Autoimmune Diseases Masquerading as Psychiatric Disorders- A Paradigm Shift in Psychiatry

iStock_000015202734MediumThe first description of an autoimmune disease affecting the brain was provided by William Osler in 1895 where he described the occurrence of psychosis in SLE. It hasn’t been until more recently that this hypothesis has gathered some momentum in neurology and psychiatry.

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6 Responses to "Autoimmune Diseases Masquerading as Psychiatric Disorders- A Paradigm Shift in Psychiatry"

  1. Bridget says:

    Great article! I find many of our members have several diagnosed autoimmune disorders as well as psychiatric. These patients most often are only receiving care for the mental health condition. I often believe if the autoimmune illness was treated; the mental health illness would resolve.

    • True, In many cases the Autoimmune disease may be causal in others may purely be coincidental or the stress may have triggered off autoimmunity and inflammation. It is up to the clinician to carefully try as best as they can to untangle these layers. Not always easy , but one has to try hard as it can make a big difference to the patient’s life.

  2. Umesh Babu says:

    Thanks for raising awareness of these conditions. In my practice it is not uncommon that after having taken note of several indicators in table 2, the exact nature of the autoimmune condition remains elusive.
    Even greater difficulty is to find an immunologist who is willing to attempt adequate immunosuppression in cases where there are compelling markers of autoimmune and psychiatric condition but no hard neurological symptoms.

    Prevalance of antithyroid antibody in community sample is so high that in case of young onset dementia with highly elevated TG it is still difficult to convince the immunologist re: the diagnosis of Hashimotos encephalopathy (SREAT) in the absence of again “hard” neurological symptoms such as seizures, motor or sensory deficits! Pulse steroid therapy is the most they would be willing to try. We need general immunologist with special interest in working with neuropsychiatric conditions. Serum levels of immune markers do not reflect the autoimmune conditions impact on CNS.
    We need to find reliable, easily accessible CNS immune markers… Brian Biopsy is only option at present.

    • Psych Scene says:

      Yes that is true. Many disorders will not be picked up with investigations and a high index of suspicion is necessary. I know exactly what you mean by willing immunologists ; it is a real challenge. Until medicine truly starts looking at diseases in an integrated and multispeciality model we will succumb to referral bias and the forms frosts cases will go under the radar. Here is a case we published…only ANA and DsDNA positive , but the rheumatologist and immunologist did not pay much attention, I was lucky to have the neuroimmunologist Dr Hodgkinson listen and trial steroid as an empirical trial. Anti neuronal antibodies were found but this may be a completely different pattern or may not be significant at all. All I know is there are many more cases waiting to be discovered and most importantly we need to probe for the patient community as a whole. https://www.dropbox.com/s/21knz2qfvgma078/Antineuronal%20antibodies%20mania.pdf?dl=0

  3. Umesh Babu says:

    Thanks for raising awareness of these conditions.

  4. Umesh Babu says:

    Thanks for raising awareness of these conditions. In my practice it is not uncommon that after having taken note of several indicators in table 2, the exact nature of the autoimmune condition remains elusive.

    Even greater difficulty is to find an immunologist who is willing to attempt adequate immunosuppression in cases where there are compelling markers of autoimmune and psychiatric condition but no hard neurological symptoms.

    Prevalance of antithyroid antibody in community sample is so high that in case of young onset dementia with highly elevated TG it is still difficult to convince the immunologist re: the diagnosis of Hashimotos encephalopathy (SREAT) in the absence of “hard” neurological symptoms such as seizures, motor or sensory deficits! Pulse steroid therapy is the most they would be willing to try. We need general immunologist with special interest in working with neuropsychiatric conditions.

    Serum levels of immune markers generally do not reflect the impact of autoimmune conditions on the CNS.We need more reliable, easily accessible CNS immune markers… brain biopsy is only option at present

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