad
Hipertiroidismo subcliacutenico (similar escalas)
The presence of antithyroid antibodies in patientswith affective and nonaffective psychiatricdisorders
John J Haggerty Jr 1 Dwight L Evans1 2 Robert N Golden1 Cort A Pedersen1 Jeffrey S Simon3 Charles B Nemeroff4
Biological Psychiatry
Volume 27 Issue 1 1 January 1990 Pages 51ndash60
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
Parestesiascefalea
Cambios aacutenimo
Maniacutea
Ansiedaddepresioacuten
Agorafobiafobia social
Fobia
Cognitivo (memoriaafasiaorientacioacuten
espacial)
Manifestaciones psiquiaacutetricas secundarias
Depresioacuten
Ansiedad
Comportamiento maniacutea
like
Funcionales
Interaccioacuten px-meacutedicoFrustracioacuten por proceso dx largo
Depresioacuten Manifestacioacuten psiquiaacutetrica maacutes comuacuten
Usualmente comienzan de manera aguda como reaccioacuten a cronicidad y limitaciones en estilo de vida
Despueacutes de una exacerbacioacuten aguda algunos pacientes pueden presentar siacutentomas de ansiedad junto o en vez de los depresivos
Ansiedad Por las posibles consecuencias de la enfermedad
Manifestada como siacutentomas somaacuteticos
Puede deteriorar en comportamiento TOC like fobia hipocondriacutea insomnio y aislamiento
Raramente se desarrolla maniacutea o trastorno orgaacutenico de la personalidad (altas dosis)
Labilidad emocional desinhibicioacuten sexual verborrea religiosidad y agresividad
Siacutendrome antifosfoliacutepidos Siacutentomas neuropsiquiaacutetricos similares a LES
Ab antifosfoliacutepidos hasta 50 en LES
SAP primario trombofilia adquirida mas comuacuten trombosis arterial y venosa abortos espontaacuteneos y otras complicaciones embarazo
Ab antifosfoliacutepidos Anticoagulante luacutepico anticardiolipina y anti glicoproteiacutena I beta 2
SNC
bull Stroke
bull Corea
bull Mielitis transversa
bull Demencia progresiva
Psiquiaacutetricos
bull Cognitivos
bull Amnesia generalizada
bull Lesiones vasculares en sustancia blanca
bull Coexistir con liacutevedoreticularis
EM
bull Algunos pude haber AB AF
bull Difiacutecil diferenciar de EM lesiones
bull Sicca
bull Sx psiquiaacutetricos parecidos a EM
bull Anti-Ro
bull Ansiedad 48
bull Depresioacuten 23Sjoumlgren
bull Rara lesiones en piel tejido subcutaacuteneo u oacuterganos internos
bull Morfologiacutea de vasos (Raynaud hipertensioacuten pulmonar arterial)
bull Siacutentomas neuropsiquiaacutetricos son raros (SNP)(depresioacuten por cronicidad)
Esclerosis sisteacutemica
Vasculitis sisteacutemicas
bullSNP
bullVasculitis necroacutetica granulomatosa
bullAsma bronquial y eosinofilia perifeacuterica
bullPsicosis y orientacioacuten
bullDiversa
bullTamantildeo de vasos
bullGrupo heterogeacuteneo
bullRaras
bullPrimarias o secundarias
bullPsicosis en joacutevenes
bullSNC por hipertensioacuten arterial
bull70 sx neuroloacutegicos neuropatiacutea perifeacuterica
bullVasculitis av
bullPersonalidad depresioacuten y demencia
bull20 meningitis y encefalitis aseacuteptica Arteritis y trombosis senos venosos
BehccediletPoliarteritis
nodosa
Churg-StraussSintomatologiacutea
Complicaciones psiquiaacutetricas debido al tratamiento
bull Prolongado altas dosis
bull Reversibles y moderadas al disminuir o quitar
Esteroides
bull Maniacutea hipomaniacutea
bull Labilidaddepresioacuten
bull Psicosisdelirium
bull Confusioacutendesorientacion
bull Cognitivosmemoria
Psiquiaacutetricasbull Suentildeo (dosis divididas)
bull Acatisia
bull Ancianos (riesgo)
bull Inicio (agitacioacuten euforia hipomaniacutea)
Depresioacuten despueacutes de terapia larga sobre todo en historia familiar de esta y OHMayor severidad a pocos diacuteas con dosis superiores a 20mg de prednisona10 necesidad de reduccioacuten y antipsicoacuteticosPsicosis aumenta en LES con hipoalbuminemia
Esteroides Psicosis diferenciar de glucocorticoide vs LES en altas
dosis
Bajas dosis memoria riesgo elevado ancianos
1 alteraciones cognitivas persistentes
Riesgo suicida elevado
Pseudotumor cerebri raro
Antipaluacutedicos
Cloroquina e hidroxicloroquina
Moderados y transitorios
Cefalea mareo
Raros labilidad agitacioacuten insomnio pesadillas ansiedad fatiga delirios y alucinaciones
Faacutermacos Siacutentesis de autoanticuerpos por faacutermacos
Mayor parte no desarrolla enfermedad autoinmune
Lupus inducido por faacutermacos sujetos sin historia de LES que desarrollan ab antinucleares + sintomas de LES despues de exposicioacuten adecuada a medicamento sintomas se resuelven al descontinuar
Fiebre Rash
Artritis Mialgias
SerositisHematoloacutegicasrenalesSNC
raras
An antihistonas en 95Hipocomplementenemia y ab anti-DNA son poco comunes
Medicamentos
bull Riesgo bajo
bull Clorpromazina
bull Perfenazina
bull Litio
Tratamiento
bull Descontinuar
bull Antipaluacutedicos
bull Glucocorticoides
bull Aines
Hipertiroiddismo Graveacutes AI
Causa mas comuacuten de hipertiroidismo
Oftalmopatiacutea psiquiaacutetricos
Hiperactividad del sistema adreneacutergico
Antagonistas beta adreneacutergicos y antitiroideos
Faacutermacos psicotroacutepicos Necesarios = eutiroideos
Manifestaciones psiquiaacutetricas del hipertiroidismo
Robert Graves
1835
Bocio palpitaciones disfuncioacuten nerviosa y siacutentomas oculares
Discretos trastornos psiquiaacutetricos no psicoacuteticos
SecundarioTP antes de Graveacutes
(comoacuterbido)
Hipertiroidismo y siacutentomas psiquiaacutetricos Depresioacuten
Ansiedad
Hipertiroidismo subcliacutenico (similar escalas)
The presence of antithyroid antibodies in patientswith affective and nonaffective psychiatricdisorders
John J Haggerty Jr 1 Dwight L Evans1 2 Robert N Golden1 Cort A Pedersen1 Jeffrey S Simon3 Charles B Nemeroff4
Biological Psychiatry
Volume 27 Issue 1 1 January 1990 Pages 51ndash60
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
Depresioacuten Manifestacioacuten psiquiaacutetrica maacutes comuacuten
Usualmente comienzan de manera aguda como reaccioacuten a cronicidad y limitaciones en estilo de vida
Despueacutes de una exacerbacioacuten aguda algunos pacientes pueden presentar siacutentomas de ansiedad junto o en vez de los depresivos
Ansiedad Por las posibles consecuencias de la enfermedad
Manifestada como siacutentomas somaacuteticos
Puede deteriorar en comportamiento TOC like fobia hipocondriacutea insomnio y aislamiento
