#adventures in autoimmune disorders

[dragon-hoard]

riding a Fine Fucking Line with my shitty body lately bc humidity makes me nauseous and makes my skin break out no matter what I do vs having it be Too Dry gives me nosebleeds and makes me more susceptible to sinus/respiratory infections

so yes I have a Personal dehumidifier AND humidifier that I use back and forth depending on the ambient humidity

[dragon-hoard]

oh this is definetely what I was looking for! I had allergic reactions to pistachios and hazelnut, my gp looked in my throat and literally saw hives. But I had no reaction to the skin test so the allergist was telling me it was my acid reflux. my physcial reaction to these literally felt more... tingly? spicy? than my acid reflux and I swore I knew the difference

the allergist was... she did her job. she wanted to just do the skin test and when those came back negative she seemed like she wanted to be done with me. I had to prod her with questions to get any kind of results beyond "youre not allergic"

I have had slightly elevated tryptase levels before. and found that both zyrtec and pepcid have helped a lot with random abdominal pains and seasonal allergies. I'm currently waiting to see an immunologist but my gp is very open to the idea of histamine intolerance

thank you so much!

hey idk if you would be able to answer this but thought I would put it out there. so I have eds and THOUGHT i was having allergic reactions but a skin test at an allergist said i have literally 0 true allergies. is histamine intolerance similar to moderate allergic reactions? Ive been through most of your health tags and done research but cant really find any forward answers. its all MAY or MAY NOT

Unfortunately, you’re not finding any straightforward answers because allergies and non-IgE-mediated allergic reactions are poorly understood, even by some allergists. (usually the gaslighty kind 🙃)

It is entirely possible to test negative for allergic reactions for things you are absolutely having allergic reactions to.

This is because allergy tests focus ONLY on “true” IgE allergies and do not take into account that there are other underlying mechanisms that can cause mast cells to degranulate, which is what happens when you have an allergic reaction.

In an IgE reaction, the cells become unstable, releasing various hormones/chemical responses, which is what we know as annoying allergic reactions in minor cases, and anaphylaxis is severe responses.

In a functional immune system, these chemicals should really only be released in response to a true IgE allergy.

When your immune system is a little over-reactive, they can release in response to stress (this is what causes stress hives, and we now think some cases of IBS) and sometimes things like viral illnesses. This is why so many people have developed MCAS or MCAS-like symptoms after having covid. (mask up, besties)

Sometimes, however, the “off” switch in the immune system gets broken, and the mast cells become increasingly over-reactive, and that's when you can start developing new or seemingly random allergies that are inconsistent and don't show up on IgE allergen test panels. It’s why you’ll sometimes see the term “idiopathic anaphylaxis” in people who have anaphylaxis that can’t be explained. Well, the explanation is wonky mast cells. Why are they wonky? We’re not really sure.

Perhaps if the medical world hadn’t ignored its existence for ten+ years and focused so much on gaslighting patients until a mass pandemic hit, we would.

This type of mast cell degranulation, triggered by a non-IgE-mediated reaction, is common in histamine intolerance and mast cell activation syndrome, which can also be comorbid with EDS.

So are you reacting to things not showing up on an allergy test? Quite possibly, and your EDS makes it more likely.

Unfortunately, the testing for both is a crapshoot and are actually intended for mastocytosis. This is not to say you shouldn’t ask for a tryptase test (the 24-hour urine test is far more accurate than the blood test); I just mention it because it is entirely possible to have HIT/MCAS and still test negative for elevated levels of tryptase.

Until better testing methods are available, HIT and MCAS-aware doctors will now often diagnose based on patient history and response to mast cell stabilizers.

Anyway, sorry for the wall of salty text, I hope some of it is helpful to you! Best of luck with figuring everything out!

