Came across this short lecture on schizophrenia and the inflammation hypothesis. The author mentions three hypothesis for the causes of schizophrenia – elevated dopamine, glutamate receptor abnormalities, and inflammation. He also mentions the fact that autoimmune diseases can present with psychosis – lupus, Hashimoto’s encephalopathy, celiac disease, etc. It’s great to hear a professional acknowledging this fact, as not all doctors look into the link between psychiatric symptoms and autoimmune diseases.
Important notes from the lecture – some inflammation can be determined in a straightforward way by checking the C-reactive protein levels. Elevated levels of this substance increase the risk of schizophrenia onset. C-reactive protein levels are used to check for infection or chronic inflammatory disease, they also lead to increased risk of heart disease. It can be elevated due to a variety of diseases, such as obstructive sleep apnea, some viral infections, lupus, and rheumatoid arthritis.
In one study lumbar puncture was performed on a sample of patients with schizophrenia. 54% of the patients had self-directed antibodies in the cerebrospinal fluid (another piece of evidence to support the immune system disturbance hypothesis). What could the antibodies be targeting? Possibly neuronal proteins or neuronal receptor proteins.
Category: schizophrenia
Great toxicology YouTube channel… and celiac disease misdiagnosed as paranoid schizophrenia?
A really great guy – a toxicologist with his own YouTube channel telling real life ER stories. Here is a link to one of his episodes. A woman with delusions read on the internet about a specific colon cleanse, which led her to drinking 1 liter of soy sauce in two hours. 1 liter of soy sauce contains 200 grams of salt. What happened then to her brain? Why did she choose to drink the soy sauce in the first place? Was it due to paranoid schizophrenia, or was something else also going on?
A Woman Drank 1 Liter Soy Sauce Colon Cleanse In 2 Hours. This Is What Happened To Her Brain.
Hot weather and other factors, autoimmune disease, and psychosis
I’m thankful to bloggers who wrote about their experience with diet and depression. I’ve learned through the blogs and then my own observation that I was making my mental health worse by eating gluten in all possible forms – pasta, sandwiches, Subway, wraps, tempura, soy sauce. I have also established that casein in cow’s milk makes me more psychotic, so I had to give up a lot of delicious habits – taro bubble tea, cheesecake, easily ordering a coffee with milk at Denny’s – I now usually carry goat milk in a cooler with me everywhere, in case I want to add it to tea. This post won’t be about diet though, I have posted on diet previously:
Autoimmune Encephalitis and Diet
This post is about the fact that changing your diet may improve your mental health but it won’t necessarily cure you. I think it’s important to remember that in order to not constantly blame yourself. I used to do that when I was on strict AIP diet – I used to blame myself for feeling depressed. After I noticed that the AIP diet was actually helping, I became convinced that I would soon be cured, as long as I stay on the diet. Probably I’ve read too many blogs claiming that grains contain lectins that cause brain inflammation and therefore depression. There are a lot of success stories online with bloggers stating that their depression vanished after going on AIP diet or paleo or keto or vegan, you name it. It’s easy then to start blaming yourself each time you feel depressed again – if all those people were cured, maybe then I am slacking, not avoiding enough foods, not being strict enough. I think we may go into the blaming state because we want to believe that we can have full control of our mood and it would be nice if as long as we didn’t eat certain ingredients, we would never be depressed or psychotic.
Blaming yourself only makes you feel worse though and it doesn’t let you accept the reality that mental health problems are caused by many factors. I think yes – you should definitely strive for a healthy diet – avoid fried foods, high glycemic foods, red meat, etc., but should you feel guilty about the brown rice bowl that you ate yesterday because AIP and paleo bloggers claim that all grains cause inflammation? No, I am not sure if there is any evidence that grains are an issue, some research actually suggests that the healthiest diets are ones that include whole grains – such as the Mediterranean and MIND diets. I think we have to accept that there are other factors affecting our mental health and some we cannot control. Periods are definitely one of them and they suck. I find that my paranoia and obsessive thoughts are definitely exacerbated during the first three days of my period. Can I cure this issue with diet? I don’t think so. Being female, my hormones will always fluctuate with the menstrual cycle, there is nothing I can do about that. I can remind myself that it’s only worse for three days and it will get better, I am not always psychotic, I can try exercising more, going for a walk. But cure? I don’t know of one.
