The Challenge of Assessing Mild Neuroinflammation in Severe Mental Disorders
Recent psychoneuroimmunology research has provided new insight into the etiology and pathogenesis of severe mental disorders (SMDs). The mild encephalitis (ME) hypothesis was developed with the example of human Borna disease virus infection years ago and proposed, that a subgroup SMD patients, mainl...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2020-08-01
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| Series: | Frontiers in Psychiatry |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fpsyt.2020.00773/full |
| _version_ | 1818290340796301312 |
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| author | Karl Bechter |
| author_facet | Karl Bechter |
| author_sort | Karl Bechter |
| collection | DOAJ |
| description | Recent psychoneuroimmunology research has provided new insight into the etiology and pathogenesis of severe mental disorders (SMDs). The mild encephalitis (ME) hypothesis was developed with the example of human Borna disease virus infection years ago and proposed, that a subgroup SMD patients, mainly from the broad schizophrenic and affective spectrum, could suffer from mild neuroinflammation, which remained undetected because hard to diagnose with available diagnostic methods. Recently, in neurology an emerging new subgroup of autoimmune encephalitis (AE) cases suffering from various neurological syndromes was described in context with the discovery of an emerging list of Central Nervous System (CNS) autoantibodies. Similarly in psychiatry, consensus criteria of autoimmune psychosis (AP) were developed for patients presenting with CNS autoantibodies together with isolated psychiatric symptoms and paraclinical findings of (mild) neuroinflammation, which in fact match also the previously proposed ME criteria. Nevertheless, identifying mild neuroinflammation in vivo in the individual SMD case remains still a major clinical challenge and the possibility that further cases of ME remain still under diagnosed appears an plausible possibility. In this paper a critical review of recent developments and remaining challenges in the research and clinical diagnosis of mild neuroinflammation in SMDs and in general and in transdisciplinary perspective to psycho-neuro-immunology and neuropsychiatry is given. Present nosological classifications of neuroinflammatory disorders are reconsidered with regard to findings from experimental and clinical research. A refined grading list of clinical states including “classical” encephalitis, AE, AP/ME,and newly proposed terms like parainflammation, stress-induced parainflammation and neuroprogression, and their respective relation to neurodegeneration is presented, which may be useful for further research on the possible causative role of mild neuroinflammation in SMDs. Beyond, an etiology-focused subclassification of ME subtypes, like autoimmune ME or infectious ME, appears to be required for differential diagnosis and individualized treatment. The present status of the clinical diagnosis of mild neuroinflammatory mechanisms involved in SMDs is outlined with the example of actual diagnosis and therapy in AP. Ideas for future research to unravel the contribution of mild neuroinflammation in the causality of SMDs and the difficulties expected to come to novel immune modulatory, anti-infectious or anti-inflammatory therapeutic principles in the sense of precision medicine are discussed. |
| first_indexed | 2024-12-13T02:26:37Z |
| format | Article |
| id | doaj.art-13558ff994b745d196149cfe0b20ce04 |
| institution | Directory Open Access Journal |
| issn | 1664-0640 |
| language | English |
| last_indexed | 2024-12-13T02:26:37Z |
| publishDate | 2020-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Psychiatry |
| spelling | doaj.art-13558ff994b745d196149cfe0b20ce042022-12-22T00:02:36ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402020-08-011110.3389/fpsyt.2020.00773520060The Challenge of Assessing Mild Neuroinflammation in Severe Mental DisordersKarl BechterRecent psychoneuroimmunology research has provided new insight into the etiology and pathogenesis of severe mental disorders (SMDs). The mild encephalitis (ME) hypothesis was developed with the example of human Borna disease virus infection years ago and proposed, that a subgroup SMD patients, mainly from the broad schizophrenic and affective spectrum, could suffer from mild neuroinflammation, which remained undetected because hard to diagnose with available diagnostic methods. Recently, in neurology an emerging new subgroup of autoimmune encephalitis (AE) cases suffering from various neurological syndromes was described in context with the discovery of an emerging list of Central Nervous System (CNS) autoantibodies. Similarly in psychiatry, consensus criteria of autoimmune psychosis (AP) were developed for patients presenting with CNS autoantibodies together with isolated psychiatric symptoms and paraclinical findings of (mild) neuroinflammation, which in fact match also the previously proposed ME criteria. Nevertheless, identifying mild neuroinflammation in vivo in the individual SMD case remains still a major clinical challenge and the possibility that further cases of ME remain still under diagnosed appears an plausible possibility. In this paper a critical review of recent developments and remaining challenges in the research and clinical diagnosis of mild neuroinflammation in SMDs and in general and in transdisciplinary perspective to psycho-neuro-immunology and neuropsychiatry is given. Present nosological classifications of neuroinflammatory disorders are reconsidered with regard to findings from experimental and clinical research. A refined grading list of clinical states including “classical” encephalitis, AE, AP/ME,and newly proposed terms like parainflammation, stress-induced parainflammation and neuroprogression, and their respective relation to neurodegeneration is presented, which may be useful for further research on the possible causative role of mild neuroinflammation in SMDs. Beyond, an etiology-focused subclassification of ME subtypes, like autoimmune ME or infectious ME, appears to be required for differential diagnosis and individualized treatment. The present status of the clinical diagnosis of mild neuroinflammatory mechanisms involved in SMDs is outlined with the example of actual diagnosis and therapy in AP. Ideas for future research to unravel the contribution of mild neuroinflammation in the causality of SMDs and the difficulties expected to come to novel immune modulatory, anti-infectious or anti-inflammatory therapeutic principles in the sense of precision medicine are discussed.https://www.frontiersin.org/article/10.3389/fpsyt.2020.00773/fullneuroinflammationmild encephalitisautoimmune encephalitisautoimmune psychosisBorna viruspsychoimmunology |
| spellingShingle | Karl Bechter The Challenge of Assessing Mild Neuroinflammation in Severe Mental Disorders Frontiers in Psychiatry neuroinflammation mild encephalitis autoimmune encephalitis autoimmune psychosis Borna virus psychoimmunology |
| title | The Challenge of Assessing Mild Neuroinflammation in Severe Mental Disorders |
| title_full | The Challenge of Assessing Mild Neuroinflammation in Severe Mental Disorders |
| title_fullStr | The Challenge of Assessing Mild Neuroinflammation in Severe Mental Disorders |
| title_full_unstemmed | The Challenge of Assessing Mild Neuroinflammation in Severe Mental Disorders |
| title_short | The Challenge of Assessing Mild Neuroinflammation in Severe Mental Disorders |
| title_sort | challenge of assessing mild neuroinflammation in severe mental disorders |
| topic | neuroinflammation mild encephalitis autoimmune encephalitis autoimmune psychosis Borna virus psychoimmunology |
| url | https://www.frontiersin.org/article/10.3389/fpsyt.2020.00773/full |
| work_keys_str_mv | AT karlbechter thechallengeofassessingmildneuroinflammationinseverementaldisorders AT karlbechter challengeofassessingmildneuroinflammationinseverementaldisorders |