Jessica Huitson began experiencing tics at the age of 12. As time passed, her condition got worse, leading to severe body spasms and trips to the hospital. However, the hospital in her town, located in Durham, England, did not take her symptoms seriously. They thought she was just anxious and spending too much time on TikTok, a mental health issue.
Tics are quick, repeated movements or sounds that a person makes without meaning to. They happen because of certain neurological conditions, such as Tourette syndrome. Tics can be simple, like blinking, sneezes or hiccups or complex, like a series of movements or words.
Jessica’s mother found the situation to be belittling (humiliating). Jessica had an autoimmune condition called Paediatric Autoimmune-Neuropsychiatric Disorders (PANDAS), which was brought on by a Streptococcus bacterial infection. Jessica mentioned to The Economist that once the infection was treated, her health began to improve.
Autoimmune condition is when the body’s defense system mistakenly attacks its own cells, thinking they are harmful. This can lead to various health problems and illnesses.
Ms. Huitson is not the only one whose brain issue has been wrongly thought of as a mental problem. More and more proof shows that certain infections can sometimes cause issues like obsessive-compulsive disorder (OCD), tics, anxiety, depression, and even psychosis.
Infections are just one part of the issue. It’s becoming more evident that inflammatory disorders and metabolic conditions can strongly impact mental health, but psychiatrists often don’t consider them. This reflects significant challenges in psychiatry.
A new way of thinking could greatly help the many individuals with mental health problems that are currently not treated effectively.
For instance, more than 90% of people with bipolar disorder will experience repeated illness or disorders over their lifetimes. In children with obsessive-compulsive disorder (OCD), over 46% do not get better completely. Around 50-60% of individuals with depression see improvement after trying various medications.
Some experts believe that a better knowledge of the biological aspects of mental health, linked to specific biological markers that could be identified through lab tests, will result in more precise diagnoses and more effective treatments.
Evaluating the Expertise of Mental Health Professionals”?
In the past, psychiatry has mainly concentrated on describing and categorizing symptoms instead of investigating the root causes.
The Diagnostic and Statistical Manual of Mental Disorders (DSM), often referred to as the psychiatry guidebook, was first published in 1952. It includes information on symptoms and criteria for diagnosis. While it has provided consistency in diagnosing, the manual has also categorized patients without understanding the root causes of their conditions. The symptoms of depression and anxiety are so similar that some people question whether they should be seen as different types of illnesses or if they are actually closely related. Additionally, depression and anxiety have various subtypes; for instance, panic disorder with or without agoraphobia are different diagnoses, although not all of them may be significantly different from each other. The variation among participants in drug trials can be so significant that the effectiveness of medications and treatments may be compromised, particularly if the group being studied lacks sufficient common characteristics.
Agoraphobia is a fear of being in situations where escape might be difficult or help wouldn’t be available if things go wrong. This often includes fear of crowded places, open spaces, or being outside alone, leading people to avoid these situations.
In 2013, the National Institute of Mental Health, a U.S. government agency, took a bold step by shifting its research focus away from the symptom-based categories of the DSM (Diagnostic and Statistical Manual of Mental Disorders), according to The Economist. This move was aimed at overcoming challenges in identifying the underlying causes of mental health conditions. Funds were directed toward basic research on how the brain functions in disease, with the goal of linking specific genes directly to behaviors. About $20 billion was invested in new research, but the approach largely failed because most of the genes identified had only minor effects. Allen Frances, a psychiatry professor at Duke University, described the search for biomarkers as highly interesting from a scientific standpoint, but noted that it has been completely unsuccessful in improving clinical treatments, reports The Economist.
Biomarkers are biological indicators meant to help diagnose or predict health issues, but in this case, they haven’t delivered practical results in patient care.
Ludger Tebartz van Elst, a psychiatry and psychotherapy professor at the University Hospital Freiburg in Germany, told The Economist that a single genetic issue, known as 22q11.2 deletion syndrome, which involves losing a small segment of chromosome 22, can lead to various conditions like schizophrenia, ADHD, anxiety, and autism. This shows that genes alone do not provide all the answers to these health issues.
