Immunity and Gilles de la Tourette syndrome: A systematic review and meta-analysis of evidence for immune implications in Tourette syndrome.

BACKGROUND AND PURPOSE: The neurobiology of Gilles de la Tourette syndrome (GTS) is known to involve corticostriatal loops possibly under genetic control. Less is known about possible environmental triggers of GTS. Specifically, immune-related events following possible environmental inducers have been evoked, but important controversies still exist. In this systematic review and meta-analysis, we looked for evidence in favor of such possibilities. METHODS: We performed a systematic review and meta-analysis of all immunological data in PubMed. RESULTS: We found large discrepancies concerning immune dysfunctions in GTS, and meta-analyzing cytokines data did not allow us to conclude there is an involvement of specific cytokines in GTS neurobiology. When looking specifically at pediatric autoimmune neuropsychiatric disorder associated with streptococcus/pediatric acute onset neuropsychiatric syndrome, we found some important evidence of a possible infectious involvement but in a limited number of studies. Our meta-analysis found an increased level of anti-streptolysin O antibodies in GTS patients, but the level of anti-DNase B antibodies was not increased. CONCLUSIONS: Too many questions still exist to allow us to definitively reach the conclusion that there is an infectious and immunological etiology in GTS. Much work is still needed to elucidate the possible role of immunology in GTS neurobiology and to favor immunological treatment rather than classical treatment.

Is sustained attention deficit related to subclinical obsessive thoughts in children and adolescents with ADHD?

Background: Thought content and its impact on sustained attention in individuals with attention deficit hyperactivity disorder (ADHD) are topics of growing interest in literature.Objective: We hypothesised that subclinical obsessive thoughts may be correlated with attention lapses in individuals with ADHD.Method: Thirty children diagnosed with ADHD participated in the study and their level of subclinical obsessive thoughts, attention, and executive function were measured using Children Yale-Brown Obsessive Scale and Conners' Continuous Performance Test II.Results: No significant correlation between sustained attention impairment and the level of obsessive thoughts in patients with ADHD was found. Nevertheless, patients with ADHD with subclinical obsessive thoughts showed more commission errors than those without (W = 51.5; p = 0.02).Conclusion: The nature of thought content in individuals with ADHD should be linked to executive dysfunction rather than attentional impairment. This could be of importance in the therapeutic strategy choice, addressing the importance of executive function remediation in the specific context of subclinical obsessive thoughts.Key points Patients with ADHD, without OCD or ASD comorbidity, still present subclinical obsessive thoughts (36% of our sample). • Subclinical obsessive thoughts could be a part of thought content in patients with ADHD. • Subclinical obsessive thoughts as measured by the CPT-II are not correlated with attention function in patients with ADHD. • ADHD patients with subclinical obsessive symptoms present more impairment in response inhibition than the ones without. • Results on subclinical obsessive thoughts are similar to those on another type of thought content called 'mind wandering'. • A clinical improvement strategy for patients with ADHD could be using executive function remediation rather than classical attention function remediation, according to both to our and previous results.

The Sapap3-/- mouse reconsidered as a comorbid model expressing a spectrum of pathological repetitive behaviours.

Symptom comorbidity is present amongst neuropsychiatric disorders with repetitive behaviours, complicating clinical diagnosis and impeding appropriate treatments. This is of particular importance for obsessive-compulsive disorder (OCD) and Tourette syndrome. Here, we meticulously analysed the behaviour of Sapap3 knockout mice, the recent rodent model predominantly used to study compulsive-like behaviours, and found that its behaviour is more complex than originally and persistently described. Indeed, we detected previously unreported elements of distinct pathologically repetitive behaviours, which do not form part of rodent syntactic cephalo-caudal self-grooming. These repetitive behaviours include sudden, rapid body and head/body twitches, resembling tic-like movements. We also observed that another type of repetitive behaviour, aberrant hindpaw scratching, might be responsible for the flagship-like skin lesions of this mouse model. In order to characterise the symptomatological nature of observed repetitive behaviours, we pharmacologically challenged these phenotypes by systemic aripiprazole administration, a first-line treatment for tic-like symptoms in Tourette syndrome and trichotillomania. A single treatment of aripiprazole significantly reduced the number of head/body twitches, scratching, and single-phase grooming, but not syntactic grooming events. These observations are in line with the high comorbidity of tic- and compulsive-like symptoms in Tourette, OCD and trichotillomania patients.

