A Nationwide Study in Denmark of the Association Between Treated Infections and the Subsequent Risk of Treated Mental Disorders in Children and Adolescents | Adolescent Medicine | JAMA Psychiatry | JAMA Network

Importance
Infections have been associated with increased risks for
mental disorders, such as schizophrenia and depression. However, the
association between all infections requiring treatment and the wide
range of mental disorders is unknown to date.

Objective
To investigate the association between all treated infections
since birth and the subsequent risk of development of any treated mental
disorder during childhood and adolescence.

Design, Setting, and Participants
Population-based cohort study using Danish nationwide
registers. Participants were all individuals born in Denmark between
January 1, 1995, and June 30, 2012 (N = 1 098 930). Dates of analysis
were November 2017 to February 2018.

Exposures
All treated infections were identified in a time-varying
manner from birth until June 30, 2013, including severe infections
requiring hospitalizations and less severe infection treated with
anti-infective agents in the primary care sector.

Main Outcomes and Measures
This study identified all mental disorders diagnosed in a
hospital setting and any redeemed prescription for psychotropic
medication. Cox proportional hazards regression was performed reporting
hazard rate ratios (HRRs), including 95% CIs, adjusted for age, sex,
somatic comorbidity, parental education, and parental mental disorders.

Results
A total of 1 098 930 individuals (51.3% male) were followed up
for 9 620 807.7 person-years until a mean (SD) age of 9.76 (4.91)
years. Infections requiring hospitalizations were associated with
subsequent increased risk of having a diagnosis of any mental disorder
(n = 42 462) by an HRR of 1.84 (95% CI, 1.69-1.99) and with increased
risk of redeeming a prescription for psychotropic medication
(n = 56 847) by an HRR of 1.42 (95% CI, 1.37-1.46). Infection treated
with anti-infective agents was associated with increased risk of having a
diagnosis of any mental disorder (HRR, 1.40; 95% CI, 1.29-1.51) and
with increased risk of redeeming a prescription for psychotropic
medication (HRR, 1.22; 95% CI, 1.18-1.26). Antibiotic use was associated
with particularly increased risk estimates. The risk of mental
disorders after infections increased in a dose-response association and
with the temporal proximity of the last infection. In particular,
schizophrenia spectrum disorders, obsessive-compulsive disorder,
personality and behavior disorders, mental retardation, autistic
spectrum disorder, attention-deficit/hyperactivity disorder,
oppositional defiant disorder and conduct disorder, and tic disorders
were associated with the highest risks after infections.

Conclusions and Relevance
Although the results cannot prove causality, these findings
provide evidence for the involvement of infections and the immune system
in the etiology of a wide range of mental disorders in children and
adolescents.

Building Bridges Between Infectious Disease Physicians and Psychiatrists

Complex problems require complex solutions with interdisciplinary cooperation.
When state mental hospitals were filled with mentally ill patients who
had syphilis, everyone recognized the close association between
infectious disease and psychiatric illness. In fact, in 1927, the first
Nobel prize in Psychiatry was awarded to Dr. Julius Wagner-Jauregg who
recognized the association between infections and mental illness and
introduced malaria inoculation, which proved to be very successful in
treating dementia paralytica. After the introduction of penicillin, the
gap between these two specialties widened with specialization and
fragmentation in medicine resulting in few physicians maintaining
updated capability in both infectious disease and psychiatry. Most
infectious disease physicians have very little current training in
neurochemistry, psychoimmunology, or the pathophysiology of mental
illness. Likewise, many psychiatrists have little current training in
infectious diseases and psychoimmunology.

More recently, this gap has been bridged by advances in evolutionary
medicine, a growing recognition of the significance of the microbiome,
improved brain imaging and testing capabilities and discoveries in
psychoimmunology which have greatly expanded our knowledge of the
pathophysiology of mental illness. Now, many, including the Center for
Disease and Prevention recognize chronic diseases and the mental
illnesses can stem from infectious agents.