Despite these challenges, there’s hope for change in psychiatry, partly due to renewed interest in identifying neurological biomarkers using advanced technology. Moreover, there’s a growing recognition that certain mental health issues stem from underlying medical conditions that need medical treatment, not just psychiatric care.
Essential Health
A crucial discovery occurred in 2007 at the University of Pennsylvania, where researchers found that 100 patients with fast-developing psychiatric symptoms or cognitive (thinking) problems were actually suffering from an autoimmune disease. Their bodies were producing antibodies that attacked crucial components in nerve cells called NMDA receptors. These receptors are important for communication between nerve cells in the brain and are involved in memory and learning. This condition causes brain swelling and can result in various symptoms like paranoia, hallucinations, and aggression. It was named “anti-NMDA receptor encephalitis. “Crucially, this condition can often be treated by eliminating the antibodies or using drugs for immune therapy or steroids. Research shows that between 5% and 10% of patients experiencing their first psychotic episode also have these antibodies that attack the brain.
It appears that in rare instances, the immune system might also cause OCD. This is observed in the childhood condition known as PANDAS, which Ms. Huitson was diagnosed with in 2021.However, this condition can also occur in adults. For instance, a 64-year-old man excessively trimmed his lawn, only to feel regret and guilt about his actions the following day. Researchers discovered that his symptoms were caused by antibodies attacking the neurons in his brain.
Recently, Belinda Lennox, a leading psychiatrist at the University of Oxford, reported by The Economist, has examined thousands of psychosis patients. She discovered that about 6% of these patients have higher levels of antibodies in their blood, primarily affecting the NMDA receptors. She notes that it’s still unclear how the same antibodies can cause a range of symptoms from seizures and psychosis to encephalitis. It’s also unclear why these antibodies are produced or whether they can pass through the blood-brain barrier, which regulates entry to the brain. However, Lennox suspects that they do get through, mainly attaching to the hippocampus. This attachment could explain their impact on memory and how they lead to delusions and hallucinations.
Encephalitis is an inflammation of the brain, often caused by an infection or the immune system attacking the brain, leading to symptoms like headaches, fever, confusion, or seizures.
The hippocampus is a part of the brain crucial for memory and learning. It helps turn short-term memories into long-term ones and is also involved in spatial navigation ( It involves knowing where you are, finding your way to a new location, and recognizing familiar places ).
Dr. Lennox emphasizes the need for a change in medical perspective to recognize the harm the immune system can cause to the brain. She calls it the “million dollar question” whether these conditions can be treated. She’s conducting trials to learn more. Studies on patients with psychosis caused by the immune system indicate that treatments like removing antibodies and using immunotherapy drugs or steroids can be effective.
Another key finding is that metabolic issues can impact mental health. The brain requires a lot of energy, and changes in how it gets this energy are linked to various mental health conditions, including schizophrenia, bipolar disorder, psychosis, eating disorders, and major depression. Stanford University hosts a metabolic psychiatry clinic where patients receive treatment through diet and lifestyle adjustments, along with medication. The clinic is actively researching the potential benefits of a ketogenic diet, which involves limiting carbohydrate intake. This diet makes the body use fat (by burning fat) as energy, producing substances called ketones. These ketones can power the brain when there’s not much sugar available.
Kirk Nylen, the head of neuroscience at the Baszucki Group, a charity in the US focused on brain research, told The Economist that there are currently 13 international studies investigating the effects of metabolic therapies on severe mental illnesses. Initial results suggest that many people are experiencing significant benefits. He also notes that the individuals benefiting from these studies often didn’t improve with medications, talk therapy, transcranial stimulation, or even electroconvulsive shock therapy. He mentions that many psychiatrists have turned to studying metabolic treatments after seeing patients experience significant mood improvements following low-carb diets. He expects results from formal, controlled trials to be released within the next year or so.