Raramente se desarrolla maniacutea o trastorno orgaacutenico de la personalidad (altas dosis)
Labilidad emocional desinhibicioacuten sexual verborrea religiosidad y agresividad
Siacutendrome antifosfoliacutepidos Siacutentomas neuropsiquiaacutetricos similares a LES
Ab antifosfoliacutepidos hasta 50 en LES
SAP primario trombofilia adquirida mas comuacuten trombosis arterial y venosa abortos espontaacuteneos y otras complicaciones embarazo
Ab antifosfoliacutepidos Anticoagulante luacutepico anticardiolipina y anti glicoproteiacutena I beta 2
SNC
bull Stroke
bull Corea
bull Mielitis transversa
bull Demencia progresiva
Psiquiaacutetricos
bull Cognitivos
bull Amnesia generalizada
bull Lesiones vasculares en sustancia blanca
bull Coexistir con liacutevedoreticularis
EM
bull Algunos pude haber AB AF
bull Difiacutecil diferenciar de EM lesiones
bull Sicca
bull Sx psiquiaacutetricos parecidos a EM
bull Anti-Ro
bull Ansiedad 48
bull Depresioacuten 23Sjoumlgren
bull Rara lesiones en piel tejido subcutaacuteneo u oacuterganos internos
bull Morfologiacutea de vasos (Raynaud hipertensioacuten pulmonar arterial)
bull Siacutentomas neuropsiquiaacutetricos son raros (SNP)(depresioacuten por cronicidad)
Esclerosis sisteacutemica
Vasculitis sisteacutemicas
bullSNP
bullVasculitis necroacutetica granulomatosa
bullAsma bronquial y eosinofilia perifeacuterica
bullPsicosis y orientacioacuten
bullDiversa
bullTamantildeo de vasos
bullGrupo heterogeacuteneo
bullRaras
bullPrimarias o secundarias
bullPsicosis en joacutevenes
bullSNC por hipertensioacuten arterial
bull70 sx neuroloacutegicos neuropatiacutea perifeacuterica
bullVasculitis av
bullPersonalidad depresioacuten y demencia
bull20 meningitis y encefalitis aseacuteptica Arteritis y trombosis senos venosos
BehccediletPoliarteritis
nodosa
Churg-StraussSintomatologiacutea
Complicaciones psiquiaacutetricas debido al tratamiento
bull Prolongado altas dosis
bull Reversibles y moderadas al disminuir o quitar
Esteroides
bull Maniacutea hipomaniacutea
bull Labilidaddepresioacuten
bull Psicosisdelirium
bull Confusioacutendesorientacion
bull Cognitivosmemoria
Psiquiaacutetricasbull Suentildeo (dosis divididas)
bull Acatisia
bull Ancianos (riesgo)
bull Inicio (agitacioacuten euforia hipomaniacutea)
Depresioacuten despueacutes de terapia larga sobre todo en historia familiar de esta y OHMayor severidad a pocos diacuteas con dosis superiores a 20mg de prednisona10 necesidad de reduccioacuten y antipsicoacuteticosPsicosis aumenta en LES con hipoalbuminemia
Esteroides Psicosis diferenciar de glucocorticoide vs LES en altas
dosis
Bajas dosis memoria riesgo elevado ancianos
1 alteraciones cognitivas persistentes
Riesgo suicida elevado
Pseudotumor cerebri raro
Antipaluacutedicos
Cloroquina e hidroxicloroquina
Moderados y transitorios
Cefalea mareo
Raros labilidad agitacioacuten insomnio pesadillas ansiedad fatiga delirios y alucinaciones
Faacutermacos Siacutentesis de autoanticuerpos por faacutermacos
Mayor parte no desarrolla enfermedad autoinmune
Lupus inducido por faacutermacos sujetos sin historia de LES que desarrollan ab antinucleares + sintomas de LES despues de exposicioacuten adecuada a medicamento sintomas se resuelven al descontinuar
Fiebre Rash
Artritis Mialgias
SerositisHematoloacutegicasrenalesSNC
raras
An antihistonas en 95Hipocomplementenemia y ab anti-DNA son poco comunes
Medicamentos
bull Riesgo bajo
bull Clorpromazina
bull Perfenazina
bull Litio
Tratamiento
bull Descontinuar
bull Antipaluacutedicos
bull Glucocorticoides
bull Aines
Hipertiroiddismo Graveacutes AI
Causa mas comuacuten de hipertiroidismo
Oftalmopatiacutea psiquiaacutetricos
Hiperactividad del sistema adreneacutergico
Antagonistas beta adreneacutergicos y antitiroideos
Faacutermacos psicotroacutepicos Necesarios = eutiroideos
Manifestaciones psiquiaacutetricas del hipertiroidismo
Robert Graves
1835
Bocio palpitaciones disfuncioacuten nerviosa y siacutentomas oculares
Discretos trastornos psiquiaacutetricos no psicoacuteticos
SecundarioTP antes de Graveacutes
(comoacuterbido)
Hipertiroidismo y siacutentomas psiquiaacutetricos Depresioacuten
Ansiedad
Hipertiroidismo subcliacutenico (similar escalas)
The presence of antithyroid antibodies in patientswith affective and nonaffective psychiatricdisorders
John J Haggerty Jr 1 Dwight L Evans1 2 Robert N Golden1 Cort A Pedersen1 Jeffrey S Simon3 Charles B Nemeroff4
Biological Psychiatry
Volume 27 Issue 1 1 January 1990 Pages 51ndash60
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
Ansiedad Por las posibles consecuencias de la enfermedad
Manifestada como siacutentomas somaacuteticos
Puede deteriorar en comportamiento TOC like fobia hipocondriacutea insomnio y aislamiento
Raramente se desarrolla maniacutea o trastorno orgaacutenico de la personalidad (altas dosis)
Labilidad emocional desinhibicioacuten sexual verborrea religiosidad y agresividad
Siacutendrome antifosfoliacutepidos Siacutentomas neuropsiquiaacutetricos similares a LES
Ab antifosfoliacutepidos hasta 50 en LES
SAP primario trombofilia adquirida mas comuacuten trombosis arterial y venosa abortos espontaacuteneos y otras complicaciones embarazo
Ab antifosfoliacutepidos Anticoagulante luacutepico anticardiolipina y anti glicoproteiacutena I beta 2
SNC
bull Stroke
bull Corea
bull Mielitis transversa
bull Demencia progresiva
Psiquiaacutetricos
bull Cognitivos
bull Amnesia generalizada
bull Lesiones vasculares en sustancia blanca
bull Coexistir con liacutevedoreticularis
EM
bull Algunos pude haber AB AF
bull Difiacutecil diferenciar de EM lesiones
bull Sicca
bull Sx psiquiaacutetricos parecidos a EM
bull Anti-Ro
bull Ansiedad 48
bull Depresioacuten 23Sjoumlgren
bull Rara lesiones en piel tejido subcutaacuteneo u oacuterganos internos
bull Morfologiacutea de vasos (Raynaud hipertensioacuten pulmonar arterial)
bull Siacutentomas neuropsiquiaacutetricos son raros (SNP)(depresioacuten por cronicidad)
Esclerosis sisteacutemica
Vasculitis sisteacutemicas
bullSNP
bullVasculitis necroacutetica granulomatosa
bullAsma bronquial y eosinofilia perifeacuterica
bullPsicosis y orientacioacuten
bullDiversa
bullTamantildeo de vasos
bullGrupo heterogeacuteneo
bullRaras
bullPrimarias o secundarias
bullPsicosis en joacutevenes
bullSNC por hipertensioacuten arterial
