Transcript Psychiatric Aspects of HTLV

By: Dr Farhad Faridhosseini
Psychiatrist
Mashhad Medical University
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Prevalence of HTLV-1 seropositivity in
psychiatric patients.
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Psychiatric complications in HTLV-1 carriers or
patients.
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Psychiatric assessment of these patients.
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Pharmacologic & Psychotherapeutic
interventions
Indirect evidence suggest that viral infection during CNS
development may be involved in the pathogenesis of
schizophrenia:
an excess number of patient births in the late winter
and early spring
(2) an association between exposure to viral epidemics
in utero and the later development of schizophrenia.
(3) a higher prevalence of schizophrenia in crowded
urban areas
(4) seroepidemiological studies indicting a higher
infection rate for certain viruses in schizophrenia
patients or their mothers:
(1)
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Borna virus, Influenza, Rubella
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Psychiatric patients showed a seroprevalence
rate similar to that for the controls (Cubo et
al, 1997, Kagoshima, Japan).
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Lack of evidence for retrovirus infection in
schizophrenic patients (Delisi et al, 1985).
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HTLV-1 infection appeared to have no
correlation with psychiatric disorders.
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frequency of anti-HTLV-I antibody was found to
be significantly higher in the patients with
dementia than in those without dementia.
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Among the various types of dementia, HTLV-I
seropositivity was found to be significantly
associated with vascular dementia.
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The presence of HTLV-I appears to be one of the
risk factors for vascular dementia in HTLV-I
endemic areas (Kira et al, 1997, Japan)
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HTLV-1 infections appear to be widely
distributed among high-risk groups in a
nonendemic area of Argentina.
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co-infection with HBV and HCV more
frequent among IV Drug Users. (Berini et al.
2007)
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HTLV-I is present in Greece among
populations at high-risk. (Tseliou et al. 2006)
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42% HTLV-1 patients had a psychiatric co-morbidity;
34% had mood disorders, 22% were anxious.
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a higher frequency of mental disorder in the
symptomatic subgroup, patients on medication &
female.
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The rate is similar to those observed in studies carried
out into patients with chronic diseases (31% to 66%)
and to those reported for HIV patients (45%).
(Carvalho et al, 2009, Brazil)
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The rate of depression was significantly higher in
HTLV-l carriers when compared with controls (39% vs.
8%).
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It was not possible to determine whether depression
was related to knowledge of chronic retroviral
infection or related to a biological effect of the
retroviral infection.
(Stumpf et al., 2009, Brazil)
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donors seropositive for HTL V-1/2 had worse scores on
a depression subscale of General Well-Being Scale.
(Guiltinan et al, 1998)
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chronic viral infection may produce a widespread dysregulation of the
immune system that may lead to depressive symptoms.
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IL-1 & IL-6 have been associated with depressive symptoms through
direct brain activity.
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decreased immune function associated with depression could be related
to increased susceptibility to immune-mediated diseases.
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stigma and the stress of having serious complications like HAM-TSP or
ATL may turn patients with HTLV-I infection vulnerable to develop
depression.
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depressed patients may be more likely to engage in behaviors that put
them at risk for contracting HTL V and other viruses
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high frequency of urinary and sexual complaints
not only in patients with myelopathy but also in
individuals considered to be HTLV-I carriers.
(Oliviera et al, 2007, Brazil)
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The percentage of Erectile Dysfunction in the
carriers was 40.5% and in HAM/TSP group, ED
frequency was 88.2%. (Castro et al, 2005, Brazil)
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It may be the first symptom of HAM/TSP.
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Both the HTLV-1 carrier group and the group of
patients with TSP/HAM exhibited a lower
performance in neuropsychological tests (Silva
et al, 2003):
 Psychomotor slowing, verbal and visual memory,
attention and visuomotor abilities.
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Progressive Cognitive decline in childhood
HAM/TSP (case report by Zorzi et al, 2010).
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Subcortical dementia could be seen (Cartier et
al., 1999)
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Chronic pain was highly prevalent.
(Netto & Brites, 2011)
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It was significantly associated with a higher
likelihood of signs/symptoms of anxiety and
depression, reflecting a negative impact of
pain on patients´ quality of life.
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History taking
R/O Depression
Anxiety
Cognitive impairment
Erectile dysfunction
Level of functional impairment
Stigma and patient’s perspective
Health behavior & high risk groups
Drug interaction
Effects of Drugs on psychiatric symptoms.
SSRIs are safer except Fluvoxamine
Buspirone could be effective
Benzodiazepines could be used but with precaution
Clozapine is contraindicated because of its drug
interactions
 stimulants for cognitive impairment & depression
 Treatment of substance dependency
 Psychotherapy:
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Stigma: education & give information
Uncertainty and anxiety: relaxation, cognitive appraisal
Pain: mindfullness
deal with many losses