#Fundamental Health

[xtruss]

Many Mental-Health Conditions Have Bodily Triggers! Psychiatrists Are At Long Last Starting To Connect The Dots

— April 24th, 2024

Illustration: The Economist/Getty Images

The tics started when Jessica Huitson was only 12 years old. Over time her condition worsened until she was having whole-body fits and being rushed to hospital. But her local hospital, in Durham, England, was dismissive, suggesting she had anxiety, a mental-health condition, and that she was probably spending too much time watching videos on TikTok. Her mother describes the experience as “belittling”. In fact, Jessica had an autoimmune condition brought on by a bacterial infection with Streptococcus. The condition is known as Paediatric Autoimmune-Neuropsychiatric Disorders Associated with Streptococcus (pandas). When the infection was identified and treated, her symptoms finally began to improve.

Ms Huitson is not alone in having a dysfunction in the brain mistaken for one in the mind. Evidence is accumulating that an array of infections can, in some cases, trigger conditions such as obsessive-compulsive disorder, tics, anxiety, depression and even psychosis. And infections are one small piece of the puzzle. It is increasingly clear that inflammatory disorders and metabolic conditions can also have sizeable effects on mental health, though psychiatrists rarely look for them. All this is symptomatic of large problems in psychiatry.

A revised understanding could have profound consequences for the millions of people with mental-health conditions that are currently poorly treated. For example, over 90% of patients with bipolar disorder will have recurrent illness during their lives; and in children with obsessive-compulsive disorder (ocd) over 46% do not achieve remission. Some 50-60% of patients with depression eventually respond after trying many different drugs.

For some in the profession, a deeper understanding of the biology of mental health, tied to clear biological fingerprints of the kind that might come from a laboratory test, will lead to more accurate diagnoses and better targeted treatments.

Shrinks, Rapped

The field of psychiatry has historically been focused around the description and classification of symptoms, rather than on underlying causes. The Diagnostic and Statistical Manual of Mental Disorders (dsm), sometimes known as the bible of psychiatry, emerged in 1952 and contains descriptions, symptoms and diagnostic criteria. On the one hand, it has brought helpful consistency to diagnosis. But on the other, it has grouped patients into cohorts without any sense of the underlying mechanisms behind their conditions. There is so much overlap between the symptoms of depression and anxiety, for example, that some wonder if these are actually even separate categories of illness. At the same time, depression and anxiety come in many different subtypes—panic disorder with and without agoraphobia, for example, are distinct diagnoses—not all of which may be meaningfully distinct. This can lead to patient groups in drug trials being so diverse that drugs and therapies fail simply because the cohort being studied has too little in common.

Previous attempts to find causal mechanisms for mental-health conditions have run into difficulty. In 2013 the National Institute of Mental Health, an American government agency, made a heroic gamble to move away from research based on the dsm’s symptom-based categories. Money was funnelled into basic research on disease processes of the brain, hoping to directly connect genes to behaviours. Some $20bn of new research was funded but the idea failed spectacularly—most of the genes uncovered had tiny effects. Allen Frances, a professor of psychiatry at Duke University, calls the search for such biomarkers “a fascinating intellectual adventure, but a complete clinical flop”.

Genes alone are clearly not the answer. Ludger Tebartz van Elst, a professor of psychiatry and psychotherapy at the University Hospital Freiburg, in Germany, says that many different conditions such as schizophrenia, attention deficit hyperactivity disorder (adhd), anxiety and autism can be triggered by the same genetic disorder, 22q11.2, caused by the loss of a small piece of chromosome 22.

Despite this counsel of misery, a shift in psychiatry is potentially on the horizon. Some of this is coming from a revived interest in finding neurological biomarkers with ever-more sophisticated technology. In addition, there is a greater understanding that some mental-health conditions actually have triggers or roots which need to be treated as medical conditions rather than psychiatric ones.

