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      Depressive Syndromes in Autoimmune Disorders of the Nervous System: Prevalence, Etiology, and Influence

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      Frontiers in Psychiatry

      Frontiers Media S.A.

      depression, anxiety, autoimmunity, nervous system disorder, etiology

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          Abstract

          Autoimmune diseases of the nervous system (ADNS) consist of a group of severely disabling disorders characterized by abnormal immune attack against protein components of the nervous system. This type of attack behavior may occur in the central or peripheral nervous system, and in the neuromuscular junction, resulting in neuronal damage, axonal injury, demyelination or destruction of the neuromuscular junction. While the neurological deficits of patients with ADNS have received significant research attention, the manifestation of depression tends to be ignored. In fact, depressive manifestation is common in ADNS and adds significant burden upon patients suffering from this disease. Here, we systematically reviewed the current literature to highlight the prevalence, etiology and influence of depressive manifestation in ADNS. Most autoimmune diseases of the nervous system are discussed in this paper, from multiple sclerosis, acute disseminated encephalomyelitis and autoimmune encephalitis to acute myelitis, neuromyelitis optica, Guillain-Barré syndrome and myasthenia gravis. Depressive symptoms usually develop as a comorbidity during the course of disease, but sometimes exist as a primary presentation of the disease. Psychosocial factors, long periods of disablement and chronic pain are the three most common causes of depressive symptoms in many chronic conditions, particularly in peripheral neuropathy. Furthermore, the higher prevalence of depressive symptoms in ADNS suggests that immunological dysregulation may contribute to the elevated morbidity of depression. Finally, structural lesions of the brain, and some medications for ADNS, are also thought to precipitate depressive states in ADNS.

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          Most cited references 79

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          Evidence for antibody-mediated pathogenesis in anti-NMDAR encephalitis associated with ovarian teratoma.

          We report the immunopathological analysis of the brain and tumor of two patients who died of anti-NMDAR-associated encephalitis, and of the tumor of nine patients who recovered. Findings included prominent microgliosis and deposits of IgG with rare inflammatory infiltrates in the hippocampus, forebrain, basal ganglia, and spinal cord. Detection of cells expressing markers of cytotoxicity (TIA, granzyme B, perforin and Fas/Fas ligand) was extremely uncommon. All tumors showed NMDAR-expressing neurons and inflammatory infiltrates. All patients’ NMDAR antibodies were IgG1, IgG2, or IgG3. No complement deposits were observed in any of the central nervous system regions examined. Overall, these findings coupled with recently reported in vitro data showing that antibodies downregulate the levels of NMDA receptors suggest that the antibody immune-response is more relevant than cytotoxic T-cell mechanisms in the pathogenesis of anti-NMDAR-associated encephalitis.
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            The worldwide prevalence of multiple sclerosis.

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              Multiple sclerosis and depression.

              Clinically significant depression can affect up to 50% of patients with multiple sclerosis over the course of their lifetime. It is associated with an increased morbidity and mortality and is regarded by patients as one of the main determinants of their quality of life. This review summarizes current perspectives relating to diagnosis, the utility of self report screening questionnaires, warning signs of suicidal intent and the biological and psychosocial variables implicated in mood change. In particular, the association between depression and structural brain abnormalities, including those derived from diffusion tensor imaging, is highlighted. Depression is treatable, as the results from randomized controlled trials of antidepressant medication, cognitive behavior therapy and mindfulness therapy, reveal. These positive findings are offset by data showing that depression in a neurological setting is often overlooked and under treated.
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                Author and article information

                Contributors
                Journal
                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                1664-0640
                25 September 2018
                2018
                : 9
                Affiliations
                Department of Neurology, The Second Xiangya Hospital, Central South University , Changsha, China
                Author notes

                Edited by: Bing Lang, University of Aberdeen, United Kingdom

                Reviewed by: Hong Sun, Louisiana State University Health Sciences Center Shreveport, United States; Jim Liu, University of New Mexico Gallup, United States

                *Correspondence: Xiangqi Tang txq6633@ 123456csu.edu.cn

                This article was submitted to Behavioral and Psychiatric Genetics, a section of the journal Frontiers in Psychiatry

                Article
                10.3389/fpsyt.2018.00451
                6168717
                Copyright © 2018 Liu and Tang.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 93, Pages: 9, Words: 7736
                Categories
                Psychiatry
                Review

                Clinical Psychology & Psychiatry

                etiology, nervous system disorder, autoimmunity, anxiety, depression

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