bull70 sx neuroloacutegicos neuropatiacutea perifeacuterica
bullVasculitis av
bullPersonalidad depresioacuten y demencia
bull20 meningitis y encefalitis aseacuteptica Arteritis y trombosis senos venosos
BehccediletPoliarteritis
nodosa
Churg-StraussSintomatologiacutea
Complicaciones psiquiaacutetricas debido al tratamiento
bull Prolongado altas dosis
bull Reversibles y moderadas al disminuir o quitar
Esteroides
bull Maniacutea hipomaniacutea
bull Labilidaddepresioacuten
bull Psicosisdelirium
bull Confusioacutendesorientacion
bull Cognitivosmemoria
Psiquiaacutetricasbull Suentildeo (dosis divididas)
bull Acatisia
bull Ancianos (riesgo)
bull Inicio (agitacioacuten euforia hipomaniacutea)
Depresioacuten despueacutes de terapia larga sobre todo en historia familiar de esta y OHMayor severidad a pocos diacuteas con dosis superiores a 20mg de prednisona10 necesidad de reduccioacuten y antipsicoacuteticosPsicosis aumenta en LES con hipoalbuminemia
Esteroides Psicosis diferenciar de glucocorticoide vs LES en altas
dosis
Bajas dosis memoria riesgo elevado ancianos
1 alteraciones cognitivas persistentes
Riesgo suicida elevado
Pseudotumor cerebri raro
Antipaluacutedicos
Cloroquina e hidroxicloroquina
Moderados y transitorios
Cefalea mareo
Raros labilidad agitacioacuten insomnio pesadillas ansiedad fatiga delirios y alucinaciones
Faacutermacos Siacutentesis de autoanticuerpos por faacutermacos
Mayor parte no desarrolla enfermedad autoinmune
Lupus inducido por faacutermacos sujetos sin historia de LES que desarrollan ab antinucleares + sintomas de LES despues de exposicioacuten adecuada a medicamento sintomas se resuelven al descontinuar
Fiebre Rash
Artritis Mialgias
SerositisHematoloacutegicasrenalesSNC
raras
An antihistonas en 95Hipocomplementenemia y ab anti-DNA son poco comunes
Medicamentos
bull Riesgo bajo
bull Clorpromazina
bull Perfenazina
bull Litio
Tratamiento
bull Descontinuar
bull Antipaluacutedicos
bull Glucocorticoides
bull Aines
Hipertiroiddismo Graveacutes AI
Causa mas comuacuten de hipertiroidismo
Oftalmopatiacutea psiquiaacutetricos
Hiperactividad del sistema adreneacutergico
Antagonistas beta adreneacutergicos y antitiroideos
Faacutermacos psicotroacutepicos Necesarios = eutiroideos
Manifestaciones psiquiaacutetricas del hipertiroidismo
Robert Graves
1835
Bocio palpitaciones disfuncioacuten nerviosa y siacutentomas oculares
Discretos trastornos psiquiaacutetricos no psicoacuteticos
SecundarioTP antes de Graveacutes
(comoacuterbido)
Hipertiroidismo y siacutentomas psiquiaacutetricos Depresioacuten
Ansiedad
Hipertiroidismo subcliacutenico (similar escalas)
The presence of antithyroid antibodies in patientswith affective and nonaffective psychiatricdisorders
John J Haggerty Jr 1 Dwight L Evans1 2 Robert N Golden1 Cort A Pedersen1 Jeffrey S Simon3 Charles B Nemeroff4
Biological Psychiatry
Volume 27 Issue 1 1 January 1990 Pages 51ndash60
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
Siacutendrome antifosfoliacutepidos Siacutentomas neuropsiquiaacutetricos similares a LES
Ab antifosfoliacutepidos hasta 50 en LES
SAP primario trombofilia adquirida mas comuacuten trombosis arterial y venosa abortos espontaacuteneos y otras complicaciones embarazo
Ab antifosfoliacutepidos Anticoagulante luacutepico anticardiolipina y anti glicoproteiacutena I beta 2
SNC
bull Stroke
bull Corea
bull Mielitis transversa
bull Demencia progresiva
Psiquiaacutetricos
bull Cognitivos
bull Amnesia generalizada
bull Lesiones vasculares en sustancia blanca
bull Coexistir con liacutevedoreticularis
EM
bull Algunos pude haber AB AF
bull Difiacutecil diferenciar de EM lesiones
bull Sicca
bull Sx psiquiaacutetricos parecidos a EM
bull Anti-Ro
bull Ansiedad 48
bull Depresioacuten 23Sjoumlgren
bull Rara lesiones en piel tejido subcutaacuteneo u oacuterganos internos
bull Morfologiacutea de vasos (Raynaud hipertensioacuten pulmonar arterial)
bull Siacutentomas neuropsiquiaacutetricos son raros (SNP)(depresioacuten por cronicidad)
Esclerosis sisteacutemica
Vasculitis sisteacutemicas
bullSNP
bullVasculitis necroacutetica granulomatosa
bullAsma bronquial y eosinofilia perifeacuterica
bullPsicosis y orientacioacuten
bullDiversa
bullTamantildeo de vasos
bullGrupo heterogeacuteneo
bullRaras
bullPrimarias o secundarias
bullPsicosis en joacutevenes
bullSNC por hipertensioacuten arterial
bull70 sx neuroloacutegicos neuropatiacutea perifeacuterica
bullVasculitis av
bullPersonalidad depresioacuten y demencia
bull20 meningitis y encefalitis aseacuteptica Arteritis y trombosis senos venosos
BehccediletPoliarteritis
nodosa
Churg-StraussSintomatologiacutea
Complicaciones psiquiaacutetricas debido al tratamiento
bull Prolongado altas dosis
bull Reversibles y moderadas al disminuir o quitar
Esteroides
bull Maniacutea hipomaniacutea
bull Labilidaddepresioacuten
bull Psicosisdelirium
bull Confusioacutendesorientacion
bull Cognitivosmemoria
Psiquiaacutetricasbull Suentildeo (dosis divididas)
bull Acatisia
bull Ancianos (riesgo)
bull Inicio (agitacioacuten euforia hipomaniacutea)
Depresioacuten despueacutes de terapia larga sobre todo en historia familiar de esta y OHMayor severidad a pocos diacuteas con dosis superiores a 20mg de prednisona10 necesidad de reduccioacuten y antipsicoacuteticosPsicosis aumenta en LES con hipoalbuminemia
Esteroides Psicosis diferenciar de glucocorticoide vs LES en altas
dosis
Bajas dosis memoria riesgo elevado ancianos
1 alteraciones cognitivas persistentes
Riesgo suicida elevado
Pseudotumor cerebri raro
Antipaluacutedicos
Cloroquina e hidroxicloroquina
Moderados y transitorios
Cefalea mareo
Raros labilidad agitacioacuten insomnio pesadillas ansiedad fatiga delirios y alucinaciones
Faacutermacos Siacutentesis de autoanticuerpos por faacutermacos
Mayor parte no desarrolla enfermedad autoinmune
Lupus inducido por faacutermacos sujetos sin historia de LES que desarrollan ab antinucleares + sintomas de LES despues de exposicioacuten adecuada a medicamento sintomas se resuelven al descontinuar
Fiebre Rash
Artritis Mialgias
SerositisHematoloacutegicasrenalesSNC
raras
An antihistonas en 95Hipocomplementenemia y ab anti-DNA son poco comunes
Medicamentos
bull Riesgo bajo
bull Clorpromazina
bull Perfenazina
bull Litio
Tratamiento
bull Descontinuar
bull Antipaluacutedicos
