|LETTER TO THE EDITOR
|Ahead of print publication
Immune dysfunction and bipolar disorder
Pawel Singh, Suprakash Chaudhury
Department of Psychiatry, Dr. D Y Patil Medical College, Hospital and Research Center, Dr. D Y Patil Vidyapeeth, Pune, Maharashtra, India
|Date of Submission||09-Jul-2021|
|Date of Decision||11-Jul-2021|
|Date of Acceptance||12-Jul-2021|
Department of Psychiatry, Dr. D.Y. Patil Medical College, Hospital and Research Center, Dr. D Y PatilVidyapeeth, Pimpri, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
Bipolar disorder (BD) is a serious, frequently recurrent mood disorder associated with great morbidity. Few studies have reported that neuroinflammation and peripheral immune dysregulation play a role in the pathophysiology of BD. This involves a complex interaction between immune cells of the central nervous system and periphery resulting in cellular damage through mechanisms involving excitotoxicity, oxidative stress, and mitochondrial dysfunction.,
| Case Report|| |
A 38-year-old male was brought to the psychiatric outpatient department with complaints of irritability, abusive, aggressive, and disinhibited behavior leading to him being fired from his job, inability to function normally at home, overspending, overfamiliarity, overtalkativeness, and decreased need for sleep, since last 10 days. Past history revealed two hypomanic episodes and one with depressive symptoms over the last 10 years. The patient also gave a history of substance use during the episodes. The patient's father suffered from vitiligo. On examination, white hypopigmented patches were seen all over the body (vitiligo confirmed by Dermatologist). There was also bilateral swelling in the neck, patient had tachycardia (P = 96 bpm), systolic hypertension with wide pulse pressure (blood pressure = 170/100 mmHg), gave a history of digital tremors, palpitations, weight loss despite overeating. On mental status examination, psychomotor activity was increased. He was elated, had delusion of grandeur that he is “Aghori baba” and can make it rain if he wants. The patient also had homicidal and suicidal ideas. Judgment was impaired, and insight was lacking. On laboratory testing, his serum T3, T4 were elevated, serum TSH was <0.01 mIU/ml, and anti-microsomal antibody levels were 108 IU/ml. Vitamin B12 levels were decreased (128 pg/ml); S. testosterone levels were raised (1500 mg/dl); and S. homocysteine levels were raised (65 mmol/L). MRI of the brain showed no abnormalities. On this basis, the patient was diagnosed with autoimmune thyroiditis by endocrinologist. With a diagnosis of organic bipolar affective disorder, he was started on olanzapine, divalproex sodium, neomercazole, metoprolol, and 6 electroconvulsive therapies were given, after which the patient fully recovered.
| Discussion|| |
In the case presented, BD was strongly associated with immune dysfunction. The bidirectional interaction of BD with immune dysfunction is likely responsible for the high rates of inflammatory comorbidities, such as autoimmune disorders, cardiovascular disease, and metabolic disturbances. This interaction is of particular importance as medical comorbidity is primarily responsible for early mortality in BD. Numerous biological mechanisms of the inflammatory-mood pathway have been identified that may present novel targets in the treatment of BD. Targeting the immune system shows promise for improving BD outcomes as it may allow for disease modification through the treatment of the underlying etiology (i.e., immune dysfunction). Numerous proof-of-concept clinical trials have demonstrated a positive effect of anti-inflammatory agents in BD with good tolerability. Current evidence suggests that anti-inflammatory agents, viz. N-acetylcysteine (NAC), pioglitazone, minocycline, and coenzyme Q10 may be helpful in the treatment of bipolar depression while celecoxib and NAC may have adjunctive anti-manic effects, but further research is needed. Prompt detection and thorough evaluation of comorbid immunological dysfunction can affect the outcome and prognosis of BD in similar cases.
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Conflicts of interest
There are no conflicts of interest.
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