• Welcome to Phoenix Rising!

    Created in 2008, Phoenix Rising is the largest and oldest forum dedicated to furthering the understanding of and finding treatments for complex chronic illnesses such as chronic fatigue syndrome (ME/CFS), fibromyalgia (FM), long COVID, postural orthostatic tachycardia syndrome (POTS), mast cell activation syndrome (MCAS), and allied diseases.

    To become a member, simply click the Register button at the top right.

Psychosis may be an immune disorder

chipmunk1

Senior Member
Messages
765
NMDA is a single receptor. there are thousands of other processes that could become dysfunctional, and affect our central nervous system.

i'm guessing that 85-99% of all psychiatric disorders, are actually biomedical disorders.

The problem is that they are far more likely to catch the most severe and obvious problems while more subtle and obscure problems will be sent to CBT.
 

taniaaust1

Senior Member
Messages
13,054
Location
Sth Australia
The immune system attacks the brain in autoimmune encephalitis, and again it is the NMDA receptor that is involved.

"However, the large majority of patients develop other symptoms for example seizures or abnormal movements," said Dr Josep Dalmau, from the University of Barcelona, who made the key breakthrough in understanding autoimmune encephalitis.

He added: "These usually bring the diagnosis to the doctors, so I think [considering] the number of patients you may have in a psychiatric institution with well established psychotic disorder for several months or years, the likelihood they have these antibodies is extremely low

umm but when the psych patients develop movement disorders don't the drs then commonly blame it on med side effects? or say the movement disorder is psychological.....
 

roller

wiggle jiggle
Messages
775
umm but when the psych patients develop movement disorders don't the drs then commonly blame it on med side effects? or say the movement disorder is psychological.....

so what?
now they blame it on "autoimmune" :(

ridiculous. all of them.
 

anciendaze

Senior Member
Messages
1,841
Notice that the change in diagnosis comes from clinical signs apparent to medical doctors without special psychiatric training. I'm still waiting for an example of a psychiatric diagnosis falsifiable within psychiatry. I'm particularly concerned about organic disease, not alternate psychiatric diagnoses. Diagnosing TB at autopsy is not what I consider a valid differential diagnosis for depression. Until we get such gross errors out of the system we won't have a chance of dealing with more subtle problems.

There is an M.D. PhD. at Cold Spring Harbor who specializes in the most serious psychiatric problems, especially those with a pattern of inheritance: Gholson Lyon. He has been quoted as saying that when anyone tells him they are researching "depression" or "schizophrenia" without further subtyping he stops listening -- because they are investigating a single disease which does not exist.

I don't know that his work has any direct relevance to ME/CFS, but I find it refreshing that a researcher with such strong qualifications who has been trained in psychiatry can question the major conditions which the profession takes for granted.
 

Sidereal

Senior Member
Messages
4,856
Very poor quality and misleading article by the BBC, as usual.

Looking at the Lancet Psychiatry paper, there was no statistically significant difference in prevalence of all the autoantibodies they measured in people with first-episode psychosis (9%) vs controls (4%). Once they eliminated all the antibodies apart from the anti-NMDAR, the difference became statistically significant due to 3% of the patients and 0 controls having this antibody. Numerous previous studies have looked at this particular antibody and its association to psychosis symptoms is well established so this study adds nothing new in that regard. There is no indication that psychosis is caused by an autoimmune encephalitis for the vast majority of patients presenting to psychiatric services with first-episode psychosis symptoms.
 

alex3619

Senior Member
Messages
13,810
Location
Logan, Queensland, Australia
Gholson Lyon. He has been quoted as saying that when anyone tells him they are researching "depression" or "schizophrenia" without further subtyping he stops listening -- because they are investigating a single disease which does not exist.
Yes, I call it a category mistake. Depression is a great example. There are many causes, and with many variations of symptoms, yet its primarily thought of as depression. Its a hodgepodge of different things, lumped together by a range of similar symptoms. Until psychiatry moves away from this model I think research is going to be mostly directed at the wrong things, and get nowhere.

Most psychiatric diagnoses are hypothesized diagnoses. Nobody doubts the symptoms and problems have real impact on people, its the diagnostic categories that are in doubt, and make research difficult.

Subgroups would be one way to deal with this.

I was thinking along these lines because we see the same issues in CFS, and especially BPS views of CFS.