bull Glucocorticoides
bull Aines
Hipertiroiddismo Graveacutes AI
Causa mas comuacuten de hipertiroidismo
Oftalmopatiacutea psiquiaacutetricos
Hiperactividad del sistema adreneacutergico
Antagonistas beta adreneacutergicos y antitiroideos
Faacutermacos psicotroacutepicos Necesarios = eutiroideos
Manifestaciones psiquiaacutetricas del hipertiroidismo
Robert Graves
1835
Bocio palpitaciones disfuncioacuten nerviosa y siacutentomas oculares
Discretos trastornos psiquiaacutetricos no psicoacuteticos
SecundarioTP antes de Graveacutes
(comoacuterbido)
Hipertiroidismo y siacutentomas psiquiaacutetricos Depresioacuten
Ansiedad
Hipertiroidismo subcliacutenico (similar escalas)
The presence of antithyroid antibodies in patientswith affective and nonaffective psychiatricdisorders
John J Haggerty Jr 1 Dwight L Evans1 2 Robert N Golden1 Cort A Pedersen1 Jeffrey S Simon3 Charles B Nemeroff4
Biological Psychiatry
Volume 27 Issue 1 1 January 1990 Pages 51ndash60
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
SNC
bull Stroke
bull Corea
bull Mielitis transversa
bull Demencia progresiva
Psiquiaacutetricos
bull Cognitivos
bull Amnesia generalizada
bull Lesiones vasculares en sustancia blanca
bull Coexistir con liacutevedoreticularis
EM
bull Algunos pude haber AB AF
bull Difiacutecil diferenciar de EM lesiones
bull Sicca
bull Sx psiquiaacutetricos parecidos a EM
bull Anti-Ro
bull Ansiedad 48
bull Depresioacuten 23Sjoumlgren
bull Rara lesiones en piel tejido subcutaacuteneo u oacuterganos internos
bull Morfologiacutea de vasos (Raynaud hipertensioacuten pulmonar arterial)
bull Siacutentomas neuropsiquiaacutetricos son raros (SNP)(depresioacuten por cronicidad)
Esclerosis sisteacutemica
Vasculitis sisteacutemicas
bullSNP
bullVasculitis necroacutetica granulomatosa
bullAsma bronquial y eosinofilia perifeacuterica
bullPsicosis y orientacioacuten
bullDiversa
bullTamantildeo de vasos
bullGrupo heterogeacuteneo
bullRaras
bullPrimarias o secundarias
bullPsicosis en joacutevenes
bullSNC por hipertensioacuten arterial
bull70 sx neuroloacutegicos neuropatiacutea perifeacuterica
bullVasculitis av
bullPersonalidad depresioacuten y demencia
bull20 meningitis y encefalitis aseacuteptica Arteritis y trombosis senos venosos
BehccediletPoliarteritis
nodosa
Churg-StraussSintomatologiacutea
Complicaciones psiquiaacutetricas debido al tratamiento
bull Prolongado altas dosis
bull Reversibles y moderadas al disminuir o quitar
Esteroides
bull Maniacutea hipomaniacutea
bull Labilidaddepresioacuten
bull Psicosisdelirium
bull Confusioacutendesorientacion
bull Cognitivosmemoria
Psiquiaacutetricasbull Suentildeo (dosis divididas)
bull Acatisia
bull Ancianos (riesgo)
bull Inicio (agitacioacuten euforia hipomaniacutea)
Depresioacuten despueacutes de terapia larga sobre todo en historia familiar de esta y OHMayor severidad a pocos diacuteas con dosis superiores a 20mg de prednisona10 necesidad de reduccioacuten y antipsicoacuteticosPsicosis aumenta en LES con hipoalbuminemia
Esteroides Psicosis diferenciar de glucocorticoide vs LES en altas
dosis
Bajas dosis memoria riesgo elevado ancianos
1 alteraciones cognitivas persistentes
Riesgo suicida elevado
Pseudotumor cerebri raro
Antipaluacutedicos
Cloroquina e hidroxicloroquina
Moderados y transitorios
Cefalea mareo
Raros labilidad agitacioacuten insomnio pesadillas ansiedad fatiga delirios y alucinaciones
Faacutermacos Siacutentesis de autoanticuerpos por faacutermacos
Mayor parte no desarrolla enfermedad autoinmune
Lupus inducido por faacutermacos sujetos sin historia de LES que desarrollan ab antinucleares + sintomas de LES despues de exposicioacuten adecuada a medicamento sintomas se resuelven al descontinuar
Fiebre Rash
Artritis Mialgias
SerositisHematoloacutegicasrenalesSNC
raras
An antihistonas en 95Hipocomplementenemia y ab anti-DNA son poco comunes
Medicamentos
bull Riesgo bajo
bull Clorpromazina
bull Perfenazina
bull Litio
Tratamiento
bull Descontinuar
bull Antipaluacutedicos
bull Glucocorticoides
bull Aines
Hipertiroiddismo Graveacutes AI
Causa mas comuacuten de hipertiroidismo
Oftalmopatiacutea psiquiaacutetricos
Hiperactividad del sistema adreneacutergico
Antagonistas beta adreneacutergicos y antitiroideos
Faacutermacos psicotroacutepicos Necesarios = eutiroideos
Manifestaciones psiquiaacutetricas del hipertiroidismo
Robert Graves
1835
Bocio palpitaciones disfuncioacuten nerviosa y siacutentomas oculares
Discretos trastornos psiquiaacutetricos no psicoacuteticos
SecundarioTP antes de Graveacutes
(comoacuterbido)
Hipertiroidismo y siacutentomas psiquiaacutetricos Depresioacuten
Ansiedad
Hipertiroidismo subcliacutenico (similar escalas)
The presence of antithyroid antibodies in patientswith affective and nonaffective psychiatricdisorders
John J Haggerty Jr 1 Dwight L Evans1 2 Robert N Golden1 Cort A Pedersen1 Jeffrey S Simon3 Charles B Nemeroff4
Biological Psychiatry
Volume 27 Issue 1 1 January 1990 Pages 51ndash60
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
bull Sicca
bull Sx psiquiaacutetricos parecidos a EM
bull Anti-Ro
bull Ansiedad 48
bull Depresioacuten 23Sjoumlgren
bull Rara lesiones en piel tejido subcutaacuteneo u oacuterganos internos
bull Morfologiacutea de vasos (Raynaud hipertensioacuten pulmonar arterial)
bull Siacutentomas neuropsiquiaacutetricos son raros (SNP)(depresioacuten por cronicidad)
Esclerosis sisteacutemica
Vasculitis sisteacutemicas
bullSNP
bullVasculitis necroacutetica granulomatosa
bullAsma bronquial y eosinofilia perifeacuterica
bullPsicosis y orientacioacuten
bullDiversa
bullTamantildeo de vasos
bullGrupo heterogeacuteneo
bullRaras
bullPrimarias o secundarias
bullPsicosis en joacutevenes
bullSNC por hipertensioacuten arterial
bull70 sx neuroloacutegicos neuropatiacutea perifeacuterica
bullVasculitis av
bullPersonalidad depresioacuten y demencia
bull20 meningitis y encefalitis aseacuteptica Arteritis y trombosis senos venosos
BehccediletPoliarteritis
nodosa
Churg-StraussSintomatologiacutea
Complicaciones psiquiaacutetricas debido al tratamiento
bull Prolongado altas dosis
bull Reversibles y moderadas al disminuir o quitar
Esteroides
bull Maniacutea hipomaniacutea
bull Labilidaddepresioacuten
bull Psicosisdelirium
bull Confusioacutendesorientacion
bull Cognitivosmemoria
