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postmodernmulticoloredcloak · 1 year ago

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This has evoked so many emotions in me and the prevailing one is a sense of... hauntingness.

We have just started understanding so many things. Not many years ago the only thing we knew about the human brain was that we knew pretty much nothing about the human brain.

We sneer at psychiatric practices and theories from the past but people in the future - possibly a near future, not even a far away one - will look back to our progressive times and be freaked out by what we are doing now, the mental institutions we have, the medication we fill our sick people with.

It's not a bad thing, of course. It means hope. But I also grieve for the lives, the happinesses, the joys and serenities that have been lost and are being lost because discoveries that will be taken from granted later have arrived too late for many.

Story from the Washington Post here, non-paywall version here.

Washington Post stop blocking linksharing and shit challenge.

"The young woman was catatonic, stuck at the nurses’ station — unmoving, unblinking and unknowing of where or who she was.

Her name was April Burrell.

Before she became a patient, April had been an outgoing, straight-A student majoring in accounting at the University of Maryland Eastern Shore. But after a traumatic event when she was 21, April suddenly developed psychosis and became lost in a constant state of visual and auditory hallucinations. The former high school valedictorian could no longer communicate, bathe or take care of herself.

April was diagnosed with a severe form of schizophrenia, an often devastating mental illness that affects approximately 1 percent of the global population and can drastically impair how patients behave and perceive reality.

“She was the first person I ever saw as a patient,” said Sander Markx, director of precision psychiatry at Columbia University, who was still a medical student in 2000 when he first encountered April. “She is, to this day, the sickest patient I’ve ever seen.” ...

It would be nearly two decades before their paths crossed again. But in 2018, another chance encounter led to several medical discoveries...

Markx and his colleagues discovered that although April’s illness was clinically indistinguishable from schizophrenia, she also had lupus, an underlying and treatable autoimmune condition that was attacking her brain.

After months of targeted treatments [for lupus] — and more than two decades trapped in her mind — April woke up.

The awakening of April — and the successful treatment of other people with similar conditions — now stand to transform care for some of psychiatry’s sickest patients, many of whom are languishing in mental institutions.

Researchers working with the New York state mental health-care system have identified about 200 patients with autoimmune diseases, some institutionalized for years, who may be helped by the discovery.

And scientists around the world, including Germany and Britain, are conducting similar research, finding that underlying autoimmune and inflammatory processes may be more common in patients with a variety of psychiatric syndromes than previously believed.

Although the current research probably will help only a small subset of patients, the impact of the work is already beginning to reshape the practice of psychiatry and the way many cases of mental illness are diagnosed and treated.

“These are the forgotten souls,” said Markx. “We’re not just improving the lives of these people, but we’re bringing them back from a place that I didn’t think they could come back from.” ...

Waking up after two decades

The medical team set to work counteracting April’s rampaging immune system and started April on an intensive immunotherapy treatment for neuropsychiatric lupus...

The regimen is grueling, requiring a month-long break between each of the six rounds to allow the immune system to recover. But April started showing signs of improvement almost immediately...

A joyful reunion

“I’ve always wanted my sister to get back to who she was,” Guy Burrell said.

In 2020, April was deemed mentally competent to discharge herself from the psychiatric hospital where she had lived for nearly two decades, and she moved to a rehabilitation center...

Because of visiting restrictions related to covid, the family’s face-to-face reunion with April was delayed until last year. April’s brother, sister-in-law and their kids were finally able to visit her at a rehabilitation center, and the occasion was tearful and joyous.

“When she came in there, you would’ve thought she was a brand-new person,” Guy Burrell said. “She knew all of us, remembered different stuff from back when she was a child.” ...

The family felt as if they’d witnessed a miracle.

“She was hugging me, she was holding my hand,” Guy Burrell said. “You might as well have thrown a parade because we were so happy, because we hadn’t seen her like that in, like, forever.”

“It was like she came home,” Markx said. “We never thought that was possible.”

...After April’s unexpected recovery, the medical team put out an alert to the hospital system to identify any patients with antibody markers for autoimmune disease. A few months later, Anca Askanase, a rheumatologist and director of the Columbia Lupus Center,who had been on April’s treatment team, approached Markx. “I think we found our girl,” she said.

