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IMMUNE-DERMATOLOGY NEUROSCIENCES

• INTRODUCTION
• DIRECTIONS
• SCHEDULE PLAN
• REFERENCES

 

INTRODUCTION

 

PANDAS & PANS

Other immune and dermatologic disorders associated with psychiatric symptomatology

 

Given the current scientific knowledge, an integrated immune-dermato-psychiatric approach for psychiatric, immune and dermatologic disorder is becoming increasingly necessary.

 

The existance of a close correlation between the nervous, endocrine and immune systems is long known. Lots of immune disorders may display psychiatric symptomatology. Growing evidence supports the notion of an immune system involvement in psychiatric disorders.

 

Antineuronal antibodies have been found in approximately 20% of subjects diagnosed with Obsessive-Compulsive Disorder.

 

Intravenous immunoglobulin treatment is able to produce an obsessive-compulsive symptomatology and tics amelioration in a subgroup of children diagnosed with Obsessive-Compulsive Disorder (1).

 

Furthermore, the nervous system and skin share the same embriological origin from neuroectoderma. Several dermatological disorders worsen under stress or anxiety circumstances which, through the brain’s production of neuropeptides and through the agency of endocrine organs and peripheral nervous system, have a direct effect on the immune system and skin (2).

 

DIRECTIONS

 

• PANDAS-like patients, that is subjects with psychiatric disorders, specifically displaying:

1. Behavioral disorders, attention and concentration disorders, cognitive disorders, mental deterioration, obsessive-compulsive disorder, tics, hyperactivity, psychomotor agitation, depression, psychotic disorders, eating disorders, autism spectrum disorders;
2. With acute onset (not only), after an infective event (fever, phariyngitis, otitis, curaneous manifestation, etc.), with recurring course;
3. Resistance to ordinary treatments (psychiatric drugs, psychotherapy) or resistance despite treatment continuation
4. Altered flogistic indexes (VES, PCR, fibrinogen), laboratory analyses showing certain or probable infection, personal and/or familiar history of autoimmune disorders.

• Psychosomatic dermatological patients, that is subjects afflicted with psoriasis, vitiligo, chronic urticaria, atopic dermatitis, seborrheic dermatitis, contact eczema, chronic itching, peri-ano-genital itching, acne, rosacea, alopecia, telogen effluvium, trichotillomania, hyperidrosis, dyshidrosis, neurodermatitis, morgellons, Ekbom syndrome,  glossodynia, Patomime, recurrent Herpes infection.

 

 

SCHEDULE PLAN

 

Medical examination and early assessment

• Psychometric assessment
• Immunological assessment
• Medical and psychiatric anamnesis
• Contingent differential diagnosis

Treatments

• Psychopharmacological treatment
• Antibiotic treatment
• Anti-inflammatory treatment
• Cortisone treatment
• Neuromodulation treatment
  • Light therapy
  • Biofeedback
  • TMS
  • Cognitive-Behavioral Psychotherapy

Psychoeducational Group

 

• Two meetings/month

Further follow-up medical examinations

 

• Patients will undergo clinical and neuropsychiatric assessment by the use of rating scales, in order to evaluate treatment response.

REFERENCES

 

1. Perlmutter SJ, Leitman SF, Garvey MA, et al. “Therapeutic plasma excange and intravenous immunohlobulin for obsessive-compulsive disorder and tic disorders in childhood.” Lancet 1999; 354:1153-1158.
2. Suárez AL, Feramisco JD, Koo J and Steinhoff M. “Psychoneuroimmunology of Psychological Stress and Atopic Dermatitis: Pathophysiologic and Therapeutic Updates.” Acta Derm Venereol 2012; 92: 7–15.