Psiquiaacutetricasbull Suentildeo (dosis divididas)
bull Acatisia
bull Ancianos (riesgo)
bull Inicio (agitacioacuten euforia hipomaniacutea)
Depresioacuten despueacutes de terapia larga sobre todo en historia familiar de esta y OHMayor severidad a pocos diacuteas con dosis superiores a 20mg de prednisona10 necesidad de reduccioacuten y antipsicoacuteticosPsicosis aumenta en LES con hipoalbuminemia
Esteroides Psicosis diferenciar de glucocorticoide vs LES en altas
dosis
Bajas dosis memoria riesgo elevado ancianos
1 alteraciones cognitivas persistentes
Riesgo suicida elevado
Pseudotumor cerebri raro
Antipaluacutedicos
Cloroquina e hidroxicloroquina
Moderados y transitorios
Cefalea mareo
Raros labilidad agitacioacuten insomnio pesadillas ansiedad fatiga delirios y alucinaciones
Faacutermacos Siacutentesis de autoanticuerpos por faacutermacos
Mayor parte no desarrolla enfermedad autoinmune
Lupus inducido por faacutermacos sujetos sin historia de LES que desarrollan ab antinucleares + sintomas de LES despues de exposicioacuten adecuada a medicamento sintomas se resuelven al descontinuar
Fiebre Rash
Artritis Mialgias
SerositisHematoloacutegicasrenalesSNC
raras
An antihistonas en 95Hipocomplementenemia y ab anti-DNA son poco comunes
Medicamentos
bull Riesgo bajo
bull Clorpromazina
bull Perfenazina
bull Litio
Tratamiento
bull Descontinuar
bull Antipaluacutedicos
bull Glucocorticoides
bull Aines
Hipertiroiddismo Graveacutes AI
Causa mas comuacuten de hipertiroidismo
Oftalmopatiacutea psiquiaacutetricos
Hiperactividad del sistema adreneacutergico
Antagonistas beta adreneacutergicos y antitiroideos
Faacutermacos psicotroacutepicos Necesarios = eutiroideos
Manifestaciones psiquiaacutetricas del hipertiroidismo
Robert Graves
1835
Bocio palpitaciones disfuncioacuten nerviosa y siacutentomas oculares
Discretos trastornos psiquiaacutetricos no psicoacuteticos
SecundarioTP antes de Graveacutes
(comoacuterbido)
Hipertiroidismo y siacutentomas psiquiaacutetricos Depresioacuten
Ansiedad
Hipertiroidismo subcliacutenico (similar escalas)
The presence of antithyroid antibodies in patientswith affective and nonaffective psychiatricdisorders
John J Haggerty Jr 1 Dwight L Evans1 2 Robert N Golden1 Cort A Pedersen1 Jeffrey S Simon3 Charles B Nemeroff4
Biological Psychiatry
Volume 27 Issue 1 1 January 1990 Pages 51ndash60
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
Vasculitis sisteacutemicas
bullSNP
bullVasculitis necroacutetica granulomatosa
bullAsma bronquial y eosinofilia perifeacuterica
bullPsicosis y orientacioacuten
bullDiversa
bullTamantildeo de vasos
bullGrupo heterogeacuteneo
bullRaras
bullPrimarias o secundarias
bullPsicosis en joacutevenes
bullSNC por hipertensioacuten arterial
bull70 sx neuroloacutegicos neuropatiacutea perifeacuterica
bullVasculitis av
bullPersonalidad depresioacuten y demencia
bull20 meningitis y encefalitis aseacuteptica Arteritis y trombosis senos venosos
BehccediletPoliarteritis
nodosa
Churg-StraussSintomatologiacutea
Complicaciones psiquiaacutetricas debido al tratamiento
bull Prolongado altas dosis
bull Reversibles y moderadas al disminuir o quitar
Esteroides
bull Maniacutea hipomaniacutea
bull Labilidaddepresioacuten
bull Psicosisdelirium
bull Confusioacutendesorientacion
bull Cognitivosmemoria
Psiquiaacutetricasbull Suentildeo (dosis divididas)
bull Acatisia
bull Ancianos (riesgo)
bull Inicio (agitacioacuten euforia hipomaniacutea)
Depresioacuten despueacutes de terapia larga sobre todo en historia familiar de esta y OHMayor severidad a pocos diacuteas con dosis superiores a 20mg de prednisona10 necesidad de reduccioacuten y antipsicoacuteticosPsicosis aumenta en LES con hipoalbuminemia
Esteroides Psicosis diferenciar de glucocorticoide vs LES en altas
dosis
Bajas dosis memoria riesgo elevado ancianos
1 alteraciones cognitivas persistentes
Riesgo suicida elevado
Pseudotumor cerebri raro
Antipaluacutedicos
Cloroquina e hidroxicloroquina
Moderados y transitorios
Cefalea mareo
Raros labilidad agitacioacuten insomnio pesadillas ansiedad fatiga delirios y alucinaciones
Faacutermacos Siacutentesis de autoanticuerpos por faacutermacos
Mayor parte no desarrolla enfermedad autoinmune
Lupus inducido por faacutermacos sujetos sin historia de LES que desarrollan ab antinucleares + sintomas de LES despues de exposicioacuten adecuada a medicamento sintomas se resuelven al descontinuar
Fiebre Rash
Artritis Mialgias
SerositisHematoloacutegicasrenalesSNC
raras
An antihistonas en 95Hipocomplementenemia y ab anti-DNA son poco comunes
Medicamentos
bull Riesgo bajo
bull Clorpromazina
bull Perfenazina
bull Litio
Tratamiento
bull Descontinuar
bull Antipaluacutedicos
bull Glucocorticoides
bull Aines
Hipertiroiddismo Graveacutes AI
Causa mas comuacuten de hipertiroidismo
Oftalmopatiacutea psiquiaacutetricos
Hiperactividad del sistema adreneacutergico
Antagonistas beta adreneacutergicos y antitiroideos
Faacutermacos psicotroacutepicos Necesarios = eutiroideos
Manifestaciones psiquiaacutetricas del hipertiroidismo
Robert Graves
1835
Bocio palpitaciones disfuncioacuten nerviosa y siacutentomas oculares
Discretos trastornos psiquiaacutetricos no psicoacuteticos
SecundarioTP antes de Graveacutes
(comoacuterbido)
Hipertiroidismo y siacutentomas psiquiaacutetricos Depresioacuten
Ansiedad
Hipertiroidismo subcliacutenico (similar escalas)
The presence of antithyroid antibodies in patientswith affective and nonaffective psychiatricdisorders
John J Haggerty Jr 1 Dwight L Evans1 2 Robert N Golden1 Cort A Pedersen1 Jeffrey S Simon3 Charles B Nemeroff4
Biological Psychiatry
Volume 27 Issue 1 1 January 1990 Pages 51ndash60
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
Complicaciones psiquiaacutetricas debido al tratamiento
bull Prolongado altas dosis
bull Reversibles y moderadas al disminuir o quitar
Esteroides
bull Maniacutea hipomaniacutea
bull Labilidaddepresioacuten
bull Psicosisdelirium
bull Confusioacutendesorientacion
bull Cognitivosmemoria
Psiquiaacutetricasbull Suentildeo (dosis divididas)
bull Acatisia
bull Ancianos (riesgo)
bull Inicio (agitacioacuten euforia hipomaniacutea)
Depresioacuten despueacutes de terapia larga sobre todo en historia familiar de esta y OHMayor severidad a pocos diacuteas con dosis superiores a 20mg de prednisona10 necesidad de reduccioacuten y antipsicoacuteticosPsicosis aumenta en LES con hipoalbuminemia
