Neuropsychiatric Syndromes Research Articles

First Diagnosis of Systemic Lupus Erythematosus in Hospitalized Patients: Clinical Phenotypes and Pitfalls for the Non-Specialist

BackgroundPrompt recognition of systemic lupus erythematosus (SLE) in hospitalized patients presenting with severe disease is essential to initiate treatment. We sought to characterize the phenotype of hospitalized patients with new-onset SLE and estimate potential diagnostic delays. MethodsAn observational study of 855 patients (“Attikon” SLE cohort). Clinical phenotype was categorized according to the leading manifestation that led to hospitalization. Disease features, time to diagnosis, classification criteria, and the SLE Risk Probability Index (SLERPI) were recorded for each patient. ResultsThere were 191 patients (22.3% of the total cohort) hospitalized due to manifestations eventually attributed to SLE. Main causes of admission were neuropsychiatric syndromes (21.4%), cytopenias (17.8%), nephritis (17.2%), and thrombotic events (16.2%). Although 79.5% of patients were diagnosed within 3 months from hospitalization, in 39 patients diagnosis was delayed, particularly in those with hematological manifestations. At hospitalization, a SLERPI >7 (indicating high probability for SLE) was found in 87.4% of patients. Patients missed by the SLERPI had fever, thrombotic or neuropsychiatric manifestations not included in the algorithm. Lowering the SLERPI threshold to 5 in patients with fever or thrombotic events increased the diagnostic rate from 88.8% to 97.9% in this subgroup, while inclusion of all neuropsychiatric events yielded no additional diagnostic value. ConclusionOne in five patients with new-onset SLE manifest disease presentations required hospitalization. Although early diagnosis was achieved in the majority of cases, in approximately 20%, diagnosis was delayed. A lower SLERPI cut-off (≥5) in patients with fever or thrombosis could enhance early diagnosis.

Long COVID and mental health.

Long COVID and mental health.

A Case Report of Non-Reactive Psychosis in a COVID-19 Patient

Background: COVID-19 causes reactive psychiatric symptoms like anxiety, depression, insomnia etc besides significant inflammatory response. A number of COVID-19 patients are found to present with complex neuropsychiatric syndromes, including the first onset of psychosis, that seem to be directly related to brain damage in the context of COVID-19. Most cases of psychotic disorder in COVID-19 patients are being found in individuals with no personal or family history of mental illness. Case Description: A 33-year-old man presented with acute restlessness, agitation, wandering, vandalizing things, suspiciousness, hallucinatory behaviour, decreased sleep for 3 days duration. There was no past history or family history of any psychiatric illness. There was a history of mild grade fever 7 days before the onset of the psychotic symptoms. The patient was uncooperative, irritable, and had hallucinatory behaviour. Rapid Antigen Test (RAT) was positive. The patient responded to injectable antipsychotic haloperidol which was later changed to Tab Olanzepine 5 mg. The patient developed no COVID symptoms and no psychotic symptoms were seen further. Conclusion: There is a possibility of a psychosis break as a COVID-19 clinical presentation, suggesting potential participation of inflammatory and autoimmunologic phenomena triggered as a response to the coronavirus infection.

Pattern and prevalence of neuropsychiatric lupus: a retrospective study from a tertiary level hospital in Bangladesh

BackgroundNeuropsychiatric systemic lupus erythematosus (NPSLE) is well known for its varying presentations and poor outcomes, but little is evident about its distribution and characteristics among the Bangladeshi population. This study aimed to assess the pattern and prevalence of neuropsychiatric symptoms in female systemic lupus erythematosus (SLE) patients of Bangladesh. A retrospective study was conducted at a tertiary care hospital in Dhaka, Bangladesh, between January and December 2018. One hundred female SLE patients were included in the study purposively. Data were collected on sociodemographic and clinical characteristics of diagnosed SLE cases visiting the SLE clinic and indoor medicine department. Neuropsychiatric (NP) syndromes were defined according to the widely accepted American College of Rheumatology (ACR) nomenclature and case definitions.ResultsA total of 244 NP events were identified in fifty-five patients. Headache was the most frequent symptom (55%), followed by cognitive dysfunction (50%), anxiety (49%), psychosis (43%), seizure (23%), depression (17%), and cerebrovascular disease (ischemic type, 7%). The NP manifestations were more prevalent among urban residents (58.2%), younger patients (41.8%), and patients with graduate-level education (34.5%). Besides, young age at diagnosis (p = 0.038), Raynaud’s phenomenon (p = 0.015), other organ involvement (p < 0.001), and time of NPSLE development (p < 0.001) were found to be significantly associated with the development of these manifestations.ConclusionNP damage is prevalent among Bangladeshi female SLE patients (55%) with headache and cognitive dysfunction being the most common symptoms. Routine screening for neuropsychiatric symptoms among suspected SLE cases and further evaluation with a larger population are warranted.