[cripplecharacters]

Ahhh im sorry i tried to shorten it but it had to be several asks to get all the info across. hi! i havent been diagnosed with any physical disability (MIGHT have an autoimmune disorder, am neurodivergent) so i wanted to get a second opinion on this? Im sorry its rambly im not the best at being succinct. Or if this isnt something you can help with. basically im worried about leaning into tropes/stereotypes about wheelchair users being helpless or. Like, damsels in distress. (1/?)

or ~needing abled characters to save them~. its a scifi fantasy secondary world and the wheelchair user in question, P, starts using it about midway through his story because of hemiplegia as a side effect of magic use. im worried about his best friend, E. E is SUPER protective of P, but he generally defers to P on actual decisions. Hes a dogboy so excuse the pun but hes basically P’s guard dog. P DOESNT boss him around (aside from. Like. “hey back off that person doesnt mean any harm”) 2/? but E would literally do anything for him. P can handle himself, E is just. A selfappointed bodyguard of sorts.what im worried about is E being so protective being read less as him not wanting his best friend hurt and more as like. Savior type knight in shining armor deal. Especially in regards to right after the magic mishap because E is the only one around and ends up bringing P to the hospital and since they were in a secluded area if he hadnt been around theres a very real possibility (3/?) --P wouldnt have been able to get help. Im hoping it wont be a problem since E is like this before and after (and doesnt change his attitude / get More protective after aside from being like hey. Please stop trying to scry oh my god.) P gets his wheelchair, plus P is still VERY involved in the adventure, but im still a little wary. thoughts? & thank you for your time! im SO sorry this got so long i tried to make it shorter <//3

Hi! I get your concern, but I think that showing this characterization before P develops hemiplegia helps to make it clear that this is just how E is more than a reaction to P's disability. I am also happy to hear that you are writing a character with hemiplegia!

Thank you and happy writing!

-Mod Bert

[oleandrsstudio]

This week's #zine #review is of "Adventures in Vampirism" by Audrey J. Ross @dragoncultcreations!

I have an autoimmune disorder. When it first developed, my body rejected all human food. I became fatigued, skeletal. Undead.

This zine explores chronic illness through the lens of vampirism. I like this kind of metaphor, applying something fantastical to the mundane. Reading it made me feel pretty cool.

#spoonie #spooniezine #disability #disabilityzine #zinereview

[thequeerlibrarian]

JOMP Challenge | November 15 | disabled character

English: Lotta and the Crumbs: A Gluten-Free Adventure

This is a beautiful children's book about the autoimmune disorder coeliac disease, my colleague bought it for my library and I actually cried reading it, seeing the representation for the first time in a children's book

[ganymedesclock]

Can you tell us more about tails in your au?

Until extremely recently, 13-year-old Miles Prower lived a peaceful life in a remote research outpost with his adventurous, globetrotting parents. Unfortunately a routine supply run seems to have not gone according to plan, and the esteemed Dr. Prower and her husband are now nowhere to be found.

Normally this wouldn't be a problem for a resourceful kid who's totally great at being left alone, he promises! But his ability to cook his own meals and repair the generator (and hide under the bed when it's thundering) don't include the ability to synthesize the medicine he needs to regularly take to manage his uncommon autoimmune disorder, so he was starting to get a little desperate when Sonic washed up on the shores of his island.

He also might have been under assault by sky pirates but it's fine! it's fine. He's great at coping.

[murderandcoffee]

josie's ocs part 1: the king's daughter trilogy (tkd)

context: a fantasy trilogy following the heir of a kingdom as she deals with war, loss, and ancient evil (there's a lot more than that but I'll spare you the lecture lmao)

MAIN CHARACTERS:

Caitriona "Cait" Câer

she/her, aquarius, fae/shifter/human

heir to the Northern kingdom of Marel (her parents' only surviving child)

a talented shifter, but lost her ability to use fae magic after the traumatic incident that killed her mother and left her physically disabled

very guarded and cold to those she doesn't know, but cares deeply about the people she lets in

likes/good at: languages, combat, shifting, botany

dislikes/bad at: playing instruments, magic, art, writing (her disability mainly affects her fine motor skills in her hands, so she hates tasks that require them), bears, being referred to as a "princess"