Fundamental Health

A key moment came in 2007, when work at the University of Pennsylvania showed that 100 patients with rapidly progressing psychiatric symptoms or cognitive impairments actually had an autoimmune disease. Their bodies were creating antibodies against key receptors in nerve cells known as nmda receptors. These lead to brain swelling and can trigger a range of symptoms including paranoia, hallucinations and aggression. The disease was dubbed “anti-nmda-receptor encephalitis”. Most important of all, in many cases it was treatable by removing the antibodies, or using immunotherapy drugs or steroids. Studies of patients having a first episode of psychosis have found that between 5% and 10% also have brain-attacking antibodies.

Illustration: The Economist/Getty Images

It seems likely that, in rare cases, ocd can be caused by the immune system, too. This is seen in the childhood condition pandas, with which Ms Huitson was diagnosed in 2021. But it is also sometimes found in adults. One 64-year-old man reported spending an extraordinary amount of time obsessively trimming his lawn only to look back on this behaviour the next day with feelings of regret and guilt. Researchers found these symptoms were being caused by antibodies attacking the neurons in his brain.

More recently, Belinda Lennox, head of psychiatry at the University of Oxford, has conducted tests on thousands of patients with psychosis. She has found increased rates of antibodies in the blood samples of about 6% of patients, mostly targeting the nmda receptors. She says it remains unknown how a single set of antibodies is capable of producing clinical presentations ranging from seizures to psychosis and encephalitis. Nor is it known why these antibodies are made, or if they can cross the blood-brain barrier, a membrane that controls access to the brain. She assumes, though, that they do—preferentially sticking to the hippocampus, which would explain how they affect memory and lead to delusions and hallucinations.

Dr Lennox says a shift in medical thinking is needed to appreciate the damage the immune system can do to the brain. The “million dollar question”, she says, is whether these conditions are treatable. She is now running trials to find out more. Work on patients with immune-driven psychosis suggests that a range of strategies including removing antibodies and taking immunotherapy drugs or steroids can be effective treatments.

Another important discovery is that metabolic disturbances can also affect mental health. The brain is an energy-hungry organ, and metabolic alterations related to energy pathways have been implicated in a diverse range of conditions, including schizophrenia, bipolar disorder, psychosis, eating disorders and major depressive disorder. At Stanford University there is a metabolic psychiatry clinic where patients are treated with diet and lifestyle changes, along with medication. One active area of research at the clinic is the potential benefits of the ketogenic diet, in which carbohydrate intake is limited. This diet forces the body to burn fat for energy, thereby creating chemicals known as ketones which can act as a fuel source for the brain when glucose is in limited supply.

Kirk Nylen, head of neuroscience for Baszucki Group, an American charity that funds brain research, says 13 trials are under way worldwide looking at the effects of metabolic therapies on serious mental illness. Preliminary results have shown a “large group of people responding in an incredibly meaningful way. These are people that have failed drugs, talk therapy, trans-cranial stimulation and maybe electroconvulsive-shock therapy.” He says that he keeps meeting psychiatrists who have come to the metabolic field because of patients whose low-carb diets were followed by huge improvements in mood. Results from randomised controlled trials are expected in the next year or so.

It is not only understanding of the immune and metabolic systems that is improving. Vast quantities of data are now being parsed with unprecedented speed, sometimes with the help of artificial intelligence (ai), to uncover connections previously hidden in plain sight.

Dr Jung, Tear Down This Wall

This could at long last bring biology more centrally into the diagnosis of mental health, potentially leading to more individualised treatments, as well as better ones. In early October 2023, uk Biobank, a biomedical database, published data revealing that people with depressive episodes had significantly higher levels of inflammatory proteins, such as cytokines, in the blood. A study last year also found about a quarter of depressed patients had evidence of low-grade inflammation. This could be useful to know as other work suggests patients with inflammation respond poorly to antidepressants.

Illustration: The Economist/Getty Images

More innovation is under way. A number of researchers are exploring different ways of improving the diagnosis of adhd, for example, classifying patients into a number of different subgroups, some of which may have been previously unknown. In three separate announcements in February 2024, different groups announced the discovery of biomarkers that could predict the risks of dementia, autism and psychosis. The search for better diagnostic tools is also likely to be accelerated by the use of ai. One firm, Cognoa, is already using ai to diagnose autism in children by analysing footage of their behaviour—side-stepping the long waits for clinicians. Another outfit, the Quantitative Biosciences Institute (qbi) in California, has used ai to create an entirely new map of the protein-protein interactions (and the molecular networks) involved in autism. This will greatly facilitate further explorations of diagnostic tools and treatments.

