Medical Bulletin 20/January/2024

Here are the top medical news of the day:

Obsessive-compulsive disorder linked to heightened risk of death

People with obsessive-compulsive disorder (OCD) may have an increased risk of death from both natural and unnatural causes than those without the disorder, finds a study from Sweden published by The BMJ today.

The researchers point out that many of the natural causes of death are preventable, suggesting that better surveillance, prevention, and early intervention strategies should be implemented to reduce the risk of fatal outcomes in people with OCD.

OCD is typically a long term psychiatric disorder affecting about 2% of the population. It is characterised by intrusive thoughts, urges or images that trigger high levels of anxiety and other distressing feelings - known as obsessions - that the person tries to neutralise by engaging in repetitive behaviours or rituals - known as compulsions.

OCD is also associated with academic underachievement, poor work prospects, alcohol and substance use disorders, and an increased risk of death. Previous studies on specific causes of death in OCD have mainly focused on unnatural causes (eg, suicide), but little is known about specific natural causes.

Using data from several Swedish population registers, they identified 61,378 people with OCD and 613,780 individuals without OCD matched (1:10) by sex, birth year, and county of residence, and a further sibling group of 34,085 people with OCD and 47,874 without OCD.

Average age at OCD diagnosis was 27 years and groups were monitored for an average of 8 years from January 1973 to December 2020. Overall, people with OCD had a higher death rate than matched individuals without OCD (8.1 versus 5.1 per 1,000 person years, respectively).

After adjusting for a range of potentially influential factors such as birth year, sex, county, migrant status, education and family income, people with OCD had an 82% increased risk of death from any cause. The excess risk of death was higher for both natural (31% increased risk) and, particularly, unnatural causes of death (a 3-fold increased risk).

Among the natural causes of death, people with OCD had increased risks due to respiratory system diseases (73%), mental and behavioural disorders (58%), diseases of the genitourinary system (55%), endocrine, nutritional, and metabolic diseases (47%), diseases of the circulatory system (33%), nervous system (21%), and digestive system (20%).

Reference: Obsessive-compulsive disorder linked to heightened risk of death: The BMJ; DOI:10.1136/bmj-2023-077564

Researchers find anti-HIV drugs may prevent complications from bacterial sepsis

Bacterial infections can lead to the formation of abscesses — pockets of dead cells and debris surrounded by inflammatory immune cells. Bacteria multiply within abscesses, causing more inflammation and further damage to surrounding tissues. In severe cases, these immune reactions spread across the body, resulting in life-threatening organ failure, or sepsis. But how these abscesses form and what can be done to prevent them were previously not well understood.

Using preclinical models, investigators from Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system, identified a key mechanism that may be driving liver abscess formation: a process known as reverse transcription, in which DNA is synthesized from RNA. Using RNA-sequencing, the researchers examined liver gene transcripts from mice infected with Escherichia coli. They found that abscess formation was associated with increased expression from endogenous retroviruses (ERVs), remnants of viruses that integrated into the mouse genome following past infections. The study is published in PNAS journal.

The authors hypothesized that DNA produced by ERVs can stimulate inflammatory immune responses, which damage surrounding cells and thus drive abscess development. If so, preventing the activity of the ERVs might prevent abscesses from forming. To test this, the team treated mice with a cocktail of reverse transcriptase inhibitors — antiretroviral drugs also used to manage HIV infections — to block ERV DNA expression. They found that a single dose of the inhibitor cocktail was enough to prevent abscess formation, if delivered quickly after bacterial infection.

“Our findings suggest that drugs used to treat HIV can be used to prevent inflammatory complications of bacterial sepsis,” said corresponding author Matthew Waldor, MD, PhD, of the Division of Infectious Diseases.

Reference: Researchers find anti-HIV drugs may prevent complications from bacterial sepsis; Proceedings of the National Academy of Science; DOI: 10.1073/pnas.2319162121

For people with migraine, feelings of stigma may impact disability, quality of life

Migraine can impact many aspects of a person’s life, but less is known about how feelings of stigma about the disease affect quality of life. For people with migraine, these feelings of stigma were linked to more disability, increased disease burden and reduced quality of life, according to new research published in the January 17, 2024, online issue of Neurology, the medical journal of the American Academy of Neurology.

“Stigma is common where the disease is not readily apparent to others, and there is indication that it could be especially relevant for those living with migraine,” said study author Robert Evan Shapiro, MD, PhD, of the University of Vermont and Fellow of the American Academy of Neurology. “This stigma may arise when a person with migraine recognizes negative stereotypes about the disease and experiences shame for having the disease, fear of experiencing stigma from others, or other negative emotions.”

For the study, researchers looked at 59,001 people with migraine with an average age of 41. Among all participants, 41% reported experiencing four or more headache days per month on average.

Participants answered 12 questions to assess two types of stigma: whether they felt others viewed migraine being used for secondary gain and whether they felt others were minimizing the burden of migraine. Questions included “How often have you felt that others viewed your migraine as a way to get attention?” “… as something that made things difficult for your co-workers or supervisor?” and “…with a lack of understanding of the pain and other symptoms?”

Researchers found that 32% of the participants experienced migraine-related stigma often or very often.

To assess migraine-related disability, participants reported the number of days they missed or had reduced productivity at work, home or social events over the previous three months. High scores on migraine-related stigma were linked with moderate to severe disability. Three-quarters of those who experienced stigma often or very often had moderate to severe disability, compared to 19% of those who never experienced stigma.

Reference: For people with migraine, feelings of stigma may impact disability, quality of life; AMERICAN ACADEMY OF NEUROLOGY; Neurology