Capturing patients’ satisfaction and experiences with suicide prevention in general practice: A bridge too far?

Elzinga, Elke; Gilissen, Renske; Beekman, Aartjan; Beurs, Derek de

doi:10.1016/j.jadr.2023.100489

Cited by 2 publications

(3 citation statements)

References 17 publications

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“…Cases were referred to the Immunopsychiatry Clinic at Uppsala University Hospital 34 . Their long-standing psychiatric symptoms were not responsive to standard treatments or patients reported intolerable side effects.…”

Section: Casesmentioning

confidence: 99%

Three cases with chronic obsessive compulsive disorder report gains in wellbeing and function following rituximab treatment

Cunningham,

Gallwitz,

Lindqvist

et al. 2024

Preprint

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Obsessive compulsive disorder (OCD) is a debilitating condition affecting about 2% of the population where half of patients do not respond to standard treatment. The emerging concept of an autoimmune OCD subgroup is grounded on findings that suggest immunological aetiology. We here present the longitudinal clinical course for three severely ill, functionally impaired complex cases with chronic treatment-resistant OCD. In all three cases, off-label treatment with rituximab was followed by clear and sustained gains regarding symptom burden and function over several years. The clinical phenotypes and clinical red flags are described in detail. Antibodies targeting mouse brain tissue were detected in cerebral spinal fluid for all three cases. We report exploratory analyses of immunological markers and proteomics and findings include elevated levels of sCD27 and markers indicative for complement pathway activation in CSF when compared to controls. Multidisciplinary collaboration, advanced clinical investigations and rituximab treatment are feasible in a psychiatric setting. The case histories provide a proof of principle for the newly proposed criteria for autoimmune OCD. The findings suggest that clinical red flags and biological measures may predict rituximab response in chronic treatment-resistant OCD. The report provides orientation that may inform the hypotheses and design of future treatment trials.

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Section: Casesmentioning

confidence: 99%

Three cases with chronic obsessive compulsive disorder report gains in wellbeing and function following rituximab treatment

Cunningham,

Gallwitz,

Lindqvist

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…This study is a cross-sectional, observational single-centre study (Uppsala University Hospital, Sweden). Recruitment was in collaboration with the Uppsala Immunopsychiatry Clinic (UIP) that evaluates patients with moderate to severe psychiatric symptoms and clinical signs of suspected immunological involvement 31 . Out of the 167 patients evaluated by the team between 2012 and 2020, 156 (93%) consented to participate in the study.…”

Section: Study Design and Patient Cohortmentioning

confidence: 99%

“…The clinical assessment was performed according to the clinical protocol of Uppsala Immunopsychiatry Clinic, which has recently been described elsewhere 31 . Brie y it involved a psychiatric interview, a neurological examination, psychometric testing and a review of the patient's medical records.…”

Section: Psychiatric and Neurological Assessmentmentioning

confidence: 99%

Damage markers in cerebrospinal fluid and other findings from a patient cohort enriched for suspected autoimmune psychiatric disease

Cunningham,

Tornvind,

Syk

et al. 2023

Preprint

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There is growing evidence suggesting that immunological mechanisms play a significant role in the development of psychiatric symptoms in certain patient subgroups. However, it is challenging to identify and classify these cases in this early research stage. Here, we aimed to describe the prevalence and distribution of potential central nervous system (CNS) pathology in psychiatric patients in relation to clinical red flags for autoimmune psychiatric disease and psychiatric symptoms. Cerebrospinal fluid (CSF) routine findings and CNS damage markers; neurofilament light chain protein (NfL), glial fibrillary acidic protein (GFAP) and total Tau (t-Tau), in CSF from 127 patients with psychiatric disease preselected for suspected immunological involvement were related to recently proposed clinical red flags, psychiatric features, MRI and EEG findings. Twenty-one percent had abnormal routine CSF findings and 27% had elevated levels of CNS damage markers. Six percent had anti-neuronal antibodies in serum and 2% in CSF. Sixty-six percent of patients examined with MRI (n = 88) had alterations, mostly atrophy or non-specific white matter lesions. Twenty-seven percent of patients with EEG recordings (n = 70) had abnormal findings. Elevated NfL was associated with comorbid autoimmunity and affective dysregulation symptoms. Elevated t-Tau was associated with catatonia and higher ratings of agitation/hyperactivity. Elevated GFAP was associated with acute onset, atypical presentation, infectious prodrome, tics, depressive/anxiety symptom ratings and overall higher psychiatric symptom burden. In conclusion, pre-selection based on suspected autoimmune psychiatric disease identifies a population with high prevalence of CSF alterations suggesting CNS pathology. Future studies should examine the value of these markers in predicting treatment responses.

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Capturing patients’ satisfaction and experiences with suicide prevention in general practice: A bridge too far?

Cited by 2 publications

References 17 publications

Three cases with chronic obsessive compulsive disorder report gains in wellbeing and function following rituximab treatment

Three cases with chronic obsessive compulsive disorder report gains in wellbeing and function following rituximab treatment

Damage markers in cerebrospinal fluid and other findings from a patient cohort enriched for suspected autoimmune psychiatric disease

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