#is schizophrenia curable?

[drrahulmathure]

Is schizophrenia curable? - Indore Psychiatric Centre

Schizophrenia is a complex and chronic mental disorder that affects how a person thinks, feels, and behaves. While there is no cure for schizophrenia in the traditional sense, it can be managed and treated to improve the individual’s quality of life.

People with schizophrenia may experience things that others don’t, like hearing voices or seeing things that aren’t there. Thoughts may become disorganized, making it difficult for the person to communicate or follow a conversation.

Early exposure to viruses, malnutrition before birth, or stressful life events may increase the risk. Imbalances in brain chemicals, particularly dopamine, play a role in schizophrenia.

Medications often target these imbalances. But it is a treatable and manageable condition. Medication and therapy are the cornerstones of treatment, and recovery is possible with the right support.

Read More: Is schizophrenia curable? - Indore Psychiatric Centre and Contact: 8818812800

[saintsenara]

the wizarding world really just does not care about anything huh? i mean. what would have happened if tom had been institutionalized due to his magic?

thank you very much for the ask, anon!

i need to actually get around to writing the big meta i have on the idea - which i know a few people have asked me about - that hogwarts applies some level of selection [that is, that - despite what lupin says in deathly hallows - it doesn't teach the majority of magical children in britain, whether they're born to magical or muggle families] when it comes to who it admits, and that muggleborn potential pupils who fall short of its criteria never get the letter-delivery meeting that we see the canonical tom riddle receive.

which would mean that, had tom been committed to a psychiatric hospital as a child, i think the wizarding world would have quietly struck his name off the list for potential admittance to hogwarts and continued on untroubled.

which is obviously grim.

although i think it's worth saying that, while there is a lot about 1930s psychiatric care which was legitimately inhumane - and the sort of one flew over the cuckoo's nest-style dystopian vibe, which makes the idea of poor wee tom being stuck in a hospital seem so terrifying, isn't entirely inaccurate - there's also, as odd as it sounds, a chance that he might have been genuinely helped by the psychiatric treatment of the time period.

we picture the psychiatric treatment of the early twentieth century as straitjackets and padded cells and lobotomies - violent and dehumanising procedures with no clinical benefit - because [as is often the case today in the way mental illness is spoken about both clinically and culturally] the medical community tended to regard anything accompanied by psychosis [schizophrenia, schizoaffective disorder, bipolar disorder, and so on] as intensive, untreatable and unmanageable [and to - therefore - institutionalise patients with these symptoms permanently].

but at the same time, mental illness which wasn't accompanied by [long-term] psychosis [depression, anxiety disorders, addiction, ptsd and so on] was increasingly seen not only as treatable, but as curable - and clinicians' aims were for patients to be treated temporarily either in the community or in modern hospitals which looked very different from the padded-cell asylums which were holdovers of the victorian/edwardian era, and to live independently after their course of treatment was done.

this was largely due to the prevalence of "shell-shock" and "soldiers' neuroses" - which we would nowadays understand as types of post-traumatic stress disorder - among men who had served in the first world war. these men - often from "respectable" backgrounds, with no history of mental illness in their families - were a very different demographic of patient than either the destitute "lunatic" or the hysterical woman of the victorian and edwardian imagination. they were also needed back in the trenches - but with their symptoms under control enough that they weren't considered dangerous to their fellow soldiers.

and treatments for shell-shock were - as a result - considerably more humane than the contemporary treatment of psychosis. emphasis was put on holistic treatments - especially the chance for men who had been shivering in the trenches to get a period of real rest - and on talking.

[british army officers were ordered - for example - to attempt to reduce shell-shock cases by encouraging their men to process their experiences of the war in individual and group settings.]

after the end of the war, the treatment of long-term shell-shock combined with the growing interest in "analysis" - which, while the image i'm sure many of us have of it is of sigmund freud suggesting the patient wanted to fuck his own mother, actually looked rather a lot like the various branches of psychotherapy do today - into courses of treatment for conditions like depression, anxiety, and ptsd [especially those caused by childhood trauma] which aren't actually terrible...

the way the young tom riddle speaks about magic in canon absolutely sounds like psychosis to someone who doesn't know he's a wizard - and so, yes, there is a very high chance that he would have been institutionalised to be stuck in restraints for the rest of his life.

but it's also the case that, since he was a child when mrs cole was trying to have him "looked at" by doctors, this increasing disciplinary focus on the psychological motivations for behaviour - especially in childhood; child psychology and the causes of juvenile delinquency were things the psychiatric community was increasingly interested in during the 1930s - might, instead, have had his belief that he could do magic put down to a fantasy which he had invented on account of his numerous [and treatable] neuroses.

and while it's not the case that he's making up being a wizard... it very much is the case that he's neurosis-central. you've never seen a more unbalanced ego.

and that actually being prompted to confront his childhood trauma [especially his grief over his mother's death] - even when the strange, freudian flavour any psychotherapy would undoubtedly have had is taken into account - would probably have done rather more to actually help him than hogwarts' "ignoring children's emotional needs is fine" approach...