Bringing back Devine

When Devine Cruz was 9, she began to hear voices. At first, the voices fought with one another. But as she grew older, the voices would talk about her, [and over the years, things got worse].

For more than a decade, the young woman moved in and out of hospitals for treatment. Her symptoms included visual and auditory hallucinations, as well as delusions that prevented her from living a normal life.

Devine was eventually diagnosed with schizoaffective disorder, which can result in symptoms of both schizophrenia and bipolar disorder. She also was diagnosed with intellectual disability.

She was on a laundry list of drugs — two antipsychotic medications, lithium, clonazepam, Ativan and benztropine — that came with a litany of side effects but didn’t resolve all her symptoms...

She also had lupus, which she had been diagnosed with when she was about 14, although doctors had never made a connection between the disease and her mental health...

Last August, the medical team prescribed monthly immunosuppressive infusions of corticosteroids and chemotherapy drugs, a regime similar to what April had been given a few years prior. By October, there were already dramatic signs of improvement.

“She was like ‘Yeah, I gotta go,’” Markx said. “‘Like, I’ve been missing out.’”

After several treatments, Devine began developing awareness that the voices in her head were different from real voices, a sign that she was reconnecting with reality. She finished her sixth and final round of infusions in January.

In March, she was well enough to meet with a reporter. “I feel like I’m already better,” Devine said during a conversation in Markx’s office at the New York State Psychiatric Institute, where she was treated. “I feel myself being a person that I was supposed to be my whole entire life.” ...

Her recovery is remarkable for several reasons, her doctors said. The voices and visions have stopped. And she no longer meets the diagnostic criteria for either schizoaffective disorder or intellectual disability, Markx said...

Today, Devine lives with her mother and is leading a more active and engaged life. She helps her mother cook, goes to the grocery store and navigates public transportation to keep her appointments. She is even babysitting her siblings’ young children — listening to music, taking them to the park or watching “Frozen 2” — responsibilities her family never would have entrusted her with before her recovery.

Expanding the search for more patients

While it is likely that only a subset of people diagnosed with schizophrenia and psychotic disorders have an underlying autoimmune condition, Markx and other doctors believe there are probably many more patients whose psychiatric conditions are caused or exacerbated by autoimmune issues...

The cases of April and Devine also helped inspire the development of the SNF Center for Precision Psychiatry and Mental Health at Columbia, which was named for the Stavros Niarchos Foundation, which awarded it a $75 million grant in April. The goal of the center is to develop new treatments based on specific genetic and autoimmune causes of psychiatric illness, said Joseph Gogos, co-director of the SNF Center.

Markx said he has begun care and treatment on about 40 patients since the SNF Center opened. The SNF Center is working with the New York State Office of Mental Health, which oversees one of the largest public mental health systems in America, to conduct whole genome sequencing and autoimmunity screening on inpatients at long-term facilities.

For “the most disabled, the sickest of the sick, even if we can help just a small fraction of them, by doing these detailed analyses, that’s worth something,” said Thomas Smith, chief medical officer for the New York State Office of Mental Health. “You’re helping save someone’s life, get them out of the hospital, have them live in the community, go home.”

Discussions are underway to extend the search to the 20,000 outpatients in the New York state system as well. Serious psychiatric disorders, like schizophrenia, are more likely to be undertreated in underprivileged groups. And autoimmune disorders like lupus disproportionately affect women and people of color with more severity.

Changing psychiatric care

How many people ultimately will be helped by the research remains a subject of debate in the scientific community. But the research has spurred excitement about the potential to better understand what is going on in the brain during serious mental illness...

Emerging research has implicated inflammation and immunological dysfunction as potential players in a variety of neuropsychiatric conditions, including schizophrenia, depression and autism.

“It opens new treatment possibilities to patients that used to be treated very differently,” said Ludger Tebartz van Elst, a professor of psychiatry and psychotherapy at University Medical Clinic Freiburg in Germany.