All such developments are promising. But many of the field’s problems could be resolved by relaxing the distinctions that exist today between neurology, which studies and treats physical, structural and functional disorders of the brain, and psychiatry, which deals with mental, emotional and behavioural disorders. Dr Lennox finds it extraordinary that the treatment options differ so completely if a patient ends up on a neurology ward or a psychiatric ward. She wants antibody testing to be more routine in Britain when someone presents with a sudden post-viral mental illness that does not get better with standard treatments. Thomas Pollak, a senior clinical lecturer and consultant neuropsychiatrist at King’s College London, says mri scans should probably be used on patients after their first episode of psychosis as, in 5% to 6% of patients, it would change the way they are treated.

This rift between neurology and psychiatry is greater in Anglo-Saxon countries, says Dr Tebartz van Elst. (These are countries including America, Britain, Canada, and New Zealand.) In Germany, psychiatry and neurology are more integrated, with neurologists training in psychiatry, and psychiatrists doing a year of neurology as part of their training. That makes it easier for investigational work to be done. He says he offers most patients with first-time psychosis or other severe psychiatric syndromes an mri of the brain, an electroencephalogram, lab tests for inflammation, and a lumbar puncture to find evidence to support different treatments in some patients. The price tag, around ���1,000 ($1,070), is no more than the cost of hospitalising a patient for three or four days, says Dr Tebartz van Elst, so may be good value for money.

What’s The Diagnosis?

All this work will one day put psychiatry, and its patients, on a firmer footing. It is already offering validation for some of those for whom the field has failed.

Jessica Huitson is only one of them. Diagnosed and treated too late, she still struggles with her condition and her future is uncertain. Those with me/cfs, a post-infectious condition which comes with a series of cognitive problems such as attention and concentration deficits, were once dismissed as malingering or diagnosed with “yuppie flu”. New work suggests it is associated with both immune and metabolic dysfunction.

Some wonder whether these conditions are the tip of a much larger iceberg. The prize in finding out more will be better patient care and outcomes. Biology is coming, whether psychiatry is ready or not.■

— This Article Appeared in the Science & Technology Section of the Print Edition Under the Headline "Psychiatry’s Blind Spots"

[bsptourist]

dm_christmas_in_the_suburbs

created by Hughlikepoo/Modestyiswimpy

[valtsv]

writing VAL pov for this character study/"what if the power of friendship was REALISTIC and NUANCED and CANNOT SAVE YOU (but is still a nice thing to have)" fic is fun because nobody in tsv really understands what mental illness is from a clinical perspective or has made that much progress in the field of psychiatry. they're barely on "you can get shellshock from being a combat veteran" stages of understanding the impacts of trauma (personal and societal) on the human mind. so everyone including VAL herself just thinks she's the bearer of the curse while readers will recognise the symptoms of cPTSD with schizoaffective comorbidity.

[girlfriendline]

claude giroux gets the helmet after scoring the OT winner

preds @ sens || 29.1.24

+ bonus Extra Large Versions under the read more (highly recommended)

[anetherealpoetess]

just discovered that robert aramayo went to juilliard. okay educated king!!

[pizzapasta23045]

Bitches on tiktok when you say you think Caitlyn was in the wrong for using the smog in the undercity that used to litterally cripple a fair majority of them as a weapon to make cilvilians leave the streets to catch one bad guy and a very clear parallel to IRL police brutality and the fact her mom died and she's grieving doesn't excuse it:

[uncanny-tranny]

The frustrating part about conversations like "should people with self-harm scars warn others before showing off their body?" and conversations like it is how nobody would tell me that my scars are obscene or should be hidden despite, literally, being self-harm scars. They just do not know because people literally do not know what self-harm scars are and what self-harm is.