best friend: Theo

romantic interest: Nix

roommate: Analei

guard: Toby

Fenix "Nix" Khalleran

they/them, virgo, giant/human

heir to the Khalleran Clan, a roaming clan of (mostly) giants in the Northern kingdom, but was raised by their aunt and uncle in the Southern kingdom after the Clan was attacked and their twin died

was forced to avoid all mention of their heritage while in the South because their aunt feared the danger their connection to the Khalleran Clan could put her children in

warm and upbeat, but nervous--they grew up rather sheltered, and are unsure of themself and their place in the world; despite this, they are open to new experiences and love meeting new people

likes/good at: pottery, biology, combat, adventure, travel, cold weather

dislikes/bad at: standing up for themself, fire, disappointing people, lying

romantic interest: Cait

Theodosius "Theo" Wren

he/him, cancer, human/fae

raised in academia by his single mother, who is a professor at the academy that he, cait, nix, and analei all attend

has an autoimmune disorder, so he's sick a lot (he's used to it, it's just an annoyance to him for the most part)

nerdy and excitable--boy is very adhd. he could talk for days about the things he's passionate about, but also loves to listen to other people talk about their passions

likes/good at: history, dragons and their care, astronomy, calligraphy

dislikes/bad at: learning languages (he tries, but he's just not good at it lol), being cold, headaches and nausea, magic, combat

best friend: Cait

Tobias "Toby" Fischer

he/him, capricorn, human

orphaned shortly after he was born, but was taken in (and basically raised by) Cait's mom; he's 9 years older than Cait, and is her older brother in every way except biologically

swore his life to Cait when she was born, and has been her personal guard ever since he was old enough to take on the role

stoic and stony on the outside, but loving and soft on the inside. he's a golden retriever in a doberman/mastiff's body (babies--both human and animal--make him cry)

likes/good at: horses, combat, anti-magic (the ability that some humans have which can block/shut down fae magic), history, his husband, dragons

dislikes/bad at: trusting other people to protect Cait, drama

charge: Cait

Analei Dûr

she/her, taurus, human/shifter

princess of the Eastern kingdom of Marel (her older brother, the prince, died when she was a teenager, so she is the heir to the throne now)

has known Cait since they were both young; the two are surprisingly close friends, despite their wildly different personalities

extremely feminine, outgoing, and flirtatious--adores being the center of attention. she is also very calculated and observant, though very few see that side of her (she exaggerates the ditzy flirt side of her personality to use it as a façade)

likes/good at: the color pink, singing, parties, cool rocks, jewelry and fashion, history

dislikes/bad at: getting her hands dirty, getting her clothes dirty, talking about her brother, anti-magic, learning tonal languages

roommate: Cait

OKAY THAT'S THE MAIN CAST (of book 1... lmao)

there's a lot more about them, but those are quick profiles! if you have any questions about them or anything else, ask away! I love talking about them <3

[seaseren]

Thinking about what Chiaki's illness actually is... I think its the aetheric equivalent of an autoimmune disorder? Their body has a hard time integrating foreign aether. Treatment from the conjurers, getting and strengthening the Blessing of Light, and learning more about both aetherology themself have helped significantly- probably the Blessing of Light most of all, to be honest. Maybe the appearance of that is the reason they were allowed to set out as an adventurer at all, to be honest? idk

[smoov-criminal]

17, 18, 19 for the ask game? ✨

17. have you ever made characters with disabilities? if yes, tell us about them and their disability?

ill be honest, im not huge into fandom stuff and that sort of thing, including making ocs. ive made ocs for dnd campaigns but none of them have been disabled. i haven't played a whole lot, but i would like to make a disabled oc for a campaign next time i do play, and i think it could be neat for them to have a small creature that they ride as a mobility aid, ive seen that recommend

18. what are your favourite disability headcanons?

in the same vein, i don't make a lot of headcannons about stuff, but if i had to think of one right now i think finn from adventure time (one of my only tv show special interests) would definitely pretend to shoot fireballs or some shit from his prosthetic arm all the time

19. whats a disability you want to see more or better representation of/for?

i answered this one previously, but i will again! i think we should see more characters with autoimmune disorders like lupus or RA

[idigitizellp21]

Why Outdoor Activity is a Must for Every Child⁠

Children often find themselves confined to structured environments, surrounded by screens and schedules. Have you ever wondered what’s missing from their daily routine? It’s the freedom and joy of outdoor play, an irreplaceable part of childhood.