In one study, published last year in Molecular Psychiatry, Tebartz van Elst and his colleagues identified 91 psychiatric patients with suspected autoimmune diseases, and reported that immunotherapies benefited the majority of them.

Belinda Lennox, head of the psychiatry department at the University of Oxford, is enrolling patients in clinical trials to test the effectiveness of immunotherapy for autoimmune psychosis patients.

As a result of the research, screenings for immunological markers in psychotic patients are already routine in Germany, where psychiatrists regularly collect samples from cerebrospinal fluid.

Markx is also doing similar screening with his patients. He believes highly sensitive and inexpensive blood tests to detect different antibodies should become part of the standard screening protocol for psychosis.

Also on the horizon: more targeted immunotherapy rather than current “sledgehammer approaches” that suppress the immune system on a broad level, said George Yancopoulos, the co-founder and president of the pharmaceutical company Regeneron.

“I think we’re at the dawn of a new era. This is just the beginning,” said Yancopoulos."

-via The Washington Post, June 1, 2023

#call me a half empty glass person #but when progress is made in medicine my heart aches for the ones who came too early #and i don't know why this topic specifically is hitting me so hard #maybe it's because of my brief and thankfully pretty much harmless #but still harrowing encounter with psychiatry #maybe because i have a minor but annoying autoimmune disorder that i finally got the right medication for after years of struggling #now #i wonder if that medication has also been helping with my brain?#i'll never know i guess #but the idea that 'psychiatric' conditions might simply be inflammatory disorders is chilling #why didn't you think of it before?? i'd yell at all the doctors in the world #doesn't it feel obvious that fucked up brain disease is caused by fucking up brain reasons??#schizophrenia is characterized by so many symptoms like fatigue brain fog difficulty with coordination etc #how couldn't you think of treating it like an illness that causes those things #...call me stupid but i just realized this is a triggering topic for me #god i just want people to be healthy and happy is that too much to ask for

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geraskier · 7 months ago

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caprice is now a level 6 bard/level 2 monk, with the helldusk gloves that add necrotic damage on unarmed attacks (along with a chance to inflict bleeding), as well as boots that give lightning charge upon dashing, and the jolty vest thing that shocks melee attackers using lightning charges. still dual-wielding hand crossbows for long range combat, and i took the dual wielding perk that increases AC. im dying a lot less partially bc ive learned how to better economize combat actions also.

gave karlach the dual wielding perk to increase her AC, and conversely am having lae'zel use two-handed weapons this time. kinda evens things out that way too, cause lae'zel has the extra action skill so she doesn't really need the offhand weapon attack. astarion kicks ass with the shrieking sword and the AOE saving throw penalty is extemely useful for bard spells.

(side note: the intimidation bonus from the durge origin pairs very well with performance/deception/persuasion bard bonuses.)

OH. something i noticed: caprice can't melee dual-wield with anything larger than shortswords, scimitars, or daggers. i suspect this is connected to being "small" instead of "medium" sized, as astarion does not have this problem and he has the same strength score (8). i don't care either way bc of my focus on unarmed strikes but that's still interesting. edit: wait nvm it's bc i didn't take the dual-wielding perk.

#i still dont really see the utility of a lot of the spells that prompt saving throws and require concentration.#theres so many points of failure and the enemies youd want to immobilize the most #are the ones most resistant to charisma checks wisdom checks etc #also losing an action turn can destroy your party if theres a lot of enemies #tashas hideous laughter is good cause its not limited by enemy type the way hold person and hold beast are #altho i think it requires an intelligence of 5 or above.#newt needs a text post tag #newt plays bg3 #at some point in the future i might redo a shiv playthru just to refine his druid battle style #i think i relied a bit too heavily on melee attacks with shiv instead of utilizing cantrips.#even with the circle of spore health buff he did not have the hp to constantly smack enemies with a quarterstaff #maybe i could have taken a lower charisma score and gotten higher wisdom earlier?#dont think multiclassing would have been the way to go for shiv #edit: level 2 monks get a movement speed bonus which is GREAT cause deep gnomes #have a starting movement speed of 7.5m and theres better uses for misty step clothing items

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