Our bodies are not vulgar or gross. We deserve to live our lives, and if our scars make you uncomfortable, we can be compassionate about that, but that doesn't mean that our bodies are Bad and should be Locked Away. Treat us like we belong, because we do.

[transrevolutions]

fuck this shit I'm going to [remembers that jokes about political assassination are considered a gray area and may not be protected by the first amendment] kill myself!!!!

[theharlotofferelden]

Browsing Stardew Valley mods and it occurs to me that there's a lot of people who just. Fundamentally do not understand alcohol addiction.

[liesmultixxx]

what’s wrong with me? why am i so fundamentally unlovable?

[captain-lovelace]

I’ve said this before but I firmly believe that fatphobia and ableism are intrinsically linked

[fibromyalgicaf]

"People fake illness/disabilities though!'

Yes, some do unfortunately, but it's not common. Factitious Disorder Imposed on Self (FDIS), formerly known as Munchausen syndrome, has a prevalence rate of approximately 1% according to the DSM-5, although a study in Germany suggested that it may affect 1.3%.

Now that 1.3% figure is not actually a general population estimate - the study surveyed doctors in independent practice and senior hospital consultants - but let's say it is. So 1 person out of every 100.

But maybe that's only the fakers who get diagnosed. Let's say there's five times as many people who manage to avoid a diagnosis. Maybe there's even a few who are good enough or lucky enough to never even tip off anyone's suspicions. Or maybe not everyone who fakes can be considered as having Factitious Disorder; maybe they're faking for the sweet sweet gains of a disability benefit, or maybe they're just straight-up evil. So let's go wild and say it's not 1.3%, it's actually closer to 10%.

So out of 100 people, 10 would be faking an illness or disability. That seems like way more than is realistic to me but I want to really stretch this... Even if that many people actually were faking, does that justify the hostility shown towards all the genuinely ill/disabled people? Even if there was a malingering epidemic, is that an excuse to automatically not believe someone who's parked in the disability space? Or to not believe that person actually needs their wheelchair? Does it make it ok to ignore people's requests for accommodations?

[blackjackkent]

Rakha enters the Counting House's high security vault on a balcony overlooking the main floor. It's an enormous room but mostly empty except for three people standing around a single chest at its center - a dwarf in a fine silk tunic and two guards armored like the ones upstairs.

No sign of Minsc. Jaheira has described him and he is definitely not any of these people.

"It's still... moving..." one of the guards quavers nervously, looking at the chest with an expression of deep anxiety.

Rakha's head tilts to one side and she squints. The chest gives an almost imperceptible twitch.

"Hush your fussing," the dwarf says irritably, pulling a pipe from his pocket and sticking it into his mouth. "Nine-Fingers had this one made especially. That little mouthful will barely slow it down."

(A/N: "Made"? This line raises a lot of questions about mimic biology and reproduction. Also, one of Glitterbeard's guards has Hector's face with an undercut and no beard, but the right eye color more or less, which is amusing me.)

"But the stories..." The guard wrings her hands.

"Stories," the dwarf scoffs. "Tall tales and big names." He pokes his pipe at the other guard, who is looking at his comrade anxiously. "Don't let them fool you, lad. Elminster the archmage. Drizzt the drow exlie. Heroes have power, aye - but not half so much as we do." He flicks his fingers, and Rakha watches with mild interest as fire flares up around his fingers, with which he lights his pipe before inhaling a mouthful of smoke.

"A little coin in the right purse," he murmurs pensively. "A soft word in the right ear. It's not glory that spins these planes, lad. It's gold. See? Now--"

He breaks off abruptly. The chest has given another distinct twitch, and this time its accompanied by a low, moaning growl that sets the hair standing up on the back of Rakha's neck.

She has only a moment to process what's happening, but it's long enough. She's seen this before, a creature disguising itself as a chest - in Grymforge, and in Moonrise Towers. A mimic, Wyll called it. A creature that is mouth and teeth and tongue and very little else, and would have swallowed her whole if she'd let it.

