Friday, March 27, 2015

Acquired Psychoses of Autoimmune Origin ?

      

Certainly survival and life in general is better without a psychotic family member.  (Rendering: www.olympichottub.com )






         I have written a number of posts lately lamenting that people with whom I am acquainted appear to have gone mad.   Of course, some of my commentary was figurative, especially when discussing various aspects of present day politics.  However, in the case of a few people of whom I was thinking, my comments were quite literal.    What makes a person who was functional through half a lifetime become psychotic ?    Some would attribute this to the oddness of a ticking time bomb which was covered until present day stress finally unmasked "the real problem".  Some physicians would say that it could be an early Alzheimer's disease.   However, there may be yet another cause.

             I have always been interested in autoimmune diseases and disorders.  The idea that under some circumstances, the body and its systems can turn against itself and wipe out certain target organs and systems is fascinating.   In Hashimoto's thyroiditis, for example,  the body turns against the last organ to go online, the thyroid.  Eventually, following what may be periods of low function alternated with higher inappropriate function, the thyroid produces insufficient hormone, leaving the remainder of body systems from kidneys to white blood cells functioning at a sub par level, and producing a variety of symptoms the result of varietal organ and system insufficiencies.    In juvenile diabetes, a trigger of some type, often a virus, causes the body to destroy the beta cells of the islets of langerhans of the pancreas. The person is left without the ability to make insulin.  Until the advent of externally provided insulin, this autoimmune process was fatal, and most often afflicted the young.   Multiple sclerosis, Lupus, Crohn's Disease, Lou Gehrig's Disease, Guillain-Barre Syndrome,  Henoch-Schonlein Purpura, Narcolepsy and a host of other illnesses have all been proven to be of some type of autoimmune origin.     I have been aware that there is a disorder called PANDAS which is an acute psychiatric disorder in children which is triggered by a strep infection, and that this too is felt to trigger an autoimmune reaction.

             Recently, rather than mental illness being only rarely attributed to an autoimmune cause, more attention is being given to it.  Perhaps those who have a maturity onset psychosis simply have a new onset autoimmune disorder which fuels a severe separation from reality)  In her paper Dr. Belinda Lennox examines the relevance of new onset antibody mediated encephalitic autoimmune disorder.   Late last year Dr. Belinda Lennox, a psychiatrist at Oxford University in England published a paper in which she examined the prevalence of autoimmune antibodies in people who have psychosis.   (Psychosis, for the purpose of our blog post today, is a severe separation from reality.  She examines the new disorders of antibody mediated psychosis.  She discusses the challenges of treating those with psychosis with immunologic therapy.
This is a highly important revelation as it not only explains how some of the people with whom I am acquainted suffered devastating psychoses in maturity or middle age, but it provides a strategy for treatment for such.  Dr. Lennox has found some success in using steroids, intravenous immunoglobulins, and low dose immunosuppressives, which are not generally considered items in the tool box of the psychiatrist.

           This week, a twenty-seven year old co-pilot crashed a jet into the side of a mountain in France, killing all aboard.  There were no obvious signs of psychosis prior, and the pilot has spent twenty-seven years impressing a wide variety of  people of his intelligence, kindness, competence and calm.  I couldn't help but wonder what happened which caused him to cause the deaths more one hundred and fifty plus people, and himself.

 It will be interesting to see the results of the Lennox study, and to see if her results are duplicated in studies by other research physicians.