Jessica actually suffers from an autoimmune disease caused by a streptococcal bacterial infection. His illness was a form of pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS). When the infection was identified and treated, her symptoms eventually began to improve.

Ms. Huston is not the only person with a brain dysfunction that is mistaken for a mental disorder. A lot of evidence shows that a series of infections can cause conditions such as obsessive-compulsive disorder, tic, anxiety, and even psychosis. Inflammatory and metabolic disorders can also have significant effects on mental health, although they are rarely considered by psychiatrists.

Rethinking the cause of mental disorders could have profound implications for the millions of people with mental illnesses who are currently undertreated. For example, more than 90% of patients with bipolar disorder develop recurrent illnesses during their lifetime. More than 46% of children with obsessive-compulsive disorder do not recover. About 50 to 60 percent of patients with depression eventually recover after trying different drugs. A deeper understanding of the biological components of mental health can lead to more accurate diagnoses and more targeted treatments.

There is a lot of overlap between the symptoms of depression and anxiety, and some question whether they are really separate illnesses. At the same time, depression and anxiety exist in different forms. For example, panic disorder with and without agoraphobia are different diagnoses, but we may not find significant differences between them. This can lead to a high diversity of patients participating in drug trials, and these trials do not achieve results due to the few commonalities and large differences among the participants.

Previous attempts to find causal mechanisms for mental illness have been challenging. In 2013, the National Institute of Mental Health tried to distance itself from research based on classifications based on DSM symptoms. Huge budgets have been spent on research into brain disease processes with the hope of linking genes directly to behaviors. But this idea ultimately failed and most of the genes discovered had small effects.

Although genes may play a role in mental disorders, they are not the only answer. Many disorders such as schizophrenia, attention deficit hyperactivity disorder, anxiety, and autism can be caused by genetic disorder 22q11.2, in which part of chromosome 22 is deleted, says Ludger Tebartz van Elst, professor of psychiatry and psychotherapy at Freiburg University Hospital in Germany.

In 2007, studies conducted at the University of Pennsylvania showed that 100 patients with psychiatric symptoms or cognitive deficits actually had some kind of autoimmune disease. Their bodies were making antibodies against a key receptor in nerve cells called the NMDA receptor. This leads to swelling of the brain and can cause a wide range of symptoms including paranoia, hallucinations, and aggression. The disease described was called anti-NMDA receptor encephalitis, and in many cases, it was treatable by removing the antibodies or using immunotherapy drugs or steroids. Studies conducted on patients who had the first episode of psychosis have shown that between 5 and 10 percent of them also had antibodies that attack the brain.

It seems that in rare cases obsessive-compulsive disorder can also be caused by the immune system. This condition is seen in childhood PANDAS, which Ms. Houston was diagnosed within 2021. This disorder is sometimes seen in adults as well. A 64-year-old man spent a lot of time mowing his lawn, but the next day he felt remorse and guilt. The researchers found that these symptoms are caused by antibodies attacking the neurons in his brain.

Recently, Belinda Lennox, director of the Department of psychiatry at the University of Oxford, conducted experiments on thousands of patients with psychosis. He has found antibodies in blood samples of about 6% of patients, which mainly target NMDA receptors. He says it’s not clear how a set of antibodies can cause clinical symptoms ranging from seizures to psychosis to encephalitis. It’s also not clear why these antibodies are made or if they can cross the blood-brain barrier (the membrane that controls access to the brain). He hypothesizes that antibodies cross the blood-brain barrier and affect memory by binding to the hippocampus, leading to delusions and hallucinations.

Studies of patients with immune-mediated psychosis show that a wider range of strategies, including the removal of antibodies and the use of immunotherapy drugs or steroids, can be effective treatments.

People with myalgic encephalomyelitis/chronic fatigue syndrome (an infectious disease associated with a range of cognitive problems such as difficulty concentrating and paying attention) were once neglected or diagnosed as retarded. New research shows that myalgic encephalomyelitis is related to both immune disorders and metabolic disorders.

Metabolic disorders can also affect mental health. The brain is an extremely energy-demanding organ, and metabolic changes related to energy pathways are involved in various disorders, including schizophrenia, bipolar disorder, psychosis, eating disorders, and major depressive disorder.

At Stanford University, there is a metabolic psychiatry clinic where patients are treated with diet and lifestyle changes along with medication. An active area of ​​research at this clinic is the potential benefits of a ketogenic diet, where carbohydrate intake is limited.

A ketogenic diet forces the body to burn fat for energy, creating chemicals known as ketones, which can be used as a fuel source in the brain when glucose is limited.

The preliminary results have shown that a large group of patients respond to these treatments in a meaningful way. Medicines, talk therapy, brain magnetic stimulation, and maybe electroshock therapy have not been effective for this group of patients.

It is not just the understanding of the immune and metabolic systems that is improving. Massive amounts of data are now being analyzed at unprecedented speed to reveal connections that were previously hidden from view. This could ultimately lead to more personalized and better treatments.

In early October 2023, the UK Biobank published data showing that people with depressive episodes had higher levels of inflammatory proteins such as cytokines in their blood. According to another study, about a quarter of depressed patients showed evidence of mild inflammation. Knowing this can be helpful because other research shows that patients with inflammation respond poorly to antidepressants.

There are new advances in understanding the underlying causes of mental disorders. A group of researchers are investigating different ways to improve the diagnosis of ADHD; Like classifying patients into different subgroups, some of which were previously unknown. Different groups of researchers announced in three different statements in February 2024 the discovery of biomarkers that can predict the risk of dementia, autism, and psychosis.

The search for better diagnostic tools is also likely to be accelerated by the use of artificial intelligence. A company called Cognoa is using artificial intelligence to diagnose autism in children by analyzing videos of their movement behaviors in doctors’ waiting rooms.

The Quantitative Biosciences Institute (QBI) in California has used artificial intelligence to create an entirely new map of the interactions between proteins and molecular networks involved in autism. This will greatly facilitate finding diagnostic and therapeutic tools.

The developments mentioned are promising. But many problems can be solved by reducing the gap that exists today between neurology and psychiatry. Neurology studies and treats physical, structural, and functional disorders of the brain, while psychiatry deals with mental, emotional, and behavioral disorders. Dr. Lennox envisions a future in which antibody testing is performed when a person who develops a sudden mental breakdown after a viral infection fails to recover with standard treatments.

According to Dr. Tebartz van Elst, the gap between neurology and psychiatry is greater in Anglo-Saxon countries (including the United States, Great Britain, Canada, and New Zealand). In Germany, psychiatry and neurology are closer together, so neurologists are trained in psychiatry and psychiatrists are trained in neurology for one year. This makes research work easier.

For most patients who are first diagnosed with psychosis or other severe psychiatric syndromes, Dr. Tebartz van Elst prescribes brain MRIs, electroencephalograms, laboratory tests for inflammation, and lumbar punctures in order to better treat them by finding clues to the cause of the illness. Submitted.