Esteroides Psicosis diferenciar de glucocorticoide vs LES en altas
dosis
Bajas dosis memoria riesgo elevado ancianos
1 alteraciones cognitivas persistentes
Riesgo suicida elevado
Pseudotumor cerebri raro
Antipaluacutedicos
Cloroquina e hidroxicloroquina
Moderados y transitorios
Cefalea mareo
Raros labilidad agitacioacuten insomnio pesadillas ansiedad fatiga delirios y alucinaciones
Faacutermacos Siacutentesis de autoanticuerpos por faacutermacos
Mayor parte no desarrolla enfermedad autoinmune
Lupus inducido por faacutermacos sujetos sin historia de LES que desarrollan ab antinucleares + sintomas de LES despues de exposicioacuten adecuada a medicamento sintomas se resuelven al descontinuar
Fiebre Rash
Artritis Mialgias
SerositisHematoloacutegicasrenalesSNC
raras
An antihistonas en 95Hipocomplementenemia y ab anti-DNA son poco comunes
Medicamentos
bull Riesgo bajo
bull Clorpromazina
bull Perfenazina
bull Litio
Tratamiento
bull Descontinuar
bull Antipaluacutedicos
bull Glucocorticoides
bull Aines
Hipertiroiddismo Graveacutes AI
Causa mas comuacuten de hipertiroidismo
Oftalmopatiacutea psiquiaacutetricos
Hiperactividad del sistema adreneacutergico
Antagonistas beta adreneacutergicos y antitiroideos
Faacutermacos psicotroacutepicos Necesarios = eutiroideos
Manifestaciones psiquiaacutetricas del hipertiroidismo
Robert Graves
1835
Bocio palpitaciones disfuncioacuten nerviosa y siacutentomas oculares
Discretos trastornos psiquiaacutetricos no psicoacuteticos
SecundarioTP antes de Graveacutes
(comoacuterbido)
Hipertiroidismo y siacutentomas psiquiaacutetricos Depresioacuten
Ansiedad
Hipertiroidismo subcliacutenico (similar escalas)
The presence of antithyroid antibodies in patientswith affective and nonaffective psychiatricdisorders
John J Haggerty Jr 1 Dwight L Evans1 2 Robert N Golden1 Cort A Pedersen1 Jeffrey S Simon3 Charles B Nemeroff4
Biological Psychiatry
Volume 27 Issue 1 1 January 1990 Pages 51ndash60
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
Esteroides Psicosis diferenciar de glucocorticoide vs LES en altas
dosis
Bajas dosis memoria riesgo elevado ancianos
1 alteraciones cognitivas persistentes
Riesgo suicida elevado
Pseudotumor cerebri raro
Antipaluacutedicos
Cloroquina e hidroxicloroquina
Moderados y transitorios
Cefalea mareo
Raros labilidad agitacioacuten insomnio pesadillas ansiedad fatiga delirios y alucinaciones
Faacutermacos Siacutentesis de autoanticuerpos por faacutermacos
Mayor parte no desarrolla enfermedad autoinmune
Lupus inducido por faacutermacos sujetos sin historia de LES que desarrollan ab antinucleares + sintomas de LES despues de exposicioacuten adecuada a medicamento sintomas se resuelven al descontinuar
Fiebre Rash
Artritis Mialgias
SerositisHematoloacutegicasrenalesSNC
raras
An antihistonas en 95Hipocomplementenemia y ab anti-DNA son poco comunes
Medicamentos
bull Riesgo bajo
bull Clorpromazina
bull Perfenazina
bull Litio
Tratamiento
bull Descontinuar
bull Antipaluacutedicos
bull Glucocorticoides
bull Aines
Hipertiroiddismo Graveacutes AI
Causa mas comuacuten de hipertiroidismo
Oftalmopatiacutea psiquiaacutetricos
Hiperactividad del sistema adreneacutergico
Antagonistas beta adreneacutergicos y antitiroideos
Faacutermacos psicotroacutepicos Necesarios = eutiroideos
Manifestaciones psiquiaacutetricas del hipertiroidismo
Robert Graves
1835
Bocio palpitaciones disfuncioacuten nerviosa y siacutentomas oculares
Discretos trastornos psiquiaacutetricos no psicoacuteticos
SecundarioTP antes de Graveacutes
(comoacuterbido)
Hipertiroidismo y siacutentomas psiquiaacutetricos Depresioacuten
Ansiedad
Hipertiroidismo subcliacutenico (similar escalas)
The presence of antithyroid antibodies in patientswith affective and nonaffective psychiatricdisorders
John J Haggerty Jr 1 Dwight L Evans1 2 Robert N Golden1 Cort A Pedersen1 Jeffrey S Simon3 Charles B Nemeroff4
Biological Psychiatry
Volume 27 Issue 1 1 January 1990 Pages 51ndash60
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
Antipaluacutedicos
Cloroquina e hidroxicloroquina
Moderados y transitorios
Cefalea mareo
Raros labilidad agitacioacuten insomnio pesadillas ansiedad fatiga delirios y alucinaciones
Faacutermacos Siacutentesis de autoanticuerpos por faacutermacos
Mayor parte no desarrolla enfermedad autoinmune
Lupus inducido por faacutermacos sujetos sin historia de LES que desarrollan ab antinucleares + sintomas de LES despues de exposicioacuten adecuada a medicamento sintomas se resuelven al descontinuar
Fiebre Rash
Artritis Mialgias
SerositisHematoloacutegicasrenalesSNC
raras
An antihistonas en 95Hipocomplementenemia y ab anti-DNA son poco comunes
Medicamentos
bull Riesgo bajo
bull Clorpromazina
bull Perfenazina
bull Litio
Tratamiento
bull Descontinuar
bull Antipaluacutedicos
bull Glucocorticoides
bull Aines
Hipertiroiddismo Graveacutes AI
Causa mas comuacuten de hipertiroidismo
Oftalmopatiacutea psiquiaacutetricos
Hiperactividad del sistema adreneacutergico
Antagonistas beta adreneacutergicos y antitiroideos
Faacutermacos psicotroacutepicos Necesarios = eutiroideos
Manifestaciones psiquiaacutetricas del hipertiroidismo
Robert Graves
1835
Bocio palpitaciones disfuncioacuten nerviosa y siacutentomas oculares
Discretos trastornos psiquiaacutetricos no psicoacuteticos
SecundarioTP antes de Graveacutes
(comoacuterbido)
Hipertiroidismo y siacutentomas psiquiaacutetricos Depresioacuten
Ansiedad
Hipertiroidismo subcliacutenico (similar escalas)
The presence of antithyroid antibodies in patientswith affective and nonaffective psychiatricdisorders
John J Haggerty Jr 1 Dwight L Evans1 2 Robert N Golden1 Cort A Pedersen1 Jeffrey S Simon3 Charles B Nemeroff4
Biological Psychiatry
Volume 27 Issue 1 1 January 1990 Pages 51ndash60
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
Faacutermacos Siacutentesis de autoanticuerpos por faacutermacos
Mayor parte no desarrolla enfermedad autoinmune
Lupus inducido por faacutermacos sujetos sin historia de LES que desarrollan ab antinucleares + sintomas de LES despues de exposicioacuten adecuada a medicamento sintomas se resuelven al descontinuar
Fiebre Rash
Artritis Mialgias
SerositisHematoloacutegicasrenalesSNC
raras