Chronology of Onset of Mental Disorders and Physical Diseases in Mental-Physical Comorbidity - A National Representative Survey of Adolescents

Background

The objective was to estimate temporal associations between mental disorders and physical diseases in adolescents with mental-physical comorbidities.

Methods

 This article bases upon weighted data (N = 6483) from the National Comorbidity Survey Adolescent Supplement (participant age: 13–18 years), a nationally representative United States cohort. Onset of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition lifetime mental disorders was assessed with the fully structured World Health Organization Composite International Diagnostic Interview, complemented by parent report. Onset of lifetime medical conditions and doctor-diagnosed diseases was assessed by self-report.

Results 


The most substantial temporal associations with onset of mental disorders preceding onset of physical diseases included those between affective disorders and arthritis (hazard ratio (HR) = 3.36, 95%-confidence interval (CI) = 1.95 to 5.77) and diseases of the digestive system (HR = 3.39, CI = 2.30 to 5.00), between anxiety disorders and skin diseases (HR = 1.53, CI = 1.21 to 1.94), and between substance use disorders and seasonal allergies (HR = 0.33, CI = 0.17 to 0.63). The most substantial temporal associations with physical diseases preceding mental disorders included those between heart diseases and anxiety disorders (HR = 1.89, CI = 1.41 to 2.52), epilepsy and eating disorders (HR = 6.27, CI = 1.58 to 24.96), and heart diseases and any mental disorder (HR = 1.39, CI = 1.11 to 1.74).

Conclusions

 Findings suggest that mental disorders are antecedent risk factors of certain physical diseases in early life, but also vice versa. Our results expand the relevance of mental disorders beyond mental to physical health care, and vice versa, supporting the concept of a more integrated mental-physical health care approach, and open new starting points for early disease prevention and better treatments, with relevance for various medical disciplines."



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Molecular Psychiatry - Launching the War on Mental Illness

It is time for a concerted effort, the ‘War on Mental Illness,’ to be launched.

On 23 December 1971, the then US President Richard Nixon signed the National Cancer Act of 1971, a United States federal law. The act was intended ‘to amend the Public Health Service Act so as to strengthen the National Cancer Institute in order to more effectively carry out the national effort against cancer’.¹ This has been widely perceived as the official launch of the War on Cancer. If one looks back at 1971, we were technologically unprepared to launch such a war then. At that time, medical research was severely limited by insufficient technology—there was no magnetic resonance imaging (MRI), no positron emission tomography (PET), very rudimentary molecular biology, no genetically modified animals, no automated DNA or human genome sequencing, no personal computers, no databases, and no universal access to bibliography. Scientific manuscripts were handwritten and then typed with manual typewriters, with no possibility for cutting and pasting. A revised version of a scientific article had to be typed in its entirety from scratch. Obviously, all our current ‘omics’ platforms, such as genomics, proteomics, metabolomics and lipidomics had not even been dreamed of. Yet, the enormity of task, the audacity of the goal, and the technical limitations of the era did not prevent the launch of that ambitious and immensely successful effort. While some cancers, such as pancreatic carcinoma and glioblastoma multiforme, remain uniformly fatal, others have been, for the vast majority of patients, either cured or transformed from a death sentence into chronic illnesses that one manages and lives a long time with.

We propose that it is now the time for a ‘War on Mental Illness’ to be officially and rapidly launched, both as national efforts within various countries and also as an international initiative. The goal of that effort will be improved translation of science into health care, resulting in more efficacious treatments than what we have available today.

Why Is Exercise Good For Mental Health?

We all know that exercise is good for mental health, but why? What factors involved in physical activity, sports and/or exercise are good for our minds? Researchers from the Trimbos Institute in the Netherlands believe that certain psychological factors that are linked to exercise - mainly body image and social interaction - play major roles in boosting mental health.

Cure Alliance for Mental Illness

Cure Alliance for Mental Illness unites the energies of consumers, family members, clinicians, scientists, and other organizations to:

• educate the public and policymakers about mental illnesses as brain disorders,
• advocate for scientific research to cure mental illnesses, and
• work toward safe, effective treatments for those suffering from mental illness.

Please support this worthy cause:or this one in the UK Time to Change