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Post by Admin on Jun 29, 2016 10:27:11 GMT -4
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Post by Jennifer Ugbede on Jun 29, 2016 15:52:44 GMT -4
Psychiatric symptoms are not uncommon in patients with autoimmune disorders such as Sjogren syndrome, multiple sclerosis, autoimmune encephalitis, hashimoto thyroiditis and myasthenia gravis. The central nervous system is mostly involved in these autoimmune disorders. The role for autoimmune dysfunction in psychiatric illness has been actively investigated over the past years. Despite all the investigations no autoantibody findings have been identified as cause for disease. In most cases patients rapidly deteriorate neurologically with symptoms such paranoid and delusional thinking, agitation, changes in speech , altered level of consciousness with catatonic like features and bizarre behavior. The article clearly shows that raising awareness of psychiatric conditions that maybe immune system disorders is pivotal in diagnosis and treatment of patients especially for those who see the patients first. For example, in the emergency room. It is very important to consider autoimmune disorders as possibilities in differential diagnosis to avoid complications and tragedies.
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Gabrielle Givens (MS3)
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Post by Gabrielle Givens (MS3) on Jun 29, 2016 17:57:47 GMT -4
The article presents an interesting case in not only psychiatry, but also neurology. It also poses the question of how many psychiatric conditions could actually have medical conditions as the underlying cause for the psychiatric symptoms. As stated in this article, I believe research is needed in order to understand this connection better. Is autoimmune dysfunction to blame for the psychiatric symptoms, or does the genetic make up of these individuals also play a role in developing either or both these conditions. As a colleague stated above, many neurologic conditions can have psychiatric symptoms. It would be interesting to read studies of how these correlated with each other, and if certain treatments could improve what were once thought to be purely psychiatric disorders.
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Post by Peter Hoang (MS3) on Jun 29, 2016 19:04:23 GMT -4
This article a great reminder that medicine is a constantly changing, evolving field that is always in a state of flux. As a med student so focused on learning all the diseases, drugs, and correct answers to multiple choice questions, it’s easy to take it for granted sometimes. It is inspiring to see that there are still many avenues to explore in the search of new ways to treat psychiatric disorders. As medicine continues to become more and more specialized it is imperative that we do not forget how interconnected everything still is. This article emphasizes the fact that there is a strong possibility that immune system disorders may play a key role in causing psychiatric conditions. The question now is: Are there purely primary psychiatric conditions or are these problems all innately due to a medical condition we have yet to fully understand. This definitely needs to be researched further and shows that we need to constantly research, refine, and even redefine how medicine is practiced.
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Post by Ali Alizadeh MS4 on Jun 29, 2016 19:46:26 GMT -4
As a person with a strong family history of autoimmune disease, who has also been living with an autoimmune disease, this article strikes a familiar chord. Consequently one of my first symptoms was a sudden brain fog which left me fairly incapacitated leading to an ER visit, head CT among many other tests which revealed absolutely nothing. As in the article’s fist case study, my ER visit ended with a scolding for not coming in with an emergency and a referral to a psychiatrist. I consider myself extremely lucky as at the time I was working at my father’s Rheumatologists office, and he suggested I be tested for ANA which came back positive, allowing for prompt treatment and a dramatic improvement in my symptoms. I have since made a great many connections with others afflicted with an AI disease, and not one hasn’t had a neurological or psychiatric complaint. To be sure, the roles AI disease has in relation to the CNS and in turn psychiatric/neurological implications is currently a burgeoning field still shrouded in mystery. Evidenced by the lack of specificity in the afflicting Auto-antibodies for the initial case study. The article portrays rather well the need for Clinicians to think outside of their comfort zone, to re-evaluate current as well as past cases for immune system related psychiatric disorders. As the mother of the patient stated, not all people are lucky enough to have a Rheumatologist on hand for an expert evaluation. As such it is research, awareness, cooperation and bridging the divide between specialties which are essential to unlocking not just AI related psychiatric disorders, but rather all disease processes as well.