An antihistonas en 95Hipocomplementenemia y ab anti-DNA son poco comunes
Medicamentos
bull Riesgo bajo
bull Clorpromazina
bull Perfenazina
bull Litio
Tratamiento
bull Descontinuar
bull Antipaluacutedicos
bull Glucocorticoides
bull Aines
Hipertiroiddismo Graveacutes AI
Causa mas comuacuten de hipertiroidismo
Oftalmopatiacutea psiquiaacutetricos
Hiperactividad del sistema adreneacutergico
Antagonistas beta adreneacutergicos y antitiroideos
Faacutermacos psicotroacutepicos Necesarios = eutiroideos
Manifestaciones psiquiaacutetricas del hipertiroidismo
Robert Graves
1835
Bocio palpitaciones disfuncioacuten nerviosa y siacutentomas oculares
Discretos trastornos psiquiaacutetricos no psicoacuteticos
SecundarioTP antes de Graveacutes
(comoacuterbido)
Hipertiroidismo y siacutentomas psiquiaacutetricos Depresioacuten
Ansiedad
Hipertiroidismo subcliacutenico (similar escalas)
The presence of antithyroid antibodies in patientswith affective and nonaffective psychiatricdisorders
John J Haggerty Jr 1 Dwight L Evans1 2 Robert N Golden1 Cort A Pedersen1 Jeffrey S Simon3 Charles B Nemeroff4
Biological Psychiatry
Volume 27 Issue 1 1 January 1990 Pages 51ndash60
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
Fiebre Rash
Artritis Mialgias
SerositisHematoloacutegicasrenalesSNC
raras
An antihistonas en 95Hipocomplementenemia y ab anti-DNA son poco comunes
Medicamentos
bull Riesgo bajo
bull Clorpromazina
bull Perfenazina
bull Litio
Tratamiento
bull Descontinuar
bull Antipaluacutedicos
bull Glucocorticoides
bull Aines
Hipertiroiddismo Graveacutes AI
Causa mas comuacuten de hipertiroidismo
Oftalmopatiacutea psiquiaacutetricos
Hiperactividad del sistema adreneacutergico
Antagonistas beta adreneacutergicos y antitiroideos
Faacutermacos psicotroacutepicos Necesarios = eutiroideos
Manifestaciones psiquiaacutetricas del hipertiroidismo
Robert Graves
1835
Bocio palpitaciones disfuncioacuten nerviosa y siacutentomas oculares
Discretos trastornos psiquiaacutetricos no psicoacuteticos
SecundarioTP antes de Graveacutes
(comoacuterbido)
Hipertiroidismo y siacutentomas psiquiaacutetricos Depresioacuten
Ansiedad
Hipertiroidismo subcliacutenico (similar escalas)
The presence of antithyroid antibodies in patientswith affective and nonaffective psychiatricdisorders
John J Haggerty Jr 1 Dwight L Evans1 2 Robert N Golden1 Cort A Pedersen1 Jeffrey S Simon3 Charles B Nemeroff4
Biological Psychiatry
Volume 27 Issue 1 1 January 1990 Pages 51ndash60
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
Medicamentos
bull Riesgo bajo
bull Clorpromazina
bull Perfenazina
bull Litio
Tratamiento
bull Descontinuar
bull Antipaluacutedicos
bull Glucocorticoides
bull Aines
Hipertiroiddismo Graveacutes AI
Causa mas comuacuten de hipertiroidismo
Oftalmopatiacutea psiquiaacutetricos
Hiperactividad del sistema adreneacutergico
Antagonistas beta adreneacutergicos y antitiroideos
Faacutermacos psicotroacutepicos Necesarios = eutiroideos
Manifestaciones psiquiaacutetricas del hipertiroidismo
Robert Graves
1835
Bocio palpitaciones disfuncioacuten nerviosa y siacutentomas oculares
Discretos trastornos psiquiaacutetricos no psicoacuteticos
SecundarioTP antes de Graveacutes
(comoacuterbido)
Hipertiroidismo y siacutentomas psiquiaacutetricos Depresioacuten
Ansiedad
Hipertiroidismo subcliacutenico (similar escalas)
The presence of antithyroid antibodies in patientswith affective and nonaffective psychiatricdisorders
John J Haggerty Jr 1 Dwight L Evans1 2 Robert N Golden1 Cort A Pedersen1 Jeffrey S Simon3 Charles B Nemeroff4
Biological Psychiatry
Volume 27 Issue 1 1 January 1990 Pages 51ndash60
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
Hipertiroiddismo Graveacutes AI
Causa mas comuacuten de hipertiroidismo
Oftalmopatiacutea psiquiaacutetricos
Hiperactividad del sistema adreneacutergico
Antagonistas beta adreneacutergicos y antitiroideos
Faacutermacos psicotroacutepicos Necesarios = eutiroideos
Manifestaciones psiquiaacutetricas del hipertiroidismo
Robert Graves
1835
Bocio palpitaciones disfuncioacuten nerviosa y siacutentomas oculares
Discretos trastornos psiquiaacutetricos no psicoacuteticos
SecundarioTP antes de Graveacutes
(comoacuterbido)
Hipertiroidismo y siacutentomas psiquiaacutetricos Depresioacuten
Ansiedad
Hipertiroidismo subcliacutenico (similar escalas)
The presence of antithyroid antibodies in patientswith affective and nonaffective psychiatricdisorders
John J Haggerty Jr 1 Dwight L Evans1 2 Robert N Golden1 Cort A Pedersen1 Jeffrey S Simon3 Charles B Nemeroff4
Biological Psychiatry
Volume 27 Issue 1 1 January 1990 Pages 51ndash60
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
Manifestaciones psiquiaacutetricas del hipertiroidismo
Robert Graves
1835
Bocio palpitaciones disfuncioacuten nerviosa y siacutentomas oculares
Discretos trastornos psiquiaacutetricos no psicoacuteticos
SecundarioTP antes de Graveacutes
(comoacuterbido)
Hipertiroidismo y siacutentomas psiquiaacutetricos Depresioacuten
Ansiedad
Hipertiroidismo subcliacutenico (similar escalas)
The presence of antithyroid antibodies in patientswith affective and nonaffective psychiatricdisorders
John J Haggerty Jr 1 Dwight L Evans1 2 Robert N Golden1 Cort A Pedersen1 Jeffrey S Simon3 Charles B Nemeroff4
Biological Psychiatry
Volume 27 Issue 1 1 January 1990 Pages 51ndash60
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
Hipertiroidismo y siacutentomas psiquiaacutetricos Depresioacuten
Ansiedad
Hipertiroidismo subcliacutenico (similar escalas)
The presence of antithyroid antibodies in patientswith affective and nonaffective psychiatricdisorders
John J Haggerty Jr 1 Dwight L Evans1 2 Robert N Golden1 Cort A Pedersen1 Jeffrey S Simon3 Charles B Nemeroff4
Biological Psychiatry
Volume 27 Issue 1 1 January 1990 Pages 51ndash60
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
The presence of antithyroid antibodies in patientswith affective and nonaffective psychiatricdisorders
John J Haggerty Jr 1 Dwight L Evans1 2 Robert N Golden1 Cort A Pedersen1 Jeffrey S Simon3 Charles B Nemeroff4
Biological Psychiatry
Volume 27 Issue 1 1 January 1990 Pages 51ndash60
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
Abstract We determined the frequency of antihyroglobulin and antimicrosomal