[sophieinwonderland]

Hello again, I have a post to show, you and resources for your page, about delusions because we noticed how many misinformation is in the internet when we talked to our doctor

https://www.tumblr.com/belablog134/744315633414635520/delusions-vs-did

I’m sending this to help, and not to dismiss your opinions or views if something, thanks for reading /gen

Thanks for taking the time to do this write-up and share it!

I do have some quibbles with this.

Mainly, voices would usually be referred to as "hallucinations" from what I've read rather than "delusions." There are thought-intrusion delusion delusions too, but those tend to specifically be feeling like your thoughts are planted from an outside source, like the government put a chip in you or aliens are beaming thoughts into your head. (This seems to be a grey area with some people classifying these as hallucinations and others as delusions.)

Beyond that, these would be my additions.

Curable through medication

This is sort of true, but I might advise using the word "treatable" instead of "curable." Most of the time, a cure implies permanently getting rid of something, while pills can often only temporarily treat symptoms, and they may recur if you stop taking your medicine.

I'd also note that there are a number of cases, about a quarter to a third, where voices are resistant to treatment.

(This might imply though that the treatment-resistant voices are misdiagnosed and would be more accurately described as dissociative.)

Sense of identity shifts between different identities (said nothing about multiple people in the head)

This point, while true of DID, is not for Partial-DID which doesn't involve switching.

Although as far as that's concerned, I'll also share the boundary with Schizophrenia from the Partial-DID page:

[twopoppies]

Thanks Gina and the other person for the advice. I don’t feel burdened by her or the support she needs, I’m more than happy to make adjustments for her. She’s generally positive and very good at getting on with things herself anyway because she is very independent despite still having clinicians involved (she lives alone and has a job). It’s just the overwhelming feeling that it shouldn’t have happened to her (I can’t wrap my head around how so many different people have done so many evil things to her) and not only has it happened but it’s given her actual life long, non curable, schizophrenia and no matter how much time passes or how hard she works there’s no possibility that it will go away. But yeah, I’ll definitely think about talking to a professional if it does become too much, because like I say,no one knows, she was an adult when she was sectioned so even told her parents it was just depression, so I’d never ever tell anyone that knows her what it actually is. I just get so stuck on the fact that a) it happened at all and b) it’s given her an illness she’ll never recover from (although I know she can have a reasonably good life and she definitely deserves one).

Thanks again for putting it out there, and I hope that other people who seem to be attracting evil people know that it’s nothing to do with them and they deserve to be around people who wouldn’t dream of hurting them.

She’s very lucky to have you. Sending you both a lot of love.

[mlobsters]

A catatonic woman awakened after 20 years. Her story may change psychiatry.

New research suggests that a subset of patients with psychiatric conditions such as schizophrenia may actually have autoimmune disease that attacks the brain

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.

Washington Post By Richard Sima June 1, 2023 at 6:00 a.m. EDT

gift link provided by nylanejane on bluesky

When the brain is under attack

A new disease at the crossroads of psychiatry and neurology could help in the understanding of psychosis

Boston Globe

By Dr. Daniela J. Lamas Globe Correspondent, May 27, 2013, 12:00 a.m.

Some speculate anti-NMDA receptor encephalitis could be behind historical descriptions of what was believed to be demonic possession. Cahalan described her first seizure in a book about her experience, “Brain on Fire”: “My arms suddenly whipped straight out in front of me, like a mummy, as my eyes rolled back and my body stiffened. I was gasping for air. . . . Blood and foam began to spurt out of my mouth through clenched teeth.” But the autoimmune disease wasn’t identified until Josep Dalmau, a neurologist at the University of Pennsylvania, was called to see a patient in the intensive care unit in 2002. The woman had come in months before, agitated and hallucinating. By the time Dalmau arrived, she couldn’t speak and could breathe only with the aid of a ventilator. She’d gone through “a million dollars’ worth of tests,” Dalmau recently recounted. All were negative. [...] Markx, the Columbia psychiatrist, met Dalmau a few years ago, after Markx had just cared for two patients with anti-NMDA receptor encephalitis. “This was eye-opening for me,” Markx said. “What if people were walking around with a psychiatric diagnosis, treated with psychotropic medications, but who may in fact have a potentially curable auto-immune disease?” he said. That is, could patients who have been diagnosed with schizophrenia actually have anti-NMDA receptor encephalitis?

in the 19th century i would've gotten diagnosed with ghosts in my brain

[foxbox23232]

Hey I just wanted to share as encouragement. Never underestimate the power of telling the truth. This man used to i guess have a crush on me in middle school on the bus he told me. I thought it was funny or whatever nbd and then decided to tell him my testimony randomly and probably decided to based on his posts because we are in the end times and people are more depressed and suicidal more than EVER BEFORE. At the time he gave a pretty unbeliever response. I just spoke with love and was on my way and stopped bothering him. Maybe year or so ago. Nothing weird or anything just sharing the gospel. Recently he started posting about the gospel and it just goes to show it’s not really about you. It’s about how deep they want to go. It’s about if they want to know the Truth or not. It has pretty much nothing to do with you 99% of the time. But I’ll tell you what, being honest, open, and loving really does make a difference in conversations. And really reveals and reflects biblically Gods heart for his people.

