Systemic Psychiatry Reviews
Psychiatry at the interface of systemic disease and brain health
Systemic Psychiatry is an international, unified platform dedicated to the scientific and clinical understanding of mental disorders in the context of systemic biological processes and complex medical comorbidity. We provide a forum for research that integrates psychiatry with immunology, metabolism, cardiovascular medicine, infection science, palliative care, neurology and other medical specialties.
Our primary aim is to advance mechanistic insight, diagnostic precision, therapeutic innovation and service design for psychiatric conditions in which systemic pathophysiology—immune, metabolic, cardiovascular, infectious or multisystem—is central to aetiology, course or outcome.
Scope
- Neuro-immune and autoimmune psychiatry, including autoimmune encephalitis and post-infectious psychiatric syndromes
- Infection-associated and post-viral neuropsychiatry (e.g., long-COVID and related conditions)
- Metabolic psychiatry, including metabolic endophenotypes, obesity, insulin resistance, mitochondrial dysfunction and dietary/metabolic interventions
- Cardiovascular–psychiatric interfaces, including psychocardiology, cardiometabolic risk in serious mental illness, and psychiatric consequences of cardiovascular disease
- Multimorbidity, complex-care pathways and frailty in psychiatric populations
- Palliative psychiatry and the management of severe and persistent mental illness (SPMI), including symptom palliation, care planning and ethical/legal considerations
- Cross-cutting mechanisms: inflammation, endocrine and metabolic signalling, autonomic dysfunction, microvascular injury, oxidative stress, sleep/circadian disruption, microbiome–brain interactions
- Precision approaches to diagnosis and treatment, including biomarkers, stratification frameworks, computational and mechanistic RCTs
- Implementation science and integrated service models spanning primary, secondary and tertiary care
- Ethical, policy, legal and health-economic analyses relevant to systemic mechanisms in psychiatry
Now published:
Is dementia-related myoclonus a biomarker of disease progression or severity, or does it represent a distinct subtype?
Summary
Dementia-related myoclonus is a frequent but often under-recognised manifestation of several neurodegenerative disorders, especially dementia with Lewy bodies and Creutzfeldt–Jakob disease, where it may be common, relatively early, and associated with more severe and rapidly progressive disease. It is thought to arise mainly from cortical hyperexcitability linked to neurodegeneration, inflammation, disrupted inhibitory neurotransmission and altered excitatory signalling, and it can substantially worsen disability by increasing falls, sleep disturbance, carer burden, healthcare costs and reduced quality of life. Diagnosis relies on clinical assessment supported by EEG, EMG, somatosensory evoked potentials and neuroimaging to exclude treatable mimics, while management may involve clonazepam, levetiracetam or valproate, together with non-pharmacological strategies, carer support and multidisciplinary care; however, stronger evidence is still needed on prevalence, carer impact and the cost-effectiveness of interventions.
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Le myoclonus lié à la démence est-il un biomarqueur de la progression ou de l’agressivité de la maladie, ou constitue-t-il un sous-type distinct ?
Résumé
La myoclonie liée à la démence est une manifestation fréquente mais souvent sous-reconnue de plusieurs troubles neurodégénératifs, en particulier la démence à corps de Lewy et la maladie de Creutzfeldt-Jakob, où elle peut être courante, relativement précoce et associée à une maladie plus sévère et plus rapidement progressive. On pense qu’elle résulte principalement d’une hyperexcitabilité corticale liée à la neurodégénérescence, à l’inflammation, à une perturbation de la neurotransmission inhibitrice et à une altération de la signalisation excitatrice, et elle peut aggraver sensiblement le handicap en augmentant les chutes, les troubles du sommeil, la charge des aidants, les coûts de santé et la détérioration de la qualité de vie. Le diagnostic repose sur l’évaluation clinique, étayée par l’EEG, l’EMG, les potentiels évoqués somesthésiques et la neuro-imagerie afin d’exclure des diagnostics différentiels traitables, tandis que la prise en charge peut inclure le clonazépam, le lévétiracétam ou le valproate, ainsi que des stratégies non pharmacologiques, le soutien aux aidants et une prise en charge pluridisciplinaire ; toutefois, des données plus solides restent nécessaires concernant la prévalence, l’impact sur les aidants et le rapport coût-efficacité des interventions.
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Ya disponible:
¿El mioclono relacionado con la demencia es un biomarcador de la progresión o la gravedad de la enfermedad, o constituye un subtipo distinto?
Resumen
La mioclonía relacionada con la demencia es una manifestación frecuente, aunque a menudo infrarrepresentada, de varios trastornos neurodegenerativos, especialmente la demencia con cuerpos de Lewy y la enfermedad de Creutzfeldt-Jakob, en las que puede ser común, relativamente temprana y asociarse a una enfermedad más grave y de progresión más rápida. Se considera que se debe principalmente a una hiperexcitabilidad cortical vinculada a la neurodegeneración, la inflamación, la alteración de la neurotransmisión inhibitoria y cambios en la señalización excitatoria, y puede agravar considerablemente la discapacidad al aumentar las caídas, las alteraciones del sueño, la carga para los cuidadores, los costes sanitarios y el deterioro de la calidad de vida. El diagnóstico se basa en la evaluación clínica, respaldada por EEG, EMG, potenciales evocados somatosensoriales y neuroimagen para descartar diagnósticos diferenciales tratables, mientras que el manejo puede incluir clonazepam, levetiracetam o valproato, junto con estrategias no farmacológicas, apoyo a los cuidadores y atención multidisciplinar; no obstante, siguen siendo necesarios datos más sólidos sobre la prevalencia, el impacto en los cuidadores y la coste-efectividad de las intervenciones.
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DEMENTIA-RELATED MYOCLONUS
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Navigating the electrophysiological landscape of cortical myoclonus
How do giant SEPs differentiate cortical from subcortical forms?
How do MRI and EEG findings differ across myoclonus disorders?
What is jerk-locked back-averaging?
What role does the cerebellum play in myoclonus disorders?
How does burst duration distinguish cortical from non-cortical myoclonus?
How do C-reflexes help diagnose cortical reflex myoclonus?
How do Purkinje cell pathologies affect myoclonus development?
What are the common causes of subcortical myoclonus?
Myoclonus: clinical classification, neurophysiology, and diagnostic challenges
Understanding the hyperexcitable brain and myoclonus
The neurophysiology of myoclonus: a primer on identifying brain generators