Menstrual Psychosis: A Forgotten Disorder?
I have recently realized that heat increases my intrusive thoughts. I had observed for a while that hot weather makes me lethargic and quick-tempered, but now I have also correlated hot weather with psychosis. It had occurred several times during the past month when I experienced exacerbated negative commentary in my head. I noticed that each time this happened on a weekend when I was away, camping. Supposedly camping is better than work – I was not alone, I was with friends, eating meals together – just as I like. Also I was moving – swimming, kayaking. Getting enough vitamin D. Definitely sniffing a lot of soil (reference to the antidepressant bacteria Soil Bacteria Work In Similar Way To Antidepressants), always bringing my own food in a cooler – tempeh, mung beans, buckwheat, freeze-dried vegetables, oatmeal. Stuff that I usually eat, so that was a constant factor. When analyzing what caused an event, we have to look into the differences, and the only factor that I could think of is heat. This summer has been very hot in Ontario, multiple days above 30 degrees. Every weekday though I am in an extremely air conditioned air building where I often wear my shawl. At home I have two functioning ACs. It was only during the camping that I was exposed to extreme heat for many hours in a row. I think I have to accept this fact – I love camping, but hot weather increases my aggression and psychotic symptoms.
There is also research supporting the idea that heat exacerbates mental health problems. “Above a threshold of 26.7°C, we observed a positive association between ambient temperature and hospital admissions for mental and behavioral disorders. Compared with non–heat-wave periods, hospital admissions increased by 7.3% during heat waves.“
The Effect of Heat Waves on Mental Health in a Temperate Australian City
“Heat exposure associated with mental illness – A mental hospital-based study in Hanoi, Vietnam looked at if there is a relationship between heat exposure and mental health problems. The results showed significant increase in hospital admissions for mental illnesses during periods of heatwaves, especially during longer periods of heat exposure.“
Heat exposure associated with mental illness
Exposure to sun can also exacerbate autoimmune disease symptoms, and for me this directly means worsening of mental problems. ”
“‘Photosensitivity can trigger the whole darn disease, including full systemic flare and joint pain and kidney failure,’ Dr. Connolly said. ‘The younger patients sometimes say, ‘The heck with this, I’m tired of carrying sun block,’ and they’ll stay out there, and it’s not just that they are going to give themselves a bad rash. This is something to take seriously.’
The link between the sun and lupus flare-ups is thought to be a set of inflammatory protein molecules called cytokines, which are activated when ultraviolet light hits the skin. The skin inflammation that results can create a chain reaction of other symptoms.“
A Sunny Day Can Mean All Sorts of Distress
This is all sad news, but I still want to go outside. I want to go hiking, kayaking down whitewater rivers, canoeing through uninhabited islands. I still have to accept that sometimes camping might make me feel worse. Probably I need to give up on t-shirts and always wear long sleeves when it’s hot. I do always wear a hat and sunscreen. Also going outside is important for vitamin D and we do need UV light to set our circadian rhythm. Therefore no, you shouldn’t lock yourself up in the house, but it’s better to not be out in the sun in the swim suit for too long. I’m going to stick with pants, shirts, running shoes, and caps. On the other hand I’m also not going to blame myself if I do feel worse. I did not create this disease, it’s not my fault that I react to weather, I can’t control the weather and I can’t avoid the weather. Let’s not feel worse by blaming, let’s learn from the available information and also remember that even if you are doing everything right, sometimes psychosis may still occur and we won’t know why. Maybe we will in the future and you will have this device that will tell you in real time ‘your dopamine levels are going higher than the suggested threshold, eat this scientifically advanced cookie and it will fix the problem’. I do hope for such a future, but for now it’s just science fiction. Research has shown that one way to reduce suffering during a psychotic episode is to accept the experience but not act on it. Accept also that there will be a peak of the symptoms but then they will diminish, it will pass.