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Post by Aishwarya Palorath on Jun 29, 2016 20:48:11 GMT -4
When the Body Attacks the Mind
This was quite an eye-opening article regarding the connection between auto-immune activation and possible psychiatric illness. An approach that treats psychosis as a symptom of an underlying illness and not a direct root opens the door to exploring different treatment options. Studies show that a simple activation of the immune system via a viral infection can lead to feelings of despair and suicidal thoughts; with this correlation, psychosis is not a far stretch. What brings this issue into the forefront is that it is a situation that can affect anyone. Viral illness and autoimmune conditions are not far and few in between, it is relatively common that as a physician, if not even as a human being, you will encounter in your own life. Hence, awareness of autoimmune neurology is needed to recognize this possible presentation in a patient demonstrating signs of psychiatric illness. This one minor tweak in outlook and approach can drastically change treatment and thus patient’s outcome. The switch can be made by prescribing anti-inflammatory agents such as corticosteroids and aspirin instead of anti-psychotics, yielding dramatic results. Psychiatric illness is not a clean-cut, definitive illness. New research is continuously coming out that expands and re-evaluates our misconceptions regarding mental illness.
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Post by PoojaShah on Jun 29, 2016 21:33:46 GMT -4
Although I agree with much of what has been said about the article in the above comments, the article brought up a couple of concerns with me. Yes, investigating the connection between diseases (autoimmune or otherwise) and the consequent appearance of mental illness is important - especially from a treatment standpoint. But with the discovery that mental illness could be the symptom of a deeper problem and not the problem itself, will that once again bring skepticism to the world of psychiatric problems? It took many decades for mental illness to get the acceptance of legitimacy in the medical field as a true illness. Even today, people carry around a stigma when they are faced with dealing with an illness that comes solely from their brain. I agree that keeping an open mind when seeing psychiatric illnesses - that they may be only a symptom of a larger disease - is important. I just fear that in time, with more emphasis on psychotic symptoms being secondary to a primary disease, primary mental illness may be downplayed and written off as a symptom.
That being said, I do think that further investigation and research into autoimmune and other diseases that may bring about profound mental changes is definitely warranted and important. People like the child in the article may have been in a psychiatric hospital for the rest of his life being given drugs that didn't help, if not for the past experience of his mother's colleague.
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Post by Heather Le on Jun 29, 2016 23:18:11 GMT -4
The article was very interesting and was very much an eye-opener with regards to keeping an open mind and exploring other alternatives in order to explain psychiatric conditions. The article mentions that Sasha is being treated with aggressive immunotherapy due to his relapse, and each time it happens his memory formation stops. Perhaps, further research should be more focused on hippocampus - one of the hippocampus’s major functions is memory, more specifically long term memory. If there was a way to constantly stimulate the hippocampus and transferring short term into long term memory - then each time Sasha would begin to relapse he wouldn’t have to relearn everything and feel fragmented.
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Post by David Vu on Jun 29, 2016 23:21:05 GMT -4
The thought that the immune system can somehow be linked to psychiatric problems according to this article may gain some merit. It is an interesting read. The body and mind or at least the immune system and mind were thought to be completely different entities. This one specific case with Sasha proves that an autoimmune disease can even manifest as psychiatric problems, where the body acts on the mind.
On another note however, we do know that the brain works on electricity and chemicals. When these chemicals come into play they affect the way we act in all situations. “Psychosis is a symptom of a lot of different illnesses.” Psychiatric disorders when described this way do have a specific physical manifestation.
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Post by Jamila Pham (MS3) on Jun 30, 2016 9:45:27 GMT -4
We as human beings are a complex species. That being said, our brain is a work of art that is complicated and difficult to understand. It is baffling to believe that sometimes our own body can attack itself and that our human body is not as clear-cut as we want it to be. This article reminds us that many times, what we think is straightforward and clear may not be that easy due to our complexities. What seems like a psychiatric case turned out to be an autoimmune situation that was attacking the brain, mimicking psychosis. We as future physicians/physicians need to be open minded when coming up with differentials. If we are the closed minded like the physician who wouldn’t consider neurological complications, we would surely miss the diagnosis, causing Sasha his life.
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Post by Jose Lobo (MS3) on Jun 30, 2016 10:48:07 GMT -4
The brain is a special and unique organ that allows us to experience many wonderful things. It helps us function in our daily lives, it controls our emotions, it stores our memories, it provides us with our basic senses and it also helps differentiate between reality and what is not real. As stated in the article Neurology and Psychiatry have been separated due to the exponential flood of information and research we have gained throughout the years. Yet, these two actually overlap in many ways. Like Helen, we need to raise awareness that not all psychosis is actually a disease of itself, but instead we need to think of it as a symptom from another etiology first and foremost before we can consider it as a mental disease of its own. With this in mind, we should practice evidence base medicine so that patients can receive the proper treatments.