Prevalence and Clinical Correlates of Comorbid Anxiety and Panic Disorders in Patients with Parkinson's Disease.

Mood and anxiety disorders are the most common neuropsychiatric syndromes associated with Parkinson’s disease (PD). The aim of our study was to estimate the prevalence of lifetime and current anxiety disorders in patients with Parkinson’s Disease (PD), to explore possible distinctive neurological and psychiatric features associated with such comorbidity. One hundred patients were consecutively recruited at the Movement Disorders Section of the Neurological Outpatient Clinic of the University of Pisa. According to the MINI-Plus 5.0.0, 41 subjects were diagnosed with lifetime anxiety disorder (22 with panic disorder) and 26 were diagnosed with current anxiety disorders. Patients with anxiety disorders were more frequently characterized by psychiatric symptoms preceding PD, lifetime major depression and antidepressant treatments. They showed more anxious temperamental traits and scored higher at Parkinson Anxiety Scale (PAS) and persistent anxiety subscale. Current anxiety disorders were associated with more severe psychopathology, depressive symptomatology, and avoidant behavior. Among anxiety subtypes, patients with lifetime panic disorder showed higher rates of psychiatric symptoms before PD, lifetime unipolar depression, current psychiatric treatment, and a more severe psychopathology. Given the overall high impact of anxiety on patients’ quality of life, clinicians should not underestimate the extent of different anxiety dimensions in PD.

A Case of Hypolipidemia and Hypocholesterolemia; Cause and Consequences

Background: Hypolipidemia and hypocholesterolemia are uncommon and because of the established risk of hypercholesterolemia for cardiovascular disease, reduced lipids and total cholesterol levels are often clinically desired and/or deemed clinically inconsequential. A finding of persistently low lipid levels and total cholesterol may however not be innocuous nor desirable. We describe the case of a 46 yr old man with persistently low total cholesterol levels <70mg/dl and the associated complications and comorbidities identified. Clinical Case: A 46 yr old Hispanic man with non-alcoholic fatty liver disease (NAFLD) was referred for evaluation of hyperhidrosis in the setting of persistent hypolipidemia and hypocholesterolemia. Review of the patient’s clinical and biochemical history showed persistently low total cholesterol (mean 58mg/dl), hypotriglyceridemia, and low LDL-C (mean 13.4mg/dl) over the prior 7 yrs in addition to undetectable serum lipoprotein A. Evaluation for secondary causes of hypolipidemia, such as multiple myeloma, was unremarkable. He was found to have low carotene, borderline vitamin A and low vitamin E levels while the rest of his serum fat-soluble vitamins were normal. His mother who had presumed Alzheimer’s dementia also had a history of very low cholesterol levels. The degree and persistence of his hypolipidemia and hypocholesterolemia raised the possibility of a genetic etiology of his hypolipidemia. Genetic testing confirmed that the patient was heterozygous for a pathogenic variant in the APOB gene, consistent with familial hypobetalipoproteinemia (FHBL) which is autosomal recessive linked. Subsequent close review of his clinical history revealed other potential complications and comorbidities of FHBL including NAFLD with prediabetes, hypogonadism, progressive cognitive and memory decline, peripheral neuropathy and multiple neuropsychiatric syndromes including adult ADHD, borderline personality disorder, bipolar disorder and chronic anxiety. He is presently on vitamin E and A supplementation and being followed by neurology and psychiatry in addition to ongoing endocrine and metabolic clinical surveillance. In addition, in view of his maternal history and several biologic children he has undergone formal genetic and family counselling. Conclusions: While lipid panels are ubiquitous in clinical care, clinicians need to be vigilant in settings of severe persistent hypolipidemia and/or hypocholesterolemia to evaluate for possible genetic basis for this and to also screen for possible associated complications and comorbidities.

