Antiphospholipid Syndrome and the Brain (Neuropsychiatric Manifestations of APS) – Dr Sanil Rege

Posted on: May 6, 2019
Last Updated: June 1, 2020

Dr Sanil Rege is a Consultant Psychiatrist and founder of Psych Scene, a platform to enhance psychiatry education and Vita Healthcare, providing high-quality mental health care services to the public. He is a Fellow of the Royal Australian and New Zealand College of Psychiatrists and Member of the Royal College of Psychiatrists (UK). His clinical and research interests include psychosis, depression, anxiety, post-traumatic stress disorders, and personality disorders. 

 

Author Quotes 

One question I started asking was, – ‘is there any symptom, any medical issue that you’ve had at any point in your life that just doesn’t seem right, that isn’t getting better?’ I find that a useful screening tool because they come up with several questions.

aPL may be implicated in antipsychotic-induced venous thromboembolisms.

Clozapine is actually associated with an increase in anticardiolipin antibodies, so the question really is – ‘Is that what might be associated with possible venous thromboembolism? Is that what possibly is associated with myocarditis, from an immune system perspective?

 

Summary

Dr. Sanil Rege begins his presentation with an overview of Antiphospholipid Syndrome (APS) and describes a few cases that he has come across. 

Covering the topic of phospholipids and the brain, he describes the relationship between the breakdown of phospholipids and the development of schizophrenia, bipolar disorder and depression. 

Moving on to present antiphospholipid syndrome in psychosis, Dr. Rege discusses the possible implications of clozapine regarding its immunomodulatory properties. He talks about an interesting subset of patients – those who develop psychosis after a thrombotic episode – and how they have been treated successfully with warfarin or heparin with the psychosis remitted. 

Next, he covers cognitive dysfunction and migraine and ends this video excerpt highlighting the connection between migraines in APS and stroke. 

Take-Home Points  

  • The ApoE2 receptor is described in Alzheimer’s and is also a pathogenic target for ß2 GPI. 
  • Migraine is one of the most commonly observed symptoms of APS although studies report contradictory results concerning any conclusive association. 
  • aPL may be implicated in antipsychotic-induced venous thromboembolism. 

Learn more about Neuropsychiatry of APS in Prof Graham Hughes talk.

Quiz

 

Learn more

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References  

  1. Cohen D, Berger SP, Steup-Beekman GM, Bloemenkamp KW, Bajema IM. Diagnosis and management of the antiphospholipid syndrome.BMJ. 2010 May 14;340:c2541.   
  2. Kurtz G, Müller N. The antiphospholipid syndrome and psychosis. Am J Psychiatry. 1994 Dec;151(12):1841-2.  
  3. Hoirisch-Clapauch S, Nardi AE. Psychiatric remission with warfarin: Should psychosis be addressed as plasminogen activator imbalance? Med Hypotheses. 2013 Feb;80(2):137-41.  
  4. Maes M, Meltzer H, Jacobs J, Suy E, Calabrese J, Minner B, Raus J. Autoimmunity in depression: increased antiphospholipid autoantibodies. Acta Psychiatr Scand. 1993 Mar;87(3):160-6.