Extrapolation flick-flicks through Rakha's brain like lightning. The visitor logs said Minsc was here only minutes ago, led here by Glitterbeard, the bank's manager. Nine-Fingers said she instructed that he be killed. Jaheira has described Minsc as a behemoth, dangerously violent, and with his own streak of madness to match Rakha's.

There are only so many ways to safely kill such a man. One of them, Rakha imagines, is having him swallowed by a mimic.

Mmmm... whispers the beast in her brain. Too quick. Too clean. No mess left behind to show the deed was done. And yet... perhaps not so easy as they think...

The mimic gives another low moan, its whole body spasming and the eyes embedded in its "wood" flesh opening wide. And then a fist explodes outward from between its teeth.

Blood spatters across the ground. The scent fills Rakha's nose and her vision goes white at the corners. She grips the balcony railing, struggling to regain control, and watches in astonishment as a huge, muscular form uncurls itself from within the mimic's body, ripping its jaw upward with a sickening crack.

The mimic screams and shudders to stillness, its tongue lolling out along the stone floor. Minsc - for certainly this is Minsc - straightens up, his eyes bright with rage as he glares down at the dwarf.

"There is no gold in here!" he bellows, pointing at the dead mimic. With a grunt, he lifts the whole creature up by its tongue and hurls it aside.

"If there is one thing Minsc hates more than beasts with bad breath," he growls. "It is those who are tricksome with the truth."

His head cocks to one side, and then he smiles, showing all of his teeth. "And turnips. But you are no turnip! Let that be a comfort to you in your final moments!"

At Rakha's side, Jaheira laughs suddenly - a sound Rakha has never heard from her before. Every muscle in her body has relaxed with sudden visible relief and her eyes have brightened as she steps forward eagerly. "Meet Minsc!" she says cheerfully. "He still seems very much himself to me."

Rakha grunts. The smell of blood from the eviscerated mimic is still plucking angrily at the strings of her brain, and it is taking most of her available effort to retain control of herself. If this is Minsc, Jaheira can handle the reunion without her.

(Part of her is intrigued, attentive. Just as she has been led to believe, she can already see something of herself in this huge behemoth of a man - the rage and edge of madness in his eyes. The brute force ripping and tearing of flesh and teeth. But there will be time to understand that when she can breathe again.)

Let Jaheira reveal herself.

Jaheira steps forward, letting her boots click loudly against the marble of the floor. Minsc stiffens at once, turning to look up - and his eyes widen, seeing her face.

"You..." he hisses.

There is something strange in his eyes - it does not look like happy recognition. Surely Jaheira sees it too - but just as surely, she doesn't want to. Her smile takes on a forced quality. "Stone Lord?" she calls down teasingly. "Better to call yourself Stone-Head."

(A/N: For once when I say in my writing that there's a long silence, I actually mean it - there was a good fifteen seconds of Jaheira and Minsc just staring at each other with Minsc looking increasingly puzzled. XD )

A long silence passes, during which Minsc's expression shows his inward struggle to parse what Jaheira has said. Then his expression goes very dark, his eyes narrowing to slits. "Your false face does not fool my eyes!" he roars. "I will cut until you look like the monster you are!"

The words resonate inside Rakha's head. The beast keens eagerly. Yes, cut, cut, cut... spill her blood, spill all their blood, rip out their throats and then we shall rip out yours, Minsc of Rashemen--

Jaheira's brief moment of relief has vanished. She has gone utterly still and a muscle is working in her jaw. "Somehow you are making even less sense than usual," she says hoarsely.

And then a voice, all too familiar, echoes across the vault. "Perhaps I can explain!"

It's Jaheira's voice.

And at the far end of the room stands... Jaheira. Or someone who looks like her, at least. Her skin shimmers with the lingering Weave-ripples of the teleportation spell they have seen before, the one used by the Absolutists and the nautiloid. She raises one eyebrow, her lips curled in an unpleasant smirk.

Understanding once again cracks through Rakha like a whip. A shapeshifter - one of Orin's doppelgangers, this time wearing Jaheira's face. But not quite her manner; the smirk is too hard, too cold, and her voice rasps with a disdain that, even in the worst moments, Rakha has never seen from her companion.

