Call for psychosis treatment overhaul after evidence of autoimmune trigger

"One of the UK’s leading psychiatrists is calling for an overhaul of the diagnosis and treatment of psychotic disorders following evidence that a small but significant fraction of cases could be triggered by an autoimmune response.

Speaking before the relaunch of a groundbreaking trial in which psychosis patients are being treated with medicines normally reserved for autoimmune conditions such as arthritis and lupus, Prof Belinda Lennox, the head of psychiatry at the University of Oxford, said she hoped the work would pave the way for new, more targeted approaches to treating conditions such as schizophrenia. This could include some patients being given immunotherapies to treat psychotic symptoms.

“It would be the first time in the whole of psychiatry that we have a diagnosis and a cause for why people develop severe mental illness,” she said."

https://www.theguardian.com/society...overhaul-after-evidence-of-autoimmune-trigger

 

I just saw that in the Grauniad.

Interesting that Fluge and Mella got their first for ME.

Although I suspect this is an offshoot of the work on autoimmune encephalopathies that we have been hearing about for maybe ten years now - which Angela Vincent has been involved with at Oxford.

But it is interesting that views in psychiatry have been so entrenched that they are probably the last specialty to try rituximab on their incurable diseases.

 

Yea Trust Me I'm a Doctor covered this around 2017? but it was known ----
From memory -
One thing I recall was that the program included a description of a small trial in a prison

• Let's say 4 tested positive for the autoantibody and responded to the treatment;
• treating the remainder yielded further + responses --- so the autoantibody test didn't seem accurate --- or there were other autoimmune diseases (different receptor).

BBC - Trust Me I'm a Doctor
Psychosis caused by an immune disorder
Surgeon Gabriel Weston meets 17-year old Nafeesa whose psychosis was suspected to be caused by an immune disorder

 

There are a number of conditions that were once the preserve of psychiatry that then had a diagnosis and a cause, it is just that usually when this happens they are shifted to a different medical specialism.

 

With dementia they've eventually funded large GWAS studies and those have identified genes ---makes you wonder why they don't use GWAS and keep going until they find genes for psychosis - schizophrenia etc.

 

Weird article, why are they highlighting this now. This is incredibly old news, over 10 years old.

 

Excuse me? Discovering and treating neurosyphilis cleared out a sizeable proportion of long stay asylum cases with psychosis. “General paresis of the insane”

Reading to the end of the article we discover why this nothingburger is being reported on. She needs participants for her trial! Of course, the problem is that immunotherapy has fairly limited efficacy in autoantibody positive cases. Many of these people end up needing ECT despite aggressive rituximab, IVIG etc treatment. Especially where it has progressed to catatonia.

 

Yes, it is unclear whether it is the source or the journalism but the quotes are pretty fluffy.

 

And I hope they figure out what infectious agent it might be.

The article looks like a friend in the media bigging it up for a post-lockdown relaunch of Lennox's research program, pre funding round preparation I shouldn't wonder.

Yes its fluff but no argument about the purpose here. After my own experiences, which I admitted on my blog bio felt like AIDS crossed with schizophrenia, I dont doubt there may be immunological causes for a significant proportion of psychosis cases and feel such research is probably worth doing, as we could all benefit from knowing more.

I also feel sincere concern when I think of how many people may be out there being diagnosed with a mentally ill label and fed mind altering psychiatric drugs when the root of their condition is immunological. I only avoided a similar fate because I was aware of the risk of that kind of diagnosis and my theatrical experience enabled me to rise above and encompass my cognitive and emotional difficulties and "act sane", which I still endeavour to do!

Though in my case the predisposition to psychosis which at first accompanied my undiagnosed ME CFIDS in the late eighties slowly changed over a few years, in a similar way to the shifting symmetrical pains in my joints and shifting patterns of recurring viruses I experience. Of course the problem with admitting you have experienced psychosis is that people will then doubt every word you say and check it in the filter of "is he mad?" which is a double edged sword in a situation like this where facing the reality of immuno-psychiatric interactions is potentially a way through to better understanding and treatments but also presents the pitfall of being stereotyped in such a way that ones own opinions are negated and one is consigned to the status of verbose idiot.

So I will sit it out, cross my fingers and hope for the best but believe there is more to find out about this, my expectation is that in years to come people will look back at these days as a gradual emergence from a dark age of ignorance, just as we look back on the suffering of humanity before the discovery of penicillin with a mixture of horror, pity and gratitude.

 

They did. Schizophrenia GWAS identified an immune cause, but because the illness is triggered during development you would have to treat people before they develop symptoms which is not really feasible because not everyone with those genes develops the condition so you would end up giving potentially dangerous treatment to healthy teenagers. Even if the cause is immune, once the illness is developed it is too late to eliminate the trigger. That is my understanding of it, anyway. It is like narcolepsy or type 1 diabetes - we know the cause is autoimmune but when the patients are diagnosed it is already too late.

 

Schizophrenia GWAS identified an immune cause --- could you post a link(s)? Thanks.

 

I don’t have any specific links but it has been known for decades that schizophrenia risk is increased by maternal flu in early pregnancy. Knowing that something has an immune cause doesn’t imply the solution is immune treatment. An immune trigger can apparently set off a chain of events that permanently alter brain development.