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Raghda Al Anbari (MS4)
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Post by Raghda Al Anbari (MS4) on Jun 30, 2016 13:34:41 GMT -4
The diseases of the autoimmune system affect approximately millions of people in the United States and reveal a hard biological, psychological, sociological issues to the country’s health care system. These illnesses includes a high cost to everyone especially to those with an illness that associates with having a lower quality of life and co-morbid mental distress, particularly depression, Psychosis and anxiety.
These diseases are one of the most common illness that diagnosed these days especially in young age patients, while I was doing some rotation at Scottish Rite hospital, I saw a 13 years old girl with a history of psychosis that being off and on for 2 months, she started with having delusions and agitation and having strange behavior, they got her admitted many time with many test but no pure diagnosis, to the end she started having regression episodes to childhood period beside the mental symptoms, after running a lot of tests they diagnosed her with SLE induce psychosis, it was really an interesting case as this one.
After reading this case, I got a better picture of the autoimmune disease and its related mental symptoms and I will make sure to include the possibility of autoimmune disease in any case I will encounter.
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Post by Fenil Patel on Jun 30, 2016 14:11:45 GMT -4
This is a very innovative article and reading was definitely interesting. Sometimes we struggle explaining the mind disease with the other types of diseases such as diabetes, and hypertension. This article emphasizes the fact that there is a strong possibility that immune system disorders may play a key role in causing psychiatric conditions. The question now is: Are there purely primary psychiatric conditions or are these problems all innately due to a medical condition we have yet to fully understand. The switch can be made by prescribing anti-inflammatory agents such as corticosteroids and aspirin instead of anti-psychotics, yielding dramatic results. Even today, people carry around a stigma when they are faced with dealing with an illness that comes solely from their brain. I agree that keeping an open mind when seeing psychiatric illnesses - that they may be only a symptom of a larger disease - is important. Basically, us as a current physicians or the future physicians have to keep the open mind about the psychiatric illness and not judge people without knowing what exactly is happening.
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Adaku Taylor (PA-S)
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Post by Adaku Taylor (PA-S) on Jun 30, 2016 15:13:43 GMT -4
When the body Attacks the Mind
This article gives a story about a 13 year old boy who began exhibiting sudden signs of what many Physicians believed to be paranoid schizophrenia with some neurologic presentation; dilated pupils, slurred speech, hallucinations and delusional behavior. His condition was getting worse, and antipsychotic medications were not effective on him. It took a aggressive family that kept searching for answers and a determined doctor, who looked at other potential causes for this patient’s psychotic behaviors, to help cure this boy. The boy was finally diagnosed with Autoimmune Encephalitis; brain infections, and after given a trial of antibiotics, his symptoms immediately began to regress. This article shows that as Health care providers, we should always be willing to look for other possible causes of persistent symptoms, instead of just writing it off and making conclusions, based on text book presentations. Although this is a new concept, to connect immune-system disorders like Lupus, Encephalitis, Neurosyphillis, to psychiatric illness like depression, dementia, and psychosis, bipolar. In fact scientists are beginning to imply the theory that perhaps psychiatric illness are also caused by autoimmune or inflammatory disorders. In 2013 Emory University scientists reported improvement in depressed patients who had high level of systemic inflammation, but responded to immunosuppressant- infliximab, and schizophrenic patients respond to Aspirin. I am very proud of this new found correlation with mental illness and immune disorders. Mental illness is field of medicine that is still growing in awareness, so any research that can applied to better understand the field is good.
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Kadeem Sampath (MS3)
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Post by Kadeem Sampath (MS3) on Jun 30, 2016 22:45:30 GMT -4
I found this article to be very interesting. It portrays a different kind of thinking with respect to differential diagnosis in psychiatric illness. The original case presentation seemed to be that of an almost “stereotyped” Psychiatry case. However as time elapsed, it was evident that there was more to this patient’s symptoms than originally suspected. The case is truly an eye-opener for physicians and the future of medicine. It opens up a new avenue for research and exploration in order to find stronger correlates between possible Auto-immune diseases as it relates to psychiatric illnesses or psychiatric presentation. I think these are very important mile-stones to acknowledge in our learning and practice of medicine. It provides us with broader horizons when thinking about differential diagnosis, and will ultimately lead to better patient care.
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