Psychiatric Aspects of HTLV-1 infection

By: Dr Farhad FaridhosseiniPsychiatrist

Mashhad Medical University

HTLV-1

Topics

Prevalence of HTLV-1 seropositivity in psychiatric patients.

Psychiatric complications in HTLV-1 carriers or patients.

Psychiatric assessment of these patients.

Pharmacologic & Psychotherapeutic interventions

Viral Hypothesis for Schizophrenia

Indirect evidence suggest that viral infection during CNS development may be involved in the pathogenesis of schizophrenia:

(1) 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:

Borna virus, Influenza, Rubella

Is HTLV-1 infection could be etiology for psychiatric disorders?

Psychiatric patients showed a seroprevalence rate similar to that for the controls (Cubo et al, 1997, Kagoshima, Japan).

Lack of evidence for retrovirus infection in schizophrenic patients (Delisi et al, 1985).

HTLV-1 infection appeared to have no correlation with psychiatric disorders.

HTLV-1 & dementia

frequency of anti-HTLV-I antibody was found to be significantly higher in the patients with dementia than in those without dementia.

Among the various types of dementia, HTLV-I seropositivity was found to be significantly associated with vascular dementia.

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)

IV drug abusers

HTLV-1 infections appear to be widely distributed among high-risk groups in a nonendemic area of Argentina.

co-infection with HBV and HCV more frequent among IV Drug Users. (Berini et al. 2007)

HTLV-I is present in Greece among populations at high-risk. (Tseliou et al. 2006)

Frequency of psychiatric symptoms in HTLV-1 patients

42% HTLV-1 patients had a psychiatric co-morbidity; 34% had mood disorders, 22% were anxious.

a higher frequency of mental disorder in the symptomatic subgroup, patients on medication & female.

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)

Depression in HTLV-1 carriers The rate of depression was significantly higher in

HTLV-l carriers when compared with controls (39% vs. 8%).

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)

donors seropositive for HTL V-1/2 had worse scores on a depression subscale of General Well-Being Scale. (Guiltinan et al, 1998)

Relationship between Depression and HTLV-1 infection

chronic viral infection may produce a widespread dysregulation of the immune system that may lead to depressive symptoms.

IL-1 & IL-6 have been associated with depressive symptoms through direct brain activity.

decreased immune function associated with depression could be related to increased susceptibility to immune-mediated diseases.

stigma and the stress of having serious complications like HAM-TSP or ATL may turn patients with HTLV-I infection vulnerable to develop depression.

depressed patients may be more likely to engage in behaviors that put them at risk for contracting HTL V and other viruses

Sexual dysfunction

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)

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)

It may be the first symptom of HAM/TSP.

Cognitive deficits

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.

Progressive Cognitive decline in childhood HAM/TSP (case report by Zorzi et al, 2010).

Subcortical dementia could be seen (Cartier et al., 1999)

Chronic pain

Chronic pain was highly prevalent. (Netto & Brites, 2011)

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.

Psychiatric assessment

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.

Treatment of psychiatric complications

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:

Stigma: education & give information Uncertainty and anxiety: relaxation, cognitive appraisal Pain: mindfullness deal with many losses

Thank You