Autoimmune Encephalitis vs. Schizophrenia
I don’t have schizophrenia so I can’t say that I experienced it, but I was misdiagnosed with it, therefore it’s possible that some of my experiences are similar to those of people with schizophrenia. Unfortunately autoimmune encephalitis is often misdiagnosed as a psychiatric disorder. I spent a lot of time in the Understanding Hashimoto’s Encephalopathy Facebook group and after talking to the women there, the commont story that emerged was that most of them were initially referred to a psychiatrist and treated with antipsychotics/antidepressants/benzodiazepines. I say women because the group members are mostly female, probably over 90%. Autoimmune diseases affect women more often than men and this seems to hold true for autoimmune encephalitis. Schizophrenia on the other hand is more common among males.
I am not a schizophrenia expert, but since my psychiatrist assumed that I had it and I was treated for it, from experience I can say that schizophrenia is usually treated with antipsychotics such as risperidone and olanzapine. Psychotherapy can also be recommended but in addition to the antipsychotics, it would not be enough on its own usually. Autoimmune encephalitis does not improve with antipsychotics. AE is inflammation of the brain that is caused by the immune system and it required immune suppression such as IV steroids, IVIG or plasmapheresis. Many patients have to stay on oral immune suppressants such as prednisone or Cellcept. Some get regular Rituxan infusions. Some patients do take antidepressants or antipsychotics in addition to the immunosuppressant treatment, but the first step should really be suppressing the immune system.
Autoimmune encephalitis often does cause psychiatric symptoms such as intense fear, panic, paranoia, delusional thoughts and depression. All these symptoms could be present in patients with schizophrenia. Schizophrenia is also much more common than autoimmune encephalitis, it affects about 1% of population. Since psychosis due to autoimmune reaction is quite rare, it’s reasonable for a psychiatrist to assume schizophrenia, schizoaffective disorder, or psychotic depression. I do think though that if the psychosis is present along with physical symptoms, a blood test for autoimmune conditions should be performed as well. I don’t think schizophrenia is associated with facial swelling, lightheadedness, brain fog, extreme fatigue, etc. Autoimmune encephalitis on the other hand does cause all these physical symptoms and more severe ones as well such as seizures and going into a coma. Also I think that if a patient has tried different antipsychotics for several months and has not responded to them, it’s probably time to consider that there might be a different cause and perform further testing. My psychiatrist for some reason did not consider this. I was not aware of existence of autoimmune diseases, it was my mom who suggested specific blood tests.
BBC – Some psychosis cases an immune disorder
Further on, once I started reading more about causes of panic, anxiety, and mood swings, I bought a glucometer and decided to check my blood glucose. My fasting blood sugar was checked previously at the hospital and it was fine, but after performing my own measures, I noticed a problem. After specific meals that contained high glycemic index foods, my blood sugar could stay at higher than 11 mmol/L two hours after eating. Diabetes UK states that blood glucose over 8 mmol / L two hours after a meal is of concern. Later on I spoke about these results to a doctor and she said I may have hyperglycemia. I also noticed feeling psychologically worse when my blood sugar was high. My point here is that if you are not responding to antipsychotics, there are further things to investigate. There is autoimmune testing – high levels of thyroid antibodies could indicate Hashimoto’s encephalitis, there are also other types of autoimmune encephalitis with different antibodies (NMDA receptor encephalitis, for example). TSH, free T3, and free T4 is a standard test to check the thyroid function, hypo/hyper thyroidism can also cause psychosis. Diabetes/hyperglycemia can affect your mood. Usually fating blood sugar is checked, but I would also verify blood glucose levels two hours after a meal with high glycemic carboydrates.
Diabetes UK – Diabetes and Hyperglycemia
Notes of a Neuropsychiatry Amateur 