Different phenotypes of neuropsychiatric systemic lupus erythematosus are related to a distinct pattern of structural changes on brain MRI

ObjectivesThe underlying structural brain correlates of neuropsychiatric involvement in systemic lupus erythematosus (NPSLE) remain unclear, thus hindering correct diagnosis.We compared brain tissue volumes between a clinically well-defined cohort of patients with NPSLE and SLE patients with neuropsychiatric syndromes not attributed to SLE (non-NPSLE). Within the NPSLE patients, we also examined differences between patients with two distinct disease phenotypes: ischemic and inflammatory.MethodsIn this prospective (May 2007 to April 2015) cohort study, we included 38 NPSLE patients (26 inflammatory and 12 ischemic) and 117 non-NPSLE patients. All patients underwent a 3-T brain MRI scan that was used to automatically determine white matter, grey matter, white matter hyperintensities (WMH) and total brain volumes. Group differences in brain tissue volumes were studied with linear regression analyses corrected for age, gender, and total intracranial volume and expressed as B values and 95% confidence intervals.ResultsNPSLE patients showed higher WMH volume compared to non-NPSLE patients (p = 0.004). NPSLE inflammatory patients showed lower total brain (p = 0.014) and white matter volumes (p = 0.020), and higher WMH volume (p = 0.002) compared to non-NPSLE patients. Additionally, NPSLE inflammatory patients showed lower white matter (p = 0.020) and total brain volumes (p = 0.038) compared to NPSLE ischemic patients.ConclusionWe showed that different phenotypes of NPSLE were related to distinct patterns of underlying structural brain MRI changes. Especially the inflammatory phenotype of NPSLE was associated with the most pronounced brain volume changes, which might facilitate the diagnostic process in SLE patients with neuropsychiatric symptoms.Key Points• Neuropsychiatric systemic lupus erythematosus (NPSLE) patients showed a higher WMH volume compared to SLE patients with neuropsychiatric syndromes not attributed to SLE (non-NPSLE).• NPSLE patients with inflammatory phenotype showed a lower total brain and white matter volume, and a higher volume of white matter hyperintensities, compared to non-NPSLE patients.• NPSLE patients with inflammatory phenotype showed lower white matter and total brain volumes compared to NPSLE patients with ischemic phenotype.

Elevated Monocyte Chemoattractant Protein-1 as the Independent Risk Factor of Delirium after Cardiac Surgery. A Prospective Cohort Study.

Background: The pathogenesis of postoperative delirium is largely unknown. The primary objective of this study is to assess whether increased levels of monocyte chemoattractant protein-1 (MCP-1) and high-sensitivity C-reactive protein (hsCRP) are associated with postoperative delirium in patients who have undergone cardiac surgery. The secondary objective is to investigate whether any association between raised inflammatory biomarkers levels and delirium is related to surgical and anesthetic procedures or mediated by pre-existing psychiatric conditions associated with raised pro-inflammatory markers levels. Methods: The patients were screened for cognitive impairment one day preoperatively with the use of the Mini-Mental State Examination Test and the Clock Drawing Test. A diagnosis of major depressive disorder (MDD) and anxiety disorders was established on the basis of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. Blood samples were collected pre- and postoperatively for hsCRP and chemokine levels. Results: Postoperative delirium developed in 34% (61 of 177) of patients. Both pre- and postoperative hsCRP, and preoperative MCP-1 levels were associated with postoperative delirium in univariate comparisons; p = 0.001; p < 0.001; p < 0.001, respectively. However, according to a multivariable logistic regression analysis, only a raised MCP-1 concentration before surgery was independently associated with postoperative delirium, and related to advancing age, preoperative anxiety disorders and prolonged intubation. Conclusions: The present study suggests that an elevated preoperative MCP-1 concentration is associated with delirium after cardiac surgery. Monitoring of this inflammatory marker may reveal the cardiovascular disease (CVD) patients who are at risk of neuropsychiatric syndromes development.