The Science Behind Outdoor Play: What Do Experts Say?

Did you know that children who spend at least an hour outdoors daily show remarkable improvements in focus and creativity? Research highlights that exposure to natural sunlight helps regulate sleep patterns by boosting melatonin production and increasing Vitamin D levels, crucial for healthy bones and immunity. Imagine the possibilities when your child’s mind and body are fully recharged!

What’s your child’s favourite outdoor activity? Whether climbing trees or chasing butterflies, every moment outside contributes to their physical and mental well-being.

Reasons Why Outdoor Play Shapes Child’s Growth

1. Builds Physical Fitness Naturally

Unlike structured indoor exercises, outdoor play offers dynamic activities like running, climbing, and skipping. These activities not only strengthen muscles and bones but also improve balance and coordination. Have you noticed how effortlessly kids enjoy movement when they’re outside? It’s because outdoor activities transform exercise into fun! Additionally, being active outdoors helps reduce childhood obesity and instils lifelong habits of fitness.

2. Boosts Emotional Well-Being

Have you ever felt calmer after a walk in the park? The same applies to children. Studies reveal that green spaces lower cortisol levels, reducing stress and anxiety. Unstructured outdoor play gives kids a healthy way to release emotions and build resilience. How does your child respond to challenges like climbing a tree or playing catch? These experiences foster confidence and emotional strength.

3. Fosters Social Connections

Outdoor activity is a natural stage for social interactions. Whether it’s a game of hide-and-seek or building a sand castle, kids learn essential skills like communication, sharing, and teamwork. Have you seen how easily children bond over a shared adventure? These interactions nurture empathy and problem-solving skills, preparing them for real-world relationships. At Elzee Preschool, our outdoor spaces encourage teamwork and collaboration, ensuring every child thrives socially.

4. Stimulates Cognitive Development

Did you know that nature is a treasure trove of sensory experiences? From observing ants at work to listening to rustling leaves, outdoor environments spark curiosity and ignite imagination. Have you ever watched your child invent a game with just sticks and stones? These moments sharpen problem-solving skills and boost sensory integration, laying a strong foundation for learning.

5. Strengthening the Immune System

Can Dirt Be Good for Kids? It might sound surprising, but exposure to outdoor microbes helps build stronger immune systems. Research suggests that children who play outside are less likely to develop allergies and autoimmune disorders. When was your child last played in the mud or splashed in a puddle? These simple joys contribute to their long-term health while reducing the risk of respiratory infection.

6. Combating the Digital Overload

In today’s digital age, are screens taking over your child’s life? Outdoor play offers a vital antidote, reducing screen time and its associated risks like eye strain and poor posture. How about trading an hour of video games for a backyard adventure? Outdoor activities reconnect children with the physical world, balancing digital interactions with real-world experiences.

How Elzee Preschool Integrates Outdoor Play?

At Elzee Preschool, we view outdoor play as a cornerstone of holistic education. Our thoughtfully designed outdoor spaces, from sensory gardens to adventure zones, offer safe yet stimulating environments for exploration and growth. Did you know our curriculum seamlessly integrates outdoor activities to ensure children receive full physical, emotional, and cognitive benefits?

Parental involvement in preschool education and outdoor play is crucial for a toddler’s overall development. What can you do to make it a part of your child’s routine? Organise family outings to parks, plan backyard games or simply encourage unstructured play. Remember, outdoor activity is not a luxury; it’s a necessity for holistic development.

Join Elzee Preschool, one of the best preschools dedicated to nurturing every aspect of your child’s growth. Experience our holistic approach to education that combines academic excellence with joyful outdoor adventures.