Our knowledge of the immune and metabolic systems is growing, but that’s not all. We are now able to analyze huge amounts of data very quickly, often with the help of artificial intelligence (AI), allowing us to discover relationships that were previously overlooked.
Dr. Jung, Bring Down This Barrier
This development might finally place biology at the heart of diagnosing mental health issues, possibly leading to more personalized and improved treatments. In early October 2023, the UK Biobank, which collects biomedical data, released findings showing that individuals experiencing depressive episodes often have much higher levels of inflammatory proteins like cytokines in their blood. A study from last year discovered that around one-fourth of people with depression showed signs of mild inflammation. This information is important because other research indicates that people with inflammation tend not to react as well to antidepressant medications.
Innovation continues to advance. Several researchers are working on better ways to diagnose Attention Deficit Hyperactivity Disorder (ADHD), including dividing patients into various subgroups, some of which might have been unrecognized before. In February 2024, three different groups made announcements about finding biomarkers that could help predict the likelihood of developing dementia, autism, and psychosis. The development of improved diagnostic tools is expected to speed up with the use of artificial intelligence (AI). For example, a company called Cognoa is using AI to diagnose autism in children by analyzing videos of their behavior, which helps avoid lengthy waits for appointments with specialists. Another group, the Quantitative Biosciences Institute (QBI) in California, has utilized AI to develop a new map showing how proteins interact and form networks in cases of autism. This breakthrough will significantly aid in the development of new diagnostic tools and treatments.
These advancements are encouraging. However, many issues in the field could be addressed by softening the current boundaries between neurology, which focuses on the brain’s physical and functional disorders, and psychiatry, which concentrates on mental, emotional, and behavioral disorders. Dr. Lennox is amazed by how different the treatment options can be depending on whether a patient is in a neurology ward or a psychiatric ward. She advocates for more routine antibody testing in the UK, especially for patients who show sudden mental health issues after a virus and do not improve with usual treatments. Thomas Pollak, a senior clinical lecturer and consultant neuropsychiatrist at King’s College London, recommends using MRI scans on patients following their initial psychotic episode. He told The Economist that the scan findings could alter the treatment approach for approximately 5% to 6% of these patients.
According to The Economist, Dr. Tebartz van Elst notes that the split between neurology and psychiatry is especially noticeable in English-speaking nations such as the United States, Britain, Canada, and New Zealand.In Germany, the fields of psychiatry and neurology are closely connected. Neurologists receive training in psychiatry, and psychiatrists spend a year studying neurology during their training. This integration simplifies research and treatment approaches. He mentions that he typically provides patients experiencing their first episode of psychosis or other serious mental health conditions with several tests. These include an MRI of the brain, an electroencephalogram (EEG), blood tests for inflammation, and a spinal tap. These tests help identify the best treatment options for some patients. Dr. Tebartz van Elst explains that the cost of these tests, approximately €1,000 ($1,070), is about the same as keeping a patient in the hospital for three or four days, making it a cost-effective option.
What is the Diagnosis?
This effort will eventually provide a stronger foundation for psychiatry and its patients. It’s also starting to offer support and validation for some individuals who have not found success with traditional psychiatric methods.
Jessica Huitson is an example. Diagnosed and treated too late, she continues to battle her condition, and her future remains unclear. People with ME/CFS, a condition that follows an infection and includes cognitive issues like difficulty with attention and concentration, were once wrongly thought to be pretending to be sick or were labeled with “yuppie flu.” Recent studies indicate that it involves both immune system and metabolic problems.
ME/CFS, or Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, is a long-term illness characterized by extreme fatigue, pain, and problems with memory and concentration, not improved by rest.
“Yuppie flu” is an outdated, informal term once used to dismissively describe chronic fatigue syndrome, suggesting it primarily affected ambitious young professionals and was not a serious illness.
Some believe these conditions might only be a small part of a much bigger problem. Discovering more could lead to improved care and outcomes for patients. Biology is advancing, regardless of whether psychiatry is prepared.
(Views expressed in the article are of author’s own and do not reflect the editorial stance of Business Upturn)