Prevalence of psychiatric diagnosis and related psychopathological symptoms among patients with COVID-19 during the second wave of the pandemic

BackgroundThe possibility of psychopathological symptoms and related risk factors among normal persons and patients infected during the outbreak of COVID-19 has been widely investigated. The mental health outcomes of the second wave of the pandemic remain unclear, especially those of patients with an infection. Thus, this study aims to explore the prevalence of and related risk factors associated with psychopathological symptoms among patients infected with COVID-19 during the second wave.MethodA cross-sectional survey was conducted in five isolated wards of a designated hospital in Beijing, China, from July 1 to July 15, 2020. The Mini International Neuropsychiatric Interview (MINI) was conducted to assess psychiatric disorders, and a series of scales were used to measure self-reported psychopathological symptoms and psychosomatic factors. Multivariate regression analysis was used to analyze the risk factors associated with psychopathological symptoms.ResultsAmong 119 participants with infections, the prevalence of generalized anxiety symptoms (51.3%), depressive symptoms (41.2%), and posttraumatic stress symptoms (PTSS)/posttraumatic stress disorder (PTSD) symptoms (33.6%) was observed. Loneliness, hope, coping strategies, and history of mental disorders were the shared risk or protective factors across several psychopathological symptoms. The perceived impact of COVID-19 is the specific risk factor associated with state anxiety symptoms.ConclusionsThe prevalence of symptoms of depression, anxiety, and PTSS/PTSD is high among patients with infections during the second wave of the pandemic in Beijing. Clinical doctors must realize that these patients will probably experience depressive disorder, anxiety disorders, and PTSS/PTSD, as well as some neuropsychiatric syndromes. Specific mental health care is urgently required to help patients manage the virus during the second wave of the pandemic.

Psychosis as a symptom of Vitamin B12 deficiency. Report of one case

IntroductionVitamin B12 deficiency may cause neurological and psychiatric symptoms, especially among elderly patients. Two clinical cases are presented of patients admitted to an Acute Inpatient Psychiatry Unit due to psychotic symptoms, being reported a B12 deficiency.ObjectivesReview clinical information about vitamin B12 deficiency as a factor involved in the development of psychiatric disorders, specifically psychotic symptoms, pointing out the peculiarities regarding clinical presentation, diagnosis, prognosis, and treatment management.MethodsSearch in the medical database PUBMED, MEDSCAPE and UPTODATE.ResultsVitamin B12 deficiency is associated with hematological, neuropsychiatric, and digestive disorders, is estimated that around 5-40% of the elderly population may present it. Neuropsychiatric syndromes may be the first, and sometimes sole, manifestation, related to a different etiological mechanism. Vitamine B12 deficiency implies enzymatic defects that cause an accumulation of methylmalonic acid and homocysteine, which is proportionally related to the severity of the neuropsychiatric symptoms. The range of clinical features includes psychotic and affective episodes, behavioral disorders, cognitive impairment, along with other neurological manifestations such as polyneuropathy and encephalopathy. The diagnosis delay is crucially important, as early detection could lead to reverse the neuropsychiatric symptoms and some of the neuroradiological alterations. Parenteral and oral vitamin B12 supplementation should be initiated, monitoring levels in plasma, together with psychiatric drugs until the symptoms are controlled.ConclusionsVitamin B12 deficiency is a factor that may be involved in the etiopathogenesis of psychiatric disorders. Thus, screening must be considered among the vulnerable population when presenting neuropsychiatric disorders as early diagnosis and treatment are key to clinical prognosis.

