#clinical research. | Explore Tumblr posts and blogs

reasonsforhope · 1 year ago

Text

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

#mental illness #schizophrenia #schizoaffective #psychotic disorders #psychology #neurology #autoimmune #autoimmine disease #neuroscience #medical news #medical research #catatonia #immunotherapy #immune system #clinical trials #good news #hope

6K notes · View notes

review-anon · 2 days ago

Note

This is Chapter 1 stuff but what are your thoughts on everyone's dark secrets revealed in that one game?

Im surprised they did it as a side thing as normally that's a full chapter motive so props to them. But with a lot of these secrets they sound bad at face value but context is everything and normally they are worded in a way to cast a bad light.

Either way thoughts are under the cut

"Ken witnessed the death of a close family member when he was six"

We find out that it was his sister and she got hit by a car. Its a tragedy that could happen to anyone really. As such I doubt most of the cast think any less of Ken as it was a horrible incident out of his control and it was done in such a mundane way as well.

"Harada has had eight romantic partners, though they were spaced out."

Well, well, Harada has quite the busy love life it seems. I do wonder why they all failed though as eight partners is quite a feat. Is he bad at holding onto relationships, were they toxic or is the whole cat piss smell. Because being a zookeeper isn't always glamourus work and often you come home smelling like shit.

"Mai has killed someone."

Doesn't really surprise me as bounty hunter work can be lethal. Mai explains that she used too much force when catching a bad guy and while it was an accident she doesn't regret. I like the fact she just outright admits it and explains some context behind the matter.

"Hama has spend a lot of time in juvenile detention centres"

I already explained why I think I know the context but I think what happened was people were starting shit about Hama's disabled sister because people suck, Hama got pissed and beated them up because no-one shit talks about his sister, and he got thrown into juvie as a result. Until we know the context this is my best theory.

"Wada spend his childhood in and out of foster care, and he now lives alone."

This right here is proof while the foster care system can really suck, as Wada is literally Maverick right here with how much he's been in foster care. And the fact he has barely any survival skills means his foster parents were probably quite shit to him as well. Not surprising given how crummy foster care in Japan is.

"Isono put her older sister in hospital."

Since she's dead now, we will never get the answer to this question but its up in the air if it was an accident or intentional. Isono doesn't strike me as someone who would put her sister in hospital on purpose so it was most likely an accident, maybe some stunt for the fans that went wrong?

"Sasaki has had a romantic relationship with a teacher."

Now I know I shit on Sasaki a lot, and she's still my least favourite Tetro Pink character but I will say this; I don't think Sasaki started it, it was the teacher who forced her into that.

What I think is the case is that the teacher forced her into a sexual relationship so she could get good grades and such. Its scummy but sadly quite common that some pervy teacher can have their way with a student. Its a unforunate common practise and since teachers are consider gospal in Japan due to their cultural views, the teacher probably got away with it as if Sasaki spoke out it was her career at risk.

"Hiroaki put himself into debt of￥200,000 due to purchasing narcotics"

We all know Hiroaki has a drug problem. Its withdrawl effects became a plot point in Chapter 2. But sometime Timeline Anon brought to my attention is that Harada doesn't have Hirokai's dope anymore which means someone stole them, especially since nobody really locks their dorm doors. That could be a problem especially is Hiroaki's withdrawal effects get worse.

I do believe he fell in with a bad crowd or was unhappy and took drugs which is why most people do so.

"Okazaki performed something unlicensed but she pressed the button before Monomeko could say it fully."

That is very sus indeed that she pressed it before the rabbit could finish what they were saying, almost as if they don't want the others to know. Unlicensed could mean anything and given my susicipions on this character it doesn't make me feel any better.

"Yanagi's family fell apart due to domestic violence and alcoholism."

This probably explains his prince act because if Yanagi's father constantly beat his mother up due to being drunk all the time, it probably made Yanagi determined to be nice to women at all costs as he probably hates his father.

"Chiba has been hospitalised for malnurtition."

This is why I said her small size has a darker side to it as I suspect she was not given enough food on purpose to stunt her growth and keep her small for child roles. Since her manager is her mother, this was 100% child neglect and abuse.

"Watari drove her parents to divorce each other."

The fact she doesn't regret it one bit, makes me wonder if her parents were bad to her or if she hated one parent and wanted them gone. I feel this is something we need more context for really.

"Tamba has physically harmed someone to get ahead in the competition."

As an Olympic athletic, it was probably really cutthroat for her and like certain other Danganronpa characters *looks at Sayaka* she probably did all she wanted to get ahead. She later explains she broke someone's knee which is quite a serious injury. Again its something to be expected in that field as she later finds out from Yanagi that figure skating isn't as ruthless as gymnastics is.

Pretty sure if she tried to do that to Akane, she would end up in hospital.

"Tsuno lied about taking a holiday to cover the fact she was going into rehab for drug addiction."

Admitting you have a drug problem is still quite the stigma, and while we do know she's on different drugs to Hirokai, I can understand why she might lie to people as admitting you are going into rehab would cause you to become a outcast. If anyone is to blame, its society.

"Kamimura has tried to unalive himself many times."

Honestly not surprised he's suicidal given his general demenour especially if this happened shortly after losing his family. I do hope Ken can keep him straight and not think about making another attempt while in the Killing Game.

"Ojima has PTSD from childhood sexual abuse."

I knew the fact he zoned out all the time was probably linked to a bad experience and the dissoance was a coping mechanism, but I didn't realise it was gonna be this bad, yikes poor Ojima.

And ftr while most I do want context behind, I think we can all agree we don't want to find out how Ojima got violated. We know his dad was famous and got arrested recently so I do think he was the culprit behind said abuse but that's all I want to know.

Overall I say this lot need help, but the Killing Game is the worst place for that and some of them we probably get more details as the Killing Game progresses.

#review anon talks #danganronpa #dr #tetro danganronpa pink #tetro danganronpa spoilers #it seems interesting that these secrets were in a side motive #normally they are a big deal #which means the game isn't about breaking people personally #but rather generally #which shows how clinical and detached this whole thing is #but i do wonder how much research into them occurred

5 notes · View notes