[nettchan02]

Welcome Collection and Jasonon adventure

I went to visit the Welcome Collection and in Euston station. Euston station the welcome collections just only five minute away needed and walk just very very local gallery in the Euston station.I had seen Jason's adventure I also had chance to see the anatomy on the work on collection is just front of the Jason collection. It’s like a pretty unique. It’s because the artist Jason had been mentioned about his main conceptions and inspiration is from the anatomic from the collection and the main inspiration for his work as he self. Also all his work has some little conceptions is like a little journey of his life. I remember when I was done a little journal about in my foundation year it’s a pretty similar. It’s like sharing a little journal. He’s also sharing his little journey and little adventures and journals just in a different way it’s not with a sketchbook is much more what he experienced is a periodic he was experienced His life.

“An emotional and whimsical expression of the joys of being human, fun for the whole family, and has something powerful to say about how society perceives disability.

Metro

Autoimmune disorder he has been battling since he was a teenager. His journey portfolio talks about how his family took part in every single bit of his family and friends. It was difficult for me to understand autoimmunity precisely when I was researching. Still, I know it highlighted for myself that the regular role of the immune system in defence against infections is disturbed, resulting in it mistakenly attacking normal healthy cells in the body. Examples of such diseases include rheumatoid arthritis, type 1 diabetes and multiple sclerosis, and there are more than 80 types of autoimmune diseases known. Describe the boat he is community attacked by the white cells. It’s pretty complicated for me to understand it because, at the time, it’s so big bones and skins got it could see about had so many challenges and for me to understand it, and that’s why I thought like maybe outside of the Oxford dictionary and the NHS descriptions because the NHS is a bit more describing what is precisely about the unit, but from the artist we are talking about from this blog about how he sees it so I also shared the little imagination so like I mentioned about his family about like with his diorama at work. So, the artwork is presented more like pink and yellow soldiers. He was about how he looked like an outside-the-box influencer, and he chose and wanted to influence so many people with a similar condition that Jason was battling. He wanted to be that to be the bright side. Jason influences everybody fighting with disabilities and wants to be influenced by many people. Still, Jason’s exhibitions about the anatomists you enjoyed are on the same floor. It’s just like in front of each other, so it could be shown that the welcome collection at the time opened at the artist. How much did they influence exhibited areas? It’s great to see that when I was going to visit the welcome collection, I also got welcomed, and I also got supported by so anyway so and so many people got their support. I couldn’t say how much I liked the work collection. One of my top 10 galleries is a modern or British gallery.

In this exhibition I was not understanding the artist perspective or the colours could symbolise something or hidden codes like in the art psychology.

I am very, very influence welcome collection so special and clinical figures. There is a couple of expeditions around on the collection. I don’t really got a chance to go. There is my time. It’s not really worked out well yet so whenever I got a chance I will be busy again and I will be doing more sketching, especially when I could object environment I will be sharing also my post about like will be a sketched on the welcome collection so I will be edited this one soon I will sketched the sculpture pieces of the anatomic that’s one of my favourites thing and the odds the anatomic sculptures of the bodies I could understand totally what was visually a bodies works and an illustration how does it work ?

There were a couple of pictures of doctors. I had been sketched and sketched rooms, but so much mess all around the person's room. It’s all Tracy Emmon. It reminded me of Tracy presenting someone terrible; unfortunately, I don’t usually have time to read every piece. What is it about? Everything is about, but it’s interesting to know as I wanted to become an illustrator. I wanted to make my own story out of it with the expressions, or are they saying that’s why I usually go to The public areas and sketch on the Underground station? I always believed that people's eyes were telling me something where they wanted to be talking to me, and they wanted to be explaining something. We don’t know that yet, so I enjoy experiencing it a lot.

[dragon-hoard]

getting low blood sugar sucks cause I always accidentally over compensate and then it gets too high

but alas just about any physical activity more than a brisk walk for longer than 1 hour for some reason tanks my fucking sugars unless I carb up literally right before which is. a pain in the ass

[toughgirlchallenges]

Mireille Siné: Pushing Boundaries - From Lupus to Long-Distance Running, Tackling the Speed Project with Unlimited Women.

Mirelle in her own words:

“My name is Mireille and I’m a certified run coach, autoimmune athlete, and podcast host based in Los Angeles, California.

