Jessica Huitson’s journey began with tics at age 12, escalating to full-body fits. Her local hospital dismissed her symptoms as anxiety and TikTok-induced, but her true diagnosis was Paediatric Autoimmune-Neuropsychiatric Disorders Associated with Streptococcus (PANDAS), triggered by a bacterial infection. Huitson’s experience highlights a growing understanding: mental illnesses are not solely mind-based, but often have biological roots.
Evidence accumulates that infections can trigger conditions like obsessive-compulsive disorder (OCD), tics, anxiety, depression, and even psychosis. Beyond infections, inflammatory disorders and metabolic conditions also play a significant role, yet psychiatrists rarely look for them. This disconnect underscores a major problem in psychiatry, leaving millions with poorly treated mental health conditions.
The field has historically focused on symptom classification rather than underlying causes. The Diagnostic and Statistical Manual of Mental Disorders (DSM), the bible of psychiatry, groups patients based on symptoms, lacking insights into the underlying mechanisms. This leads to overlapping symptoms and diverse patient groups, hindering drug trial efficacy.
The search for causal mechanisms has been challenging. A 2013 initiative by the National Institute of Mental Health to link genes to behaviors failed spectacularly, revealing the complexity of mental health. However, a shift in perspective is emerging, driven by advancements in technology and a renewed focus on the biological basis of mental illness.
A turning point arrived in 2007 when researchers discovered that 100 patients with rapidly progressing psychiatric symptoms had anti-NMDA-receptor encephalitis, an autoimmune disease where antibodies attack nerve cells, leading to brain swelling and a range of symptoms. Importantly, this condition was often treatable. Studies now suggest that even conditions like OCD can be immune-driven, as seen in PANDAS and cases of obsessive behavior linked to brain-attacking antibodies.
Dr. Belinda Lennox, at the University of Oxford, found increased rates of antibodies in the blood of about 6% of psychosis patients, primarily targeting NMDA receptors. While the mechanism remains unclear, it highlights the immune system’s potential to disrupt brain function.
Another significant discovery is the link between metabolic disturbances and mental health. The brain’s energy requirements make it vulnerable to metabolic alterations. Research at Stanford University’s metabolic psychiatry clinic shows promising results in treating mental illnesses with diet and lifestyle changes, including the ketogenic diet, which forces the body to burn fat for energy.
The field is witnessing a data-driven revolution, leveraging AI to uncover previously hidden connections. The UK Biobank revealed higher levels of inflammatory proteins in the blood of people with depressive episodes. Researchers are also exploring biomarkers for conditions like ADHD, dementia, autism, and psychosis.
These developments call for a paradigm shift in psychiatry, integrating neurological and psychiatric approaches. Dr. Lennox advocates for routine antibody testing in cases of sudden post-viral mental illnesses. Dr. Thomas Pollak suggests MRI scans after the first episode of psychosis. In Germany, psychiatry and neurology are more integrated, leading to more comprehensive assessments.
The future of psychiatry lies in understanding the intricate interplay between the mind and body. This shift promises more targeted treatments, improved diagnoses, and ultimately, better outcomes for patients. Jessica Huitson’s story serves as a reminder of the need for this revolution, as she continues to navigate her condition, a testament to the challenges and opportunities facing psychiatry in the years to come.
