Pathogenesis and Diagnostic Indicators for Antiphospholipid Syndrome (APS) in Psychiatry-Dr Sanil Rege

Posted on: May 6, 2019
Last Updated: April 27, 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 

The question is, are they biomarkers? Could antiphospholipid antibodies be biomarkers, telling us we need a different kind of treatment?

So, are psychiatric disorders manifestations of autoimmunity? For a subset – a very high biological plausibility is present.

I think we may have a range of other medications in the future; N-acetyl cysteine, coenzyme Q10, lipoic acid, curcuma (recent trials being done there) – so there’s a lot of other aspects I think might come out in the future.

Summary

Dr. Sanil Rege begins this video excerpt with a look at Sneddon’s Syndrome and livedo reticularis and discusses some clinical cases.  

Moving to discuss the APS pathogenesis, Dr. Rege explains how the first hit might be infections, but that there seems to be a need for a second hit that then results in the formation of ß2-GPI complexes. 

He presents the diagnostic challenge of aspirin vs placebo effect and discusses when to suspect antiphospholipid syndrome in psychiatry. 

Concluding this presentation, he discusses the connection between trauma, stress, and the immune system, and examines whether psychiatric disorders are manifestations of autoimmunity. 

 

 

Take-home Points  

  • Aspirin, omega 3 and statins are three evidence-based treatments with benefits in both psychiatric disorders and thrombotic illnesses. 
  • Medical evaluations are extremely important and the psychiatrist must first and foremost be a physician. 
  • Psychiatrists should pay attention to the milder incomplete cases of anti-NMDA encephalitis; SLE and NPSLE. 

Quiz

Learn more

  1. Antiphospholipid Syndrome (APS) in Psychiatry – Neuropsychiatric Manifestations – Dr Sanil Rege
  2. Neuroinflammation Simplified – The Link Between the Immune System and The Brain- Dr Sanil Rege
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  6. Observed Clinical Activity (OCA) and MEQ – Passing the RANZCP Exam- Dr Sanil Rege
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  8. Psychiatric Formulation and Management- Tips and Techniques- Dr Sanil Rege
  9. A Summary of 3 Important Autoimmune Neuropsychiatric Disorders for Psychiatrists – Dr Sanil Rege
  10. What is Regression Analysis in Critical Appraisal? – Dr. Sanil Rege
  11. Principles of Entrepreneurship and Innovation in Medicine – Dr Sanil Rege
  12. The Power of Serendipity and Multidisciplinary Learning in Medicine – Solving a Complex Clinical Case- Dr Rege
  13. Psychiatry Exams – What’s the Right Mindset?- Dr Sanil Rege
  14. Psychiatry Trainee to Consultant Psychiatrist – Skills Breakdown- Dr Sanil Rege
  15. From Psychiatry Trainee to Consultant Psychiatrist – Stages of Training for the RANZCP Exams- Dr Sanil Rege
  16. From Psychiatry Trainee to Consultant Psychiatrist- Dr. Sanil Rege

References 

(additional references are available from the presentation slides)  

  1. Rege S, Hodgkinson SJ. Immune dysregulation and autoimmunity in bipolar disorder: Synthesis of the evidence and its clinical application. Aust N Z J Psychiatry. 2013 Dec;47(12):1136-51.
  2. Muscal E, Brey RL. Neurologic manifestations of systemic lupus erythematosus in children and adults. Neurol Clin. 2010;28(1):61-73 
  3. Aerni A, Traber R, Hock C, et al. Low-dose cortisol for symptoms of posttraumatic stress disorder. Am J Psychiatry. 2004 Aug;161(8):1488-90.  
  4. Dalmau J, Lancaster E, Martinez-Hernandez E, Rosenfeld MR, Balice-Gordon R. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol. 2011 Jan;10(1):63-74.