"The Stone Lord sees through your lies, shapeshifter!" she barks up at Jaheira. Her voice rings like a bell in the high-ceilinged room. "Count yourself lucky he cannot stay." She turns the sharp edge of her glare down towards the dwarf next to the dead mimic. "Nine-Fingers set a poor trap, little banker. Let the Absolute's faithful show you how it is done."

The Weave rocks. From every corner of the room, figures with weapons and spiked armor shiver out of the dark. Absolutists. Bhaalists. Rakha's staves are out in her hands before she has fully registered what is happening.

"Now come, Stone Lord!" the imposter barks. "We have the gold - and the Absolute has need of it elsewhere."

For a long moment, Minsc does not move, just looks up at Jaheira - the true Jaheira - with narrowed eyes. Then he turns. "As you say, Jaheira," he rumbles. Crossing the room with a few enormous strides, he moves to the imposter's side.

The imposter's smirk widens. And then there's another flash of dark energy, and they're gone, and the cultists begin to close ranks on all sides.

Jaheira has gone very pale with fury and alarm. She pulls her scimitars free, but there is no time for her to do anything but watch as her friend disappears in the Absolutists' company.

"Stlarning shapechangers!" she roars, almost matching Minsc in thunderous volume despite her smaller frame. "Enough - let us deal with these cultists, then find out where they are nesting!"

[jochona]

i will wash my hair tomorrow

[tennessoui]

I think I really lose braincells each time you post about couples counselling au - because I have never felt a characterization of Obi-Wan and Anakin fit *so much* to my own headcanon that it drives me crazy. The lack of communication? The desperate need to please (Anakin) the delusion of thinking you're giving someone complete access (Obi-Wan) while keeping them out. It is SO perfect, it's literally my favourite obikin fic, I am so invested in this au. The questions you have them answer at the end. When Obi-Wan said he's "happy to make the list as an obligation" because free time means a lot to an enslaved man. Kit. KIT *stick figure gore of me sinking my talons into your shoulders* When Anakin says he has nothing to hide from Obi-Wan but Obi-Wan never asks and he feels like he's getting away with something each time he learns something while Obi-Wan is like. He can ask me anything. KIT *BLOOD IN MY MOUTH*

ahhh thank you so much!!! i really love writing chapters and answering asks about this fic because i'm really attached to these versions of obi-wan and anakin like. their motivations are so interesting to me, especially at this part of the story, in the beginning, when all they are are motivations

anakin absolutely feels this need to please and be loved and the focus of his master's attentions. he also feels helpless in the face of thinking obi-wan will never let him in like that. he also is unhealthily controlling in small ways (checking and rechecking his closed door, for one, trying to have a say in what he eats out of concerns for his health) but he just loves him so much and he really experienced like.d devastation when obi-wan was temporarily dead that i feel like altered his motivations fundamentally, especially because he restarted his heart so.....probably a tiny part of him....illogically feels as if that's his heart now......

and obi-wan absolutely thinks he is so transparent for anakin!! he has let him in!!! more than he's ever let anyone in at all probably, but it's probably not that much. he's so practiced at keeping him out and hiding his real emotions that that's second nature. not to mention he feels betrayed in his own way at anakin marrying padmé --instead of just having an affair with her-- and he's trying to frantically detach himself before anakin leaves the order because he'll be devastated when that happens. not to mention he can also be shit at respecting boundaries (he reads the messages on anakin's phone when he's asleep)

and it's all just so interesting especially because there's so much narrative bias and just narrative inaccuracies where the narrator/POV character completely reads the other's reactions wrong, which makes the little questionnaire at the end have so much more weight because the counselor is 1000% right when she says that that's what's most important--how they feel about each other and their relationship after honest deliberation and reflection

[funkytoesart]

you can always tell the people who give social media advice who are naturally or conventionally attractive even without even having to look at a photo of them cause they're always the ones that recommend showing your face in reels or videos to promote your art and it's like,,, talk about pretty/skinny privilege lol