ABSTRACT
La encefalitis autoinmune es una entidad heterogénea en cuanto a su presentación clínica y pronóstico. Es frecuente que este cuadro presente síntomas psiquiátricos por lo que es habitual la intervención de los servicios de psiquiatría tanto en el proceso diagnóstico como en el manejo sintomático. El curso de la enfermedad suele ser agudo o rápidamente progresivo motivo por el cual es esencial la detección precoz de esta enfermedad con el fin de realizar las exploraciones complementarias y el tratamiento etiológico. Describimos el caso de un varón de 49 años, sin antecedentes psiquiátricos que presenta sintomatología maniforme en urgencias pero que a las pocas horas de ingresar en la unidad de agudos presenta disminución del nivel de consciencia y fiebre. Las exploraciones complementarias permiten orientarlo como encefalitis autoinmune por anticuerpos contra el receptor metabotrópico de glutamato 5. La psiquiatría de interconsulta participa en el manejo sintomático del paciente
Autoimmune encephalitis is a heterogeneous entity in terms of its symptoms and prognosis. As the clinical presentation frequently includes psychiatric symptoms, the intervention of psychiatric services is usual in the diagnostic process, as well as in the management of the symptoms. The course of the disease is usually acute or rapidly progressive, making the early detection of this disease essential in patients in order to perform the complementary tests and to treat the origin. The case is presented of a 49 year-old man, with no psychiatric history, who presents with maniac symptoms in the emergency room. A few hours after being admitted to the inpatient unit he presents with decrease in consciousness level and fever. Complementary tests led to the diagnosis of autoimmune encephalitis with antibodies against the metabotropic receptor of glutamate 5. The psychiatric approach for symptomatic treatment was made by joint consultation
Subject(s)
Humans , Male , Middle Aged , Receptor, Metabotropic Glutamate 5/immunology , Encephalitis/complications , Affective Disorders, Psychotic/etiology , Encephalitis/immunology , Autoimmune Diseases/complications , Cerebrospinal Fluid , Diagnosis, DifferentialABSTRACT
BACKGROUND: Multiple sclerosis is a chronic disease considered the major cause of neurological disability in young adults worldwide. While depression is considered a determinant factor of impaired quality of life and poorer prognosis among patients with multiple sclerosis, it is very often dismissed and undertreated by physicians. Depression has been related to treatment with some immunomodulatory drugs, such as IFNß. Data from patients who committed suicide during the pivotal study of interferon used as a disease modifying treatment in multiple sclerosis support this association. Moreover, there is plenty of evidence of neuropsychiatric toxicity caused by the use of IFNα as a treatment for other medical conditions. Although this link still remains relatively unknown, the presence of warnings regarding the possible relationship between depression and IFNß led to restriction in medical indications in these patients. The purpose of this paper is to try to understand the reasons for an increased prevalence in depression in multiple sclerosis and to examine the impact that IFNß treatment has on their mood. METHODS: We performed a literature search on MEDLINE and Google Scholar databases applying PRISMA guidelines for systematic reviews. Studies were included if the participants were diagnosed with MS and prescribed IFNß as the main treatment. We excluded non-english and full-text non available papers, as well as the articles where mental health was assessed exclusively as a feature of quality of life. The sample includes articles from 1980 to 2014, although filtration by year of publication was not applied and contains data from IFNß-1a and IFNß-1b. The Cochrane Collaboration Tool assessing risk of bias was used to determine the quality of the studies. RESULTS: Ten studies met full criteria for inclusion and final data extraction. The articles have heterogeneity regarding the samples, the methodology used and the expression of the results. Only three studies support the evidence of a relationship between depression and interferon, which is statistically significant in some patients at the beginning of the treatment. They suggest that only patients on IFNß treatment with a past history of depression may develop a major depression episode during the first six months. The remaining articles reviewed (including BENEFIT, BEYOND, and LTF trials) suggest the absence of an association. CONCLUSION: The reviewed studies conclude that there is not a clear relationship between IFNß and depression. A history of depression is a risk factor for developing depression during the first 6 months of treatment, nevertheless, it is not sufficient to contraindicate it. The development of new strategies is crucial for early detection of depressive symptoms. An adequate treatment can both improve the mood and deal with the neurological disease by increasing treatment adherence and interfering with inflammation. Chronic destructive brain changes and serotonergic depletion due to inflammatory factors have been proposed as the underlying cause of depression in these patients. It is suggested that these patients would have fewer functional reserve remaining to deal with stressful life events, which could precipitate a depressive disorder.
Subject(s)
Depressive Disorder/complications , Immunologic Factors/therapeutic use , Interferon-beta/therapeutic use , Multiple Sclerosis/complications , Multiple Sclerosis/drug therapy , Depressive Disorder/physiopathology , Humans , Immunologic Factors/adverse effects , Interferon-beta/adverse effects , Multiple Sclerosis/physiopathology , Multiple Sclerosis/psychologyABSTRACT
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