Therapeutic use of virtual reality relaxation in schizophrenia: A pilot study.

Virtual reality can be used for psychotherapeutic purposes. Our main objective is to assess the feasibility and the tolerance of a relaxation therapy in virtual reality from patients suffering from schizophrenia, by studying the risks of symptoms of depersonalization or cybersickness. It is a prospective, open, five-week clinical study. Evaluations were carried out before and after each session. They were 13 patients aged 18 to 65. Analyzes showed a good tolerance and acceptance regarding virtual reality and anxiolytic effects have been observed between baseline values and those obtained after the first session and after the fifth session (p < 0.05).

Clinical characteristics of adults suffering from high-functioning autism and comorbid obsessive-compulsive disorder.

Autism spectrum disorder (ASD) is a very heterogeneous disorder. Obsessive compulsive disorder (OCD) comorbidity, frequent in ASD, could be useful to define a specific ASD subtype. Our objective was to explore if adults with ASD and comorbid OCD could present a specific clinical profile of ASD in 89 high functioning-adult ASD patients. We found that adults with ASD and comorbid OCD showed a lower verbal IQ and a more severe impairments in social cognition. ASD with comorbid OCD present a specific clinical profile which could constitute a possible subtype of ASD.

Trichotillomania is more related to Tourette disorder than to obsessive-compulsive disorder.

OBJECTIVE: Trichotillomania (TTM) is characterized by the pulling out of one's hair. TTM was classified as an impulse control disorder in DSM-IV, but is now classified in the obsessive-compulsive related disorders section of DSM-5. Classification for TTM remains an open question, especially considering its impact on treatment of the disorder. In this review, we questioned the relation of TTM to tic disorder and obsessive-compulsive disorder (OCD). METHOD: We reviewed relevant MEDLINE-indexed articles on clinical, neuropsychological, neurobiological, and therapeutic aspects of trichotillomania, OCD, and tic disorders. RESULTS: Our review found a closer relationship between TTM and tic disorder from neurobiological (especially imaging) and therapeutic standpoints. CONCLUSION: We sought to challenge the DSM-5 classification of TTM and to compare TTM with both OCD and tic disorder. Some discrepancies between TTM and tic disorders notwithstanding, several arguments are in favor of a closer relationship between these two disorders than between TTM and OCD, especially when considering implications for therapy. This consideration is essential for patients.

Individualized Immunological Data for Precise Classification of OCD Patients.

Obsessive⁻compulsive disorder (OCD) affects about 2% of the general population, for which several etiological factors were identified. Important among these is immunological dysfunction. This review aims to show how immunology can inform specific etiological factors, and how distinguishing between these etiologies is important from a personalized treatment perspective. We found discrepancies concerning cytokines, raising the hypothesis of specific immunological etiological factors. Antibody studies support the existence of a potential autoimmune etiological factor. Infections may also provoke OCD symptoms, and therefore, could be considered as specific etiological factors with specific immunological impairments. Finally, we underline the importance of distinguishing between different etiological factors since some specific treatments already exist in the context of immunological factors for the improvement of classic treatments.

Trichotillomania is more related to Tourette disorder than to obsessive-compulsive disorder

Objective: Trichotillomania (TTM) is characterized by the pulling out of one's hair. TTM was classified as an impulse control disorder in DSM-IV, but is now classified in the obsessive-compulsive related disorders section of DSM-5. Classification for TTM remains an open question, especially considering its impact on treatment of the disorder. In this review, we questioned the relation of TTM to tic disorder and obsessive-compulsive disorder (OCD). Method: We reviewed relevant MEDLINE-indexed articles on clinical, neuropsychological, neurobiological, and therapeutic aspects of trichotillomania, OCD, and tic disorders. Results: Our review found a closer relationship between TTM and tic disorder from neurobiological (especially imaging) and therapeutic standpoints. Conclusion: We sought to challenge the DSM-5 classification of TTM and to compare TTM with both OCD and tic disorder. Some discrepancies between TTM and tic disorders notwithstanding, several arguments are in favor of a closer relationship between these two disorders than between TTM and OCD, especially when considering implications for therapy. This consideration is essential for patients.