Major depression: An under reported neuropsychiatric manifestation of Mixed Connective Tissue Disease

Manohar, Harshini; Kuppili, Pooja Patnaik; Menon, Vikas

doi:10.1016/j.ajp.2017.07.011

Cited by 4 publications

(4 citation statements)

References 10 publications

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“…Chronic pain can independently contribute to the pathogenesis of depression, through elevation of inflammatory cytokines IL‐1β, IL‐6, and TNF‐α . Here, we review the prevalence and characteristics of depression, and its correlation to the levels of inflammatory cytokines and disease activity among different CTD (Tables and ).…”

Section: Depression In Connective Tissue Diseasesmentioning

confidence: 99%

“…Titers of anti‐U1‐RNP antibodies in the CSF were useful indicators of central neuropsychiatric manifestations in patients . However, it is indicated that the concurrent development of depression and other neuropsychiatric manifestations are neither common nor severe in patients with genuine MCTD . Other existing research on the CNS syndromes and cognitive functions in MCTD evaluated both SLE and MCTD or MCTD patients who were found to meet the classification criteria for SLE in a follow‐up study, suggesting that the neuropsychiatric manifestations could be a consequence of coexisting SLE rather than a manifestation of MCTD itself …”

Section: Depression In Connective Tissue Diseasesmentioning

confidence: 99%

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Cytokine secretion and the risk of depression development in patients with connective tissue diseases

Grygiel-Górniak

Limphaibool

Puszczewicz

2019

Psychiatry Clin Neurosci

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Research in the past two decades has revolutionized our understanding of depressive illnesses. Proinflammatory cytokines have become a point of interest in the interconnecting areas of neuropsychiatric and autoimmune diseases. The cytokine hypothesis of depression suggests that pro‐inflammatory cytokines play a primary role in the mediation of the pathophysiological characteristics of major depression, in which an inflammatory process may be induced by external and internal stressors, such as psychological and inflammatory diseases, respectively. The higher prevalence of depression, particularly in patients with chronic autoimmune connective tissue disorders (CTD), suggests that depression may present a dysfunctional adaptation of cytokine‐induced sickness, which could manifest in times of an exacerbated activation of the innate immune system. Inflammation is thought to contribute to the development of clinical depression through its ability to induce sickness behaviors corresponding to the neurovegetative features of depression, through the dysregulation of the hypothalamic–pituitary–adrenal axis, alterations in neurotransmitter synthesis and reuptake, and through its involvement in the neuroprogression pathways. This review explores the complex interrelationships in which inflammatory responses alter neuroendocrine and neuropsychological regulation contributing to depressive symptoms in CTD. The prevalence and characteristics of depression, and its correlation to the levels of inflammatory cytokines and disease activity among different CTD will be reviewed.

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Section: Depression In Connective Tissue Diseasesmentioning

confidence: 99%

Section: Depression In Connective Tissue Diseasesmentioning

confidence: 99%

Cytokine secretion and the risk of depression development in patients with connective tissue diseases

Grygiel-Górniak

Limphaibool

Puszczewicz

2019

Psychiatry Clin Neurosci

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“…Depressive symptoms occur in about 50% of patients with multiple sclerosis (5). However, they can also occur in the context of different connective tissue diseases, especially in systematic lupus erythematosus (SLE) (6,7). Predominant brain involvement of SLE refers to neuropsychiatric SLE (8,9).…”

Section: Introductionmentioning

confidence: 99%

Probable Autoimmune Depression in a Patient With Multiple Sclerosis and Antineuronal Antibodies

et al. 2020

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Background: In a subgroup of patients with mood disorders, clear-cut organic disorders are responsible for depressive symptoms (e.g., autoimmune diseases such as multiple sclerosis or systemic lupus erythematosus). In these cases, an organic affective disorder can be diagnosed. Case Presentation: The authors present the case of a 59-year-old male patient who developed a severe depressive episode over approximately 6 months and was, therefore, admitted to the hospital. In retrospect, he reported that, at age 39, he suffered from selflimiting sensory disturbances and muscle weakness in both legs. The current magnetic resonance imaging of his brain showed several conspicuous FLAIR-hyperintense supratentorial white matter lesions compatible with chronic inflammatory brain disease. Imaging of the spinal axis revealed no clear spinal lesions. Cerebrospinal fluid (CSF) analyses showed CSF-specific oligoclonal bands. Therefore, multiple sclerosis was diagnosed. Further CSF analyses, using tissue-based assays with indirect immunofluorescence on unfixed murine brain tissue, revealed a (peri-)nuclear signal and a strong neuritic signal of many neurons, especially on granule cells in the cerebellum, hippocampus, and olfactory bulb, as well as in the corpus callosum. Additionally, antinuclear antibody (ANA) titers of 1:12,800 and a lymphopenia were detected in blood tests. Further system clarification showed no suspicion of rheumatic or oncological disease. Anti-inflammatory treatment led to rapid and sustained improvement. Conclusion: The present patient suffered from a probable "autoimmune depression" in the context of newly diagnosed multiple sclerosis with typical MRI and CSF pathologies, alongside mild concomitant latent systemic autoimmune process (with high-titer ANAs and lymphopenia) and unknown antineuronal antibodies. The case report illustrates that a

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“…Previous studies have reported MCTD patients presenting with depression and peripheral neuropathies (Manohar et al, 2017; Vincent and Van Houzen, 1980). However, to our knowledge, no study has reported psychosis as the initial presentation of MCTD without any previous history of rheumatological symptoms.…”

mentioning

confidence: 99%

Mixed Connective Tissue Disease Presenting With Psychosis—A Case Report

Tondehal,

Sengupta,

Mohankumar

et al. 2024

J Nerv Ment Dis

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Mixed connective tissue disease (MCTD) is a systemic autoimmune disease with features overlapping multiple autoimmune disorders. One study found that over 55% of patients with MCTD experienced neuropsychiatric symptoms, the most common of which was an “aseptic meningitis-like syndrome.” We present a case of a 17-year-old adolescent girl presenting with abnormal speech and behavior, auditory hallucinations, and paranoid delusions after an isolated episode of fever. She was treated for her psychotic symptoms but later developed symptoms resembling neuroleptic malignant syndrome. An antibody screen revealed elevated anti-U1-ribonucleoprotein antibodies with a possible diagnosis of MCTD. She finally responded to steroid therapy. To our knowledge, this is the first reported case of MCTD initially presenting with psychosis. A diagnosis of autoimmune disorders should be kept in the differential of similar clinical presentations including connective tissue disorders and autoimmune thyroid conditions.

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Major depression: An under reported neuropsychiatric manifestation of Mixed Connective Tissue Disease

Cited by 4 publications

References 10 publications

Cytokine secretion and the risk of depression development in patients with connective tissue diseases

Cytokine secretion and the risk of depression development in patients with connective tissue diseases

Probable Autoimmune Depression in a Patient With Multiple Sclerosis and Antineuronal Antibodies

Mixed Connective Tissue Disease Presenting With Psychosis—A Case Report

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