By: Dr Farhad Faridhosseini Psychiatrist Mashhad Medical University

 Prevalence of HTLV-1 seropositivity in psychiatric patients.  Psychiatric complications in HTLV-1 carriers or patients.  Psychiatric assessment of these patients.  Pharmacologic & Psychotherapeutic interventions

Indirect evidence suggest that viral infection during CNS development may be involved in the pathogenesis of schizophrenia: (1) an excess number of patient births in the late winter and early spring (2) an association between exposure to viral epidemics in utero and the later development of schizophrenia. (3) a higher prevalence of schizophrenia in crowded urban areas (4) seroepidemiological studies indicting a higher infection rate for certain viruses in schizophrenia patients or their mothers:  Borna virus, Influenza, Rubella

 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.

 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)

 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)

 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)

 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)

 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

 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.

 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)

 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.

 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.

 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