MAR 14, 2019 12:00 PM PDT

Keynote Presentation: Infections and Inflammation as Possible Causes of Severe Mental Disorders - Paving the Way for new Treatment Targets

Presented at: Neuroscience 2019
C.E. Credits: P.A.C.E. CE Florida CE
Speaker
  • Research Leader, Mental Health Care Copenhagen, Copenhagen University Hospital
    Biography
      Dr. Michael E. Benros, MD, PhD is a clinician and Research Leader into biological causes of mental disorders at the Mental Health Centre Copenhagen, Copenhagen University Hospital. He got his medical degree and PhD at Aarhus University and conducted his psychiatric and neurological residencies at the Copenhagen University Hospitals. His research has focused on the possible role of inflammation in the aetiology of mental disorders, where he has taking advantage of the valuable data from the Danish nationwide registers and biobanks. He has been guided by the idea that maybe some of the mental disorders could be prevented or cured by focusing on the possible role of infection, autoimmune diseases and other inflammatory mechanisms. He is a board member of the Psychiatric Immunology Section of the World Psychiatric Association and the DANFUND research collaboration. He has received a number of awards, including the prestigious Sapere Aude Research Leader award from the Independent Research Fond Denmark. He is recognized internationally for his ongoing involvement in clinical & epidemiological research into mental health, being at the forefront of the emerging field of psychiatric immunology and has helped advancing the field through several landmark papers highlighting the association between immune-related factors and mental illness. He now leads a sizable effort - PSYCH-FLAME - to disentangle the role of Inflammation in the development of Severe Mental Disorders. PSYCH-FLAME combines immune exposures from the nationwide Danish registers, with immunogenetic investigations, and novel research on cerebrospinal fluid and blood obtained from biobank and clinical studies of patients with schizophrenia and affective disorders also utilizing omics and systems biology approaches. These novel extensive investigations of the possible immunological contribution to the disorders aims to increase the understanding of the immune system's role and pave the way more precise diagnostics and new treatment targets.

    Abstract

    The immune system is linked to an increasing number of medical diseases, including lately also severe mental disorders. Hence, infections, autoimmunity and other immune responses could be involved in the pathogenesis of some patients with severe mental disorders.

    Our large-scale epidemiological studies have consistently displayed that infections and autoimmune diseases increases the risk of developing severe mental disorders in a dose-response relationship, where the risk of severe mental disorders particularly increases with the amount of infections exposed to. It is a broad range of infections and autoimmune diseases that are associated with an increased risk of severe mental disorders, with the more severe infections increasing the risk the most. The risk of severe mental disorders is particularly increased with the temporal proximity to the infection. Furthermore, we have shown that the genetics for psychosis does not explain the association with infections but that the genetics and infections are additive risk factors for psychosis.  Moreover, at diagnosis there are elevated levels of inflammatory markers in the blood and studies on the cerebrospinal fluid surrounding the brain have shown some evidence for elevated immune markers in the brain and signs of disrupted blood-brain barrier in some of the patients, making them more vulnerable to potential detrimental effects of immune components. Our meta-analyses of randomized clinical trials have shown that anti-inflammatory treatment seems to be effective for depression and depressive symptoms and also for psychotic disorders in addition to antipsychotic treatment but intensive work is under way to identify subgroups that would be most likely to respond to anti-inflammatory add-on treatment, which might results in clinical impact.

    Psychiatric symptoms can be directly triggered by infections reaching the brain, or be secondary to systemic inflammation indirectly affecting the brain through immune components, such as brain-reactive antibodies and cytokines. Nonetheless, shared genetic factor or other unmeasured environmental factors might account for some of this increased prevalence of immune-related diseases among individuals with psychosis; however, the common genetic variants associated with schizophrenia does not seem to increase the susceptibility for acquiring infections. Hence, a thorough differential diagnostic assessment of immune-related diseases, signs of neuroinflammation or other detectable physical diseases are of utmost importance in individuals with psychosis, particularly during onset of symptoms, to improve the psychiatric symptoms, survival rates and quality of life.

    Learning Objectives: 

    1. The association between infections and mental disorders
    2. The association between autoimmune diseases and mental disorders


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