Neuropsychiatric complications of traumatic brain injury

IntroductionTraumatic brain injury (TBI) is a leading cause of morbidity and mortality, giving rise to a variety of neuropsychiatric syndromes associated with great functional impairments, chronic disability and poor quality of life. Depending on diagnostic criteria, 20-90% of victims of TBI develop at least one neuropsychiatric manifestation in the first month, and about 40% present at least three symptoms during three months, with higher incidence in females. Survivors of TBI are at increased risk for development of severe, long-term psychiatric disorders. The aetiology of these disturbances remains unclear.ObjectivesTo review current knowledge on the neuropsychiatric consequences associated with TBI.MethodsNon-systematic review of literature through search on PubMed/MEDLINE database for publications up to 2020, following the terms “traumatic brain injury” and “neuropsychiatry”.ResultsAlthough the experience of neuropsychiatric symptoms may be temporary and may resolve in the acute period, many patients with TBI can experience psychopathology that is persistent or that develops in the post-acute period, regardless of injury severity. These symptoms can involve personality changes, psychosis, major depression, generalized anxiety disorder, post-traumatic stress disorder, maladaptive social behaviours, poor disability adjustment, reduced coping skills and cognitive impairment. Evidence remains insufficient to conclude the role of TBI-related neuropathological consequences in the development of post-TBI neuropsychiatric disorder. Non-organic factors are also implicated in its generation and maintenance.ConclusionsNeuropsychiatric sequelae are common following TBI. Several of these syndromes are amenable to treatment. Further investigations are required to better understand the mechanistic aetiology of these conditions and the effectiveness of therapeutic modalities.

Protocolo de manejo clínico del síndrome confusional en el lupus eritematoso sistémico

Acute confusional syndrome (ACS) is one of the 19 neuropsychiatric syndromes associated with systemic lupus erythematosus (SLE). It consists of impaired level of consciousness and attention, ranging from mild disturbance to coma. The prevalence of this manifestation in patients with SLE is 1.8% to 4.7%. When a case of ACS in a patient with SLE presents, it is often difficult to differentiate whether the aetiology is CNS involvement secondary to lupus activity or other causes. The differential diagnosis is very broad and includes infections, metabolic disorders, disorders secondary to drugs (especially glucocorticoids) and vascular disorders. The treatment of choice is a combination of glucocorticoids and an immunosuppressant, with cyclophosphamide being the most used drug.

Impulse Control Disorders in Parkinson's Disease: From Bench to Bedside.

Parkinson’s disease (PD) is a neurodegenerative disorder that is characterized by symptoms that impact both motor and non-motor domains. Outside of motor impairments, PD patients are at risk for impulse control disorders (ICDs), which include excessively disabling impulsive and compulsive behaviors. ICD symptoms in PD (PD + ICD) can be broadly conceptualized as a synergistic interaction between dopamine agonist therapy and the many molecular and circuit-level changes intrinsic to PD. Aside from discontinuing dopamine agonist treatment, there remains a lack of consensus on how to best address ICD symptoms in PD. In this review, we explore recent advances in the molecular and neuroanatomical mechanisms underlying ICD symptoms in PD by summarizing a rapidly accumulating body of clinical and preclinical studies, with a special focus on the utility of rodent models in gaining new insights into the neurochemical basis of PD + ICD. We also discuss the relevance of these findings to the broader problem of impulsive and compulsive behaviors that impact a range of neuropsychiatric syndromes.

High-dose thiamine strategy in Wernicke-Korsakoff syndrome and related thiamine deficiency conditions associated with alcohol use disorder.

Thiamine is essential for the activity of several enzymes associated with energy metabolism in humans. Chronic alcohol use is associated with deficiency of thiamine along with other vitamins through several mechanisms. Several neuropsychiatric syndromes have been associated with thiamine deficiency in the context of alcohol use disorder including Wernicke–Korsakoff syndrome, alcoholic cerebellar syndrome, alcoholic peripheral neuropathy, and possibly, Marchiafava–Bignami syndrome. High-dose thiamine replacement is suggested for these neuropsychiatric syndromes.

Cognitive Behavioral Therapy for Anxiety in Parkinson's Disease: A Randomized Controlled Trial.

ABSTRACTBackgroundAnxiety disorders are among the most prevalent and disabling neuropsychiatric syndromes in patients with Parkinsonʼs disease (PD), but no randomized controlled treatment trials of anxiety have been published to date.ObjectiveThe aim of this study was to assess the effectiveness of cognitive behavioral therapy (CBT) in the treatment of anxiety in patients with PD.MethodsForty‐eight patients with PD with anxiety were randomized 1:1 between CBT and clinical monitoring only (CMO). The CBT program was developed to specifically address anxiety symptoms in PD and consisted of 10 weekly sessions. Assessments were conducted by blinded assessors at baseline, at the end of the intervention, after 3 months, and after 6 months (CBT group only). Main outcome measures were the Hamilton Anxiety Rating Scale (HARS) and the Parkinson Anxiety Scale (PAS).ResultsBoth the CBT and CMO groups showed clinically relevant improvement. Although there was no between‐group difference in outcome on the Hamilton Anxiety Rating Scale (6.7‐point reduction in the CBT group versus 3.9‐point reduction in the CMO group; P = 0.15), there was both a statistically significant and a clinically relevant between‐group difference on the total PAS in favor of CBT (9.9‐point reduction in the CBT group versus 5.2‐point reduction in the CMO group; P = 0.012), which was due to improvement on the PAS subscales for episodic (situational) anxiety and avoidance behavior. This greater improvement was maintained at 3‐ and 6‐month follow‐ups.ConclusionCBT is an effective treatment for anxiety in patients with PD and reduces situational and social anxiety, as well as avoidance behavior. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society

