Fire in the Brain: How Psychosis May Arise When the Body Attacks Itself
Antibodies made by the immune system can sometimes target human brain cells, producing psychiatric symptoms. Researchers aim to better identify such rare cases as well as fine-tune treatments The post Fire in the Brain: How Psychosis May Arise When the Body Attacks Itself appeared first on Nautilus .
In rare cases, antibodies produced by the immune system can target human brain cells, leading to psychiatric symptoms such as hallucinations and psychosis. One such patient treated by Peter Jones, a psychiatrist at the University of Cambridge, experienced vivid hallucinations of animals that persisted despite being given antipsychotic drugs.
However, when the patient received plasma exchange, a treatment for immune system malfunction, his hallucinations vanished. This case was not a typical example of schizophrenia, but rather autoimmune encephalitis, a condition where the immune system attacks the brain, causing psychosis.
Autoimmune encephalitis is often first identified through testing blood or spinal fluid for specific antibodies. If these antibodies are found, it suggests that the immune system may be attacking the brain. Other diagnostic clues include bright patches of inflammation on MRI scans, rapid worsening of psychotic symptoms, and clear neurological signs such as seizures. Despite these indicators, a patient's lack of noticeable neurological symptoms, like Jones' patient, may lead to a missed diagnosis.
Researchers are working to identify more patients with autoimmune encephalitis by screening a wider range of psychiatric patients and discovering new antibodies responsible for the condition. They acknowledge the potential for overdiagnosis and the risk of setting false hopes for those who do not actually need psychiatric treatments. The distinction between the mind and body in psychiatry and neurology is blurring, as psychosis can stem from various mental and biological factors, including physical diseases or infections.
Autoimmune encephalitis has been recognized for the past two decades, with its core features of psychosis often appearing in the early stages. In some cases, the cause of the condition is tumors containing nerve tissue with NMDA receptors, which the immune system mistakenly identifies as foreign, leading to antibody production that binds to the NMDA receptor in both healthy and diseased brain tissue.
The trigger for this condition is often mysterious, with previous infections such as herpes simplex virus in the brain being another possible cause.
Approximately 1 to 2 percent of psychosis cases are due to autoimmune causes. Untreated, patients may decline into a coma and even die. To avoid missing these patients, skilled psychiatrists look for neurological symptoms, such as seizures or catatonia. If such signs appear, blood or spinal fluid may be tested for autoantibodies, and if the results point to autoimmune encephalitis, patients undergo immunotherapy with drugs to suppress the overactive immune system.
Many patients recover fully, as seen in the case of Zandi's patients who regained their independence after immunotherapy.
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