antibodies in 173 consecutively admitted psychiatric inpatients (We found antihydroid antibodies in 8 (565) of patients with DSM-III major depression 13 (431) with bipolar disorder and in 0 (04) of those with schizoaffective disorder) The rate of antibody occurrence was unrelated to lithium exposure either within individual diagnostic categories or for the sample as a whole The overall frequency of positive antihydroid antibody titers in patients with DSM-III affective disorder 9 (999) did not differ from that in patients with nonaffective disorders 10 (768) However patients with bipolar affective disorder-mixed or bipolar affective disorder-depressed had a higher rate of positive antithyroid antibody titers than other patients Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder even in the absence of lithium exposure However as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
disordersMuumlller N Ackenheil M
1 Parallel to the current rapid development of new immunological methods immune mechanisms are gaining more importance for our understanding of psychiatric disorders The purpose of this article is to review basic and clinical investigations that elucidate the relationship between the CNS and the immune system 2 The topical literature dealing with the interactions of immune system neurotransmitters psychological processes and psychiatric disorders especially in relation to cytokines is reviewed 3 An activation of the immune system in schizophrenia and depressive disorders has repeatedly been described Cytokines actively transported into the CNS play a key role in this immune activation It was recently observed that cytokines activate astrocytes and microglia cells which in turn produce cytokines by a feedback mechanism Moreover they strongly influence the dopaminergic noradrenergic and serotonergic neurotransmission 4 There are indications that the cascade of cytokines can be activated by neuronal processes These findings close a theoretical gap between stress and its influence on immunity Psychomotor sickness behavior and sleep are related to IL-1 disturbances of memory and cognitive impairment are to IL-2 in part also to TNF-alpha The hypersecretion of IL-2 is assumed to have a prominent influence on schizophrenia and IL-6 on depressive disorders 5 Although single cytokines most likely do not have a specificity for certain psychiatric disorders a characteristic pattern of cytokine actions in the CNS including influences of the cytokines on the blood-brain barrier seems to play a role in psychiatric disorders This may have therapeutic implications for the future
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
Volume 51 Issue 4 15 February 2002 Pages 305ndash311
Abstract Background We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and
thyroid failure in outpatients with bipolar disorder compared with two control groups Methods The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226) a
population control group (n = 252) and psychiatric inpatients of any diagnosis (n = 3190) were measured Thyroid failure was defined as a raised thyroid stimulating hormone level previously diagnosed hypothyroidism or both Subjects were compared with attention to age gender and exposure to lithium
Results The TPO-Abs were more prevalent in bipolar patients (28) than population and psychiatric controls (3ndash18) The presence of TPO-Abs in bipolar patients was associated with thyroid failure but not with age gender mood state rapid cycling or lithium exposure Thyroid failure was present in 17 of bipolar patients and more prevalent in women It was associated with lithium exposure especially in the presence of TPO-Abs but not with current rapid cycling although an association may have been masked by thyroid hormone replacement
Conclusions Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment These variables appear to be independent risk factors for the development of hypothyroidism especially in women with bipolar disorder
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
nelli Aa middot Fiore Eb middot Chiovato Lb middot Perugi Ga middotMarazziti Da
Abstract Several studies have underlined the high prevalence of psychiatric
symptoms and disorders in thyroid diseases The aim of this study was to evaluate the prevalence of psychiatric disorders in 93 inpatients affected by different thyroid diseases during their lifetimes by means of a standardized instrument ie the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised Upjohn Version (SCID-UP-R) The results showed higher rates of panic disorder simple phobia obsessive-compulsive disorder major depressive disorder bipolar disorder and cyclothymia in thyroid patients than in the general population These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities
Neuropsychobiology 199838222ndash225
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65
with bipolar disorderRoos C Padmosa
Background In a previous study we reported an increased prevalence of thyroperoxidase antibodies (TPOA) in
patients with bipolar disorder Here we report the prevalence of other organ-specific autoantibodies HK adenosine triphosphatase (ATPA) glutamic acid decarboxylase-65 (GAD65A) and GAD-67 (GAD67A)
Methods ATPA GAD65A and GAD67A were determined (via a commercially available enzyme linked
immunosorbent assay for ATPA and a standardized radio immunoassays for GAD65A and GAD67A)in the sera of 239 patients with DSM-IV bipolar disorder in 74 patients with DSM-IV schizophrenia and in 220 healthy control subjects
Results The positivity prevalences for ATPA and GAD65A (but not GAD67A) were elevated in bipolar patients
compared with those in healthy control subjects (117 vs 61 and 113 vs 26 respectively p lt05) Schizophrenia patients did not show such statistically higher prevalence The elevated prevalence of ATPA and GAD65A in bipolar disorder was associated with neither rapid cycling nor the use of lithium Interestingly the presence of GAD65A (and not that of TPOA and ATPA) tended to be associated with the activity of bipolar disorder The level of TPOA was negatively correlated with the serum level of sIL-2R a measure of T cell activation
Conclusion Bipolar disorder is associated with organ-specific autoimmunity to the antigens TPO HK ATPase
and GAD65