Streptococcus and Tics

Tourette syndrome (TS) is a neurodevelopmental condition characterized by multiple tics. Tics are the most common hyperkinetic manifestations in youth, often causing physical discomfort, emotional distress, social difficulties, and interference with education and desired activities. It has been established that tic severity does not remain constant, but fluctuates over time in a typical waxing and waning pattern. Moreover, patients with TS frequently present with challenging neuropsychiatric comorbidities, most notably obsessive-compulsive disorder (OCD) and attention-deficit/hyperactivity disorder (ADHD).1 Despite its epidemiologic relevance and its potential effect on patients' health-related quality of life, there are still several crucial known unknowns about TS. Specifically, the clinical management of TS continues to be difficult, as the genetics, neurophysiology, and neuropathology of this disorder are largely unknown.2 As in most neuropsychiatric conditions, it is thought that both genetic and environmental factors are likely to play a role as etiologic mechanisms: the commonly agreed view is that “the genes load the gun and the environment pulls the trigger.” Among the environmental factors, prenatal and perinatal difficulties, as well as hormonal and immunologic contributions, have emerged as promising candidates. Over the past 2 decades, group A Streptococcus (GAS) has been investigated as a possible environmental agent associated with tic disorders. Isolated clinical observations, interpreted in the light of the established motor presentation of Sydenham chorea, have suggested the inclusion of tic disorders as a collateral feature within a group of conditions called pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS).3 PANDAS are currently incorporated in the broader concept of pediatric acute neuropsychiatric syndromes.4 The link between Streptococcus and tics is the subject of intense debate, as a few longitudinal clinical studies including mixed populations of PANDAS and chronic tic disorders found that tic exacerbations were unrelated to GAS infection in the majority of cases.5,6 Interestingly, the results of a case–control study of a large primary care database also led to arguing against this association.7

Treatment of functional neurological disorder: current state, future directions, and a research agenda.

Functional neurological disorder (FND) encompasses a complex and heterogeneous group of neuropsychiatric syndromes commonly encountered in clinical practice. Patients with FND may present with a myriad of neurological symptoms and frequently have comorbid medical, neurological, and psychiatric disorders. Over the past decade, important advances have been made in understanding the pathophysiology of FND within a biopsychosocial framework. Many challenges remain in addressing the stigma associated with this diagnosis, refining diagnostic criteria, and providing access to evidence-based treatments. This paper outlines FND treatment approaches, emphasizing the importance of respectful communication and comprehensive explanation of the diagnosis to patients, as critical first step to enhance engagement, adherence, self-agency, and treatment outcomes. We then focus on a brief review of evidence-based treatments for psychogenic non-epileptic seizures and functional movement disorder, a guide for designing future treatment trials for FND, and a proposal for a treatment research agenda, in order to aid in advancing the field to develop and implement treatments for patients with FND.

The psychiatric and neuropsychiatric repercussions associated with severe infections of COVID-19 and other coronaviruses