I have been an athlete all my life but I found myself in distance running while in college. 

As an exercise science major, I was immersed in the world of bio-mechanics, physical performance, and health. 

However it was also in college where I was diagnosed with Lupus; an autoimmune disorder that left me sidelined from physical activity for 1.5 years. 

Luckily after treatment, I was able to use running to gain back my health and then some! 

Over the last ten years, I have experienced so much of what running can bring; determination, fun, discipline, adventure, and confidence." 

Some accomplishments include:

-   Completed 12 marathons (& counting)

-   First Black women to run from Boston to NYC (200 miles in 11 days as part of the FALKE team)

-   Completed a relay from Santa Monica to Las Vegas. (The Speed Project 2023 - with Unlimited Women)

***

This episode of the Tough Girl Podcast is proudly sponsored by INOV8, the pioneers in cutting-edge sportswear. 

Learn more about INOV8 and get your 15% discount. Click Here.

***

Show notes

Who is Mireille

Living in LA, California, but originally from Cameroon, West Africa

Growing up in Cameroon before moving over to America at 6 years old

Wanting to finish school and to go on to college

Being inspired by her dad who was active and loved to ride bikes

Playing basketball, and enjoying being active

Having ambitious dreams and a love for learning 

Wanting to have a safe profession 

Being interested in science and wanting to pursue college

Studying exercise science for her undergraduate degree

Running track in high school and being curious about distance running at college

Wanting to pursue physical therapy and the challenges of trying to progress in the career

Enjoying running and feeling healthier while doing it 

Dealing with stress while at college

Being diagnosed with Lupus an auto immune disease and the impact it had on her life

The impacts of Lupus on her body

Making changes and how Lupus impacted on her life

Needing to pivot and make a change in her life

Having a year left in school and needing to make some key decisions about her future

Doing what she thought was best

Needing to take a semester off from school/college

Working as a PT assistant and getting back into running 

Balancing health and fitness while having Lupus

Turning to vegetarianism to help manage her Lupus

Training for her first marathon

Magical moments while running 

Running in the Speed Project (2023) - running from LA to Las Vegas over a weekend

Unlimited women - a team of 10 women, bringing diversity and awareness into the running sphere

Dealing with challenges on the Speed Project

Mental tips and tricks for when it gets tough 

Race strategy and how the race worked 

Starting to eat meat again and dabbling in veganism 

Nutrition while running and racing and making it easy. 

Running from Boston to NYC and becoming the first Black woman to be involved in the project with FALKE

Working with FALKE 

Running the Berlin Marathon

Entering the lottery for the London Marathon

The Los Angeles Marathon

Working as a running coach and her coaching philosophy and values

Coaching road, trail and autoimmune athletes 

Education, communication, commitment and joy. 

Why it’s more than just a training plan

Making the training adaptable to your life

Hosting the “Running in Public” Podcast - combining messages about running and public health.

How to connect with Mireille on social media

Final words of advice for other women who want to get into running

Speaking up and the power of advocating for yourself 

The importance of making it fun!

  Social Media

Website: www.coachedbymireille.com 

Instagram: @heycoachmireille 

Ko-Fi: ko-fi.com/coachmireille 

  Check out this episode!

[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"

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I am SO genuinely excited to be playing dnd with people for the first time in time in like a year and a half!! Heres my little guy! His name is Tethren Nailo, a noble sorcerer whose magic causes physical damage to him. (Aka its really an autoimmune disorder that just flares when magic is used). Hes out adventuring to master control of his powers and prove himself a worthy heir to his family’s house. He also is a feared master of law and uses his skills to fight for the minorities and outcasts of society, who he feels more close to than others in his social class.

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Sometimes I genuinely feel like I’ve failed to have the “college experience” because I have a relatively small circle of friends on campus and my autoimmune disorder prevents me from partaking in strenuous late night adventures but then I realize that it’s only been a semester and I have 3 more years ahead of me to make memories. There’s just way too much pressure to be having fun 24/7 in college which is simply unattainable.