I’ve actually been seeing a lot of posts about Jesus lately and I do try to comment or whatever I see about it and of course I make posts about Jesus. Facebook is probably the least demonic social media for some reason probably because we actually talk, learn, have discussion, don’t jump the gun like twitter, probably the best social media if you’re a Christian or like learning IMO I’ve been seeing a lot of people I know come forward about their republican beliefs or Jesus as well. I also really enjoy tumblr because you can post whatever you want and collect things you learn about. I like how it has nothing to do with anyone you really know if you don’t want it to. I like how you’re free to express yourself on here. I know this website is kind of known as a “hellsite” but TBH it is what you make your blog about.

This man is also schizophrenic and although I want to be the one to help him I also know depending on how bad he wants the truth God could just do it and totally heal him and deliver him from that demonic spirit. And FYI science says there is no cure for schizophrenia but it is 100% curable with God. And instantly too… which again is impossible according to science. So ya science is good for nothing maybe?

[automatismoateo]

My friends mom thinks God will heal her sons severe mental disabilities via /r/atheism

My friend’s mom thinks God will heal her son’s severe mental disabilities I have a friend who has 2 brothers, one with severe schizophrenia and one with severe autism. Obviously, these conditions aren’t curable today, maybe in the future but we haven’t found cures at this point in history for any mental illnesses or developmental disabilities. But my friends mom thinks one day god will cure them and I get it’s a coping mechanism but like it sucks that she believes this shit but it’s never going to happen and her sons will unfortunately never be able to live independently. Like idk it’s a battle between understanding the coping mechanism she has but debating whether it’s healthy or not. Submitted June 04, 2024 at 06:38PM by wellz-or-hellz (From Reddit https://ift.tt/xAMaXet)

[ojasnpc]

De-addiction center in Kangra

ojas is the best de-addiction Treatment Center In Kangra.Our services include the treatment of mood disorders, Schizophrenia, Anxiety disorders, Drug Addiction Treatment, Alcohol addiction, Sleep disorders, Dementia.But good news is that addiction is a curable disorder. If you are suffering from any type of addiction eg: alcohol, heroine, smack, cannabis etc, you can contact the best de-addiction center in kangra. https://ojasnpc.com/

[mentalhealthsposts]

What are some common misconceptions about mental health recovery?

Today we are living in the 21st century and even in this modernised and growing society there exists several social taboos.One of the social taboos that exists in our society sadly is mental health .people suffering from mental illness are often isolated and are rediciled and made fun of rather than being supported. Mental health disorder is considered as a matter of shame and thus is always hidden by the family members of the person suffering from it. People suffering from mental illness are often called by hurtful names like 'mad','crazy','pagal' and the list can go on and on.

Let us look at the most common mental health disorders that exists today-

Depression

Anxiety

Panic attacks

Chronic disease

Obsessive compulsive disorder

Borderline personality disorder

Severe mood swings

Eating disorders

Schizophrenia

Apart from these judgments that  society paases on to the people suffering from mental health disorders, there is a misconception that mental illness can not be treated and there are no specific treatment facilities available for it.

This is a completely false notion, if the person suffering from illness accepts his need to seek to a professional help and reaches out to a suitable treatment, mental illness is highly curable. Mental health treatments involves-

Therapy sessions

Group sessions active participation in support groups

Family therapy sessions

Indulging in yoga and meditation centres

Proper intake of medication

Indulging time in activities that one love

Spending quality time with close ones

Mental health is as important as physical health and needs to be protected at every cost.

[girlcalledwhatsername]

I find myself explaining to people a lot recently why using "bipolar" "narcissistic" "psychopath" etc is an issue, because it can be hard to articulate in the moment, so here it is all together:

The terminology that is related to certain conditions, disorders, and neurotypes being appropriated by others to be used in commonplace situations necessarily creates problems for those whose conditions these terms are supposed to belong to and help. It stigmatises certain behaviours, makes them the butt of the joke, or underplays how debilitating they can be.

For someone who has to live with bipolar disorder, people using "bipolar" or "mania" loosely suggests that the actual bipolar people are overreacting, or else that their condition is a joