Psych iatric Aspects of HTLV-1 infection

1. By: Dr Farhad Faridhosseini Psychiatrist Mashhad Medical University Psychiatric Aspects of HTLV-1 infection

2. HTLV-1

3. 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

4. Viral Hypothesis for Schizophrenia Indirect evidence suggest that viral infection during CNS development may be involved in the pathogenesis of schizophrenia: • an excess number of patient births in the late winter and early spring • an association between exposure to viral epidemics in utero and the later development of schizophrenia. • a higher prevalence of schizophrenia in crowded urban areas • seroepidemiological studies indicting a higher infection rate for certain viruses in schizophrenia patients or their mothers: • Borna virus, Influenza, Rubella

5. 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.

6. 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)

7. 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)

8. 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)

9. 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)

10. 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

11. 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.

12. 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)

13. 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.

14. 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.

15. 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

16. Thank You