Depression is a hodgepodge created due to a symptom. Weak definitions of CFS, like Oxford, have a similar problem. How is it acceptable to define a disease based on a single symptom?

Stronger definitions of CFS, and ME, have less of this problem. However even with ME there are probably different subgroups lumped together. Subgrouping is what some researchers hope to do with ME.
 

PennyIA

Senior Member
Messages
728
Location
Iowa
NMDA is a single receptor. there are thousands of other processes that could become dysfunctional, and affect our central nervous system.

i'm guessing that 85-99% of all psychiatric disorders, are actually biomedical disorders.
That's what I was about to say. It may just be that 3% of these are caused by NMDA, but if this opens up research we may find there are other operators involved with other psychosis diagnosis... I'd love to see the day when we have real cures for conditions that have been treated by therapy and symptom management that hasn't been ideal for many decades.

My own son realizes he is probably bipolar but knows too many people who hate the way they feel on the drugs to treat it so he avoids seeking a diagnosis of it.
 

PennyIA

Senior Member
Messages
728
Location
Iowa
umm but when the psych patients develop movement disorders don't the drs then commonly blame it on med side effects? or say the movement disorder is psychological.....

I do know two people diagnosed with bipolar disorder who tell me their doctors more or less ignore any and all symptoms and insist any medical condition needs to be screened by the psychiatrist first. :(
 

Hip

Senior Member
Messages
17,824
Ever since I read a story some years ago, of one girl who developed sudden severe psychosis, and was about to be incarcerated into an institution, but luckily someone figured out that the cause was anti-NMDA receptor encephalitis, which is treatable, and she made a full recovery, I started to wonder just how many people with psychosis in institutions or under heavy anti-psychotic medication might have this anti-NMDA receptor encephalitis.

If 3% do have anti-NMDA receptor autoantibodies, and if this is the cause of their psychosis, and if it can be successfully treated using immune modulating drugs like rituximab, then it could save at least some people being heavily drugged up with anti-psychotics and possibly institutionalized for years or decades.



I strongly suspect that organic causes are more like 100%, we just have not figured it out yet.

I do too, and since we know that NMDA receptor autoantibodies can cause psychosis, it would make sense to search for other autoantibodies that might be behind the other cases of psychosis / schizophrenia.
 

anciendaze

Senior Member
Messages
1,841
We don't have to argue about 100% being organic when even 3% are definite. The point which keeps getting missed is that misdiagnosis condemns some number of real people to long-term disability or death. Further this disability is not like being crippled but having use of your mind, like Stephen Hawking -- even your mind is gone.

Arguments about the condition being rare amount to saying it isn't worth the cost to screen these patients out because their lives are not worth the effort.
 

Hip

Senior Member
Messages
17,824
The point which keeps getting missed is that misdiagnosis condemns some number of real people to long-term disability or death.

I do not really follow the point you are making here. Can you explain it in different words please.
 

anciendaze

Senior Member
Messages
1,841
When an organic illness is treated as if it were psychological, and the physiological cause is left uncorrected, there is a very real chance it will completely disable the patient, or even kill them. I know of a case of miliary TB where the patient died after being treated with ECT. I can point to figures for mortality and life expectancy among those with "serious mental illness", as currently defined, which look bad even compared with prospects for patients being treated for cancer.

As an example, consider the incidence of seizure disorders, which can easily become disabling or even fatal. Seizures are regularly found in cases of autoimmune encephalitis. One well-known fact about seizures is "kindling", the more seizures you have, the higher the probability of further seizures. Neglecting a treatable cause can result in irreversible neurological damage and long-term disability.

I am arguing against the idea that psychiatric treatment is harmless, provided the treatment itself does not cause measurable harm, but merely suppresses symptoms. Neglecting a seizure disorder is an example that can lead to death or permanent disability when it finally becomes impossible to ignore. I am thinking of a case that ultimately produced a seizure that broke the patient's back.

Another problem shows up with stroke, and I am aware of cases where a patient's strange movements were blamed on schizophrenia, when a nurse transferred in from a different ward took one look and said "call the doctor, this man has had a major stroke." She was right.

The incidence of mental illness, at least once in life, is surprisingly high. If only 3% of a million patients have a condition like autoimmune encephalitis we are still talking about 30,000 people, a number like the casualty list from a substantial war.
 
Last edited: