9/3/2023 0 Comments Ocd medicationIt is not entirely clear what prompts the body to misdirect its immune response against neurons, but one possibility is that a mild, otherwise harmless, infection can kick off an immune response that goes awry. “They’re both treatments purely targeting the immune system and you wouldn’t think they have anything to do with neuroreceptors or chemicals,” said Lennox. A month later, patients receive an infusion of the drug rituximab, which temporarily suppresses the immune system. First, patients will receive intravenous immunoglobulins (IVIG), antibodies from donor blood samples that are designed to outcompete the problematic antibodies and detach them from the surface of neurons. Patients who test positive for the relevant antibodies will be given a two-pronged treatment designed to remove the “bad antibodies” from the brain and dampen the immune system to prevent it pumping out more of them. “But if you start and finish with a psychiatric presentation there’s a lot of argument whether it’s equally causative.” “ cases of encephalitis almost all start off with a psychiatric presentation,” she said. The trial, which is restarting recruitment after being put on hold during the pandemic, is aiming to secure the “gold standard” evidence of efficacy required to shift clinical practice. ![]() Lennox’s team has published a series of case reports in which patients with psychosis, but no physical symptoms, appeared to benefit from immunotherapies. Psychosis is often the first sign of encephalitis, before patients go on to experience physical symptoms including seizures, loss of balance, impaired speech and losing consciousness. It is already accepted that the same antibodies can trigger encephalitis, a dangerous swelling of the brain, and these patients can be quickly and successfully treated with immunotherapy. “These antibodies stick to the neuronal surface and disrupt signalling in the brain,” said Lennox. The trial was conceived after previous research by Lennox’s team revealed that around one in 12 patients admitted for a first psychotic episode tested positive for antibodies that are known to target brain cells. “I think a key illness that needs attention as being high potential as being autoimmune is postpartum psychosis, considered a variant of bipolar disorder, with abrupt onset soon after childbirth, and has a lot of the characteristics of an autoimmune illness,” she said. Lennox believes that immune responses in the brain could play a role in other psychiatric conditions, including bipolar disorder and postnatal psychosis. “There are psychological treatments and we treat people in a much kinder way, but we’re no way further forward in understanding the causes and fundamentally we still treat people in the same way.” “We are basically stuck with the same diagnostic systems that we’ve had since the back end of the 19th century and there have been no really novel treatments since the 1950s,” said Lennox. “It’s the most stigmatised of illnesses,” she said.ĭespite its devastating impact and the significant number of people affected, there has been little progress in diagnosing or treating schizophrenia in recent decades and current drugs work largely by controlling symptoms rather than tackling the underlying cause of the condition. If the trial demonstrates the treatment is effective, Lennox hopes it will help change the way psychosis and schizophrenia are viewed and prompt the development of other new treatments. “We need a systematic shift in the way we assess and treat people with severe mental illness,” she added. ![]() “Psychosis is a group of disorders, some of which are neurodevelopmental, some will be people with adverse life experiences that give a vulnerability and for other people it will be an infectious cause. “A problem with the whole of psychiatry is that our diagnoses aren’t fit for purpose,” she said. The approach will not be suitable for most patients with psychosis – and Lennox is not challenging the view that mental illnesses can be rooted in traumatic life experiences or other causes. “It would be the first time in the whole of psychiatry that we have a diagnosis and a cause for why people develop severe mental illness,” she said.
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