IntroductionIt is known that viral infections are epidemiologically prevalent and some of them are harmful to the central nervous system (CNS) due to the development of neuropsychiatric syndromes which affect the cognitive, affective, behavioral and perceptual domains. ObjectiveTo carry out a comprehensive analysis of the psychiatric and neuropsychiatric repercussions of COVID-19 based on epidemiological, pathophysiological and clinical foundations observed in previous and recent pandemic events, and also to make a proposition about effective therapeutic interventions to help tackle this serious public health problem, more specifically in its neuropsychiatric developments. MethodThis current literature review has utilized literature reserves and scientific search engines MEDLINE, EMBASE and Web of Science. The search terms included, “SARS-CoV-2”, “etiology,” “psychiatric and neuropsychiatric repercussions”, “severe infections” “COVID-19”. Specific choices of unique papers from each of the searches were identified. The inclusion criteria were relevance and availability of full-text. Papers were excluded on the basis of relevance and non-availability of full-text. Papers were identified in the general literature reserve as pertinent to the search terms. ResultsThe main psychiatric and neuropsychiatric repercussions analyzed were depression, anxiety, post-traumatic stress disorder, psychosis, nonspecific neurological symptoms, delirium, cerebrovascular complications, encephalopathies, neuromuscular disorders, anosmia and ageusia. ConclusionThe psychiatric and neuropsychiatric symptoms of acute respiratory syndromes can appear during or after the infectious stage. Among the risk factors pointed out for such effects are the female gender, health professionals, presence of avascular necrosis and distressing pain.

Thiamine deficiency in the outpatient psychiatric oncology setting: A case series.

B vitamins are essential for the functioning of the nervous system. Vitamin B1 (thiamine) deficiency is associated with neuropsychiatric syndromes such as Wernicke's encephalopathy (WE), which, if untreated, has an estimated mortality of 17-20%. Although the prevalence of thiamine deficiency in the general population is difficult to estimate, it is being increasingly recognized in oncology, especially in the inpatient setting. We describe three cases of thiamine deficiency (TD) in the outpatient psychiatric oncology setting. Retrospective chart review of three adult patients, who were seen in the psychiatric oncology clinic and found to have TD on laboratory testing, was done. Patient, disease, and thiamine treatment-related information were obtained, and descriptive statistics were used to analyze the data. The average age was 59 years, mean body mass index (BMI) was 22.00 ± 4.58 (mean ± SD), and mean thiamine level was 59.10 ± 7.69 that ranged from 45 to 68 nmol/L (normal thiamine level reference: 70-180 nmol/L). None of the patients had brain imaging nor cerebrospinal fluid analysis. Risk factors such as unbalanced nutrition, prior GI surgery, renal disease, and chemotherapy were noted. TD can have a multifactorial etiology in oncology. Identification of TD in both inpatient and outpatient setting is important. Our report highlights how early identification of TD in the outpatient setting can help prevent further clinical progression.

Racemization Hypothesis of COVID-19. Tip of the Iceberg

The impact of viral infections on the central nervous system is widely known. Virus-related neuropsychiatric and neurobehavioral syndromes are caused by the distortion of cognitive, affective, behavioral, and perceptual domains. Although it is a commonly known phenomenon, the mechanism behind it is not well-understood. The contagious and deadly features of coronavirus disease 2019 (COVID-19) have been associated with the virus-host cell interaction at the molecular level. However, there is no reliable biomarker characterizing the disease progression. Studies of the structure, function, and evolution of coronavirus transmembrane spike glycoproteins (S-, N-, and E-proteins) suggest an essential role of protein chirality in virus-cell membrane interaction. The virus-host interaction is the subject of multidisciplinary research from the biochirality and systems biology, to cell physiology and non-equilibrium thermodynamics of phase transitions in proteins. At the protein level, virus-host interaction is modulated by the amino acid sequence of viral proteins and cellular metabolism. Enzymatic and spontaneous post-translational modifications (PTMs) are two mutually influential mechanisms governing the dynamics of virus and host cell proteome. Among them, phosphorylation and racemization are the most inter-related and studied. The spontaneous phase transitions within viral glycoprotein impacts the cell-entry capability of the virus. The spontaneous racemization is a particular and highly specific metabolic event in virus-cell interaction that is the focus of our attention. Many viral proteins are characterized by a high proportion of the serine (Ser) residues, which are the common target of the host-cell glycosylation, phosphorylation, and racemization, and proteolytic enzymes. Particularly, coronavirus N proteins were found to be phosphorylated at multiple Ser residues, a portion of which are shown to be phosphorylation-prone by the Ser-associated kinases. Since Ser is known as one of the most racemization prone amino acids, we promote an idea of the specific impact of spontaneous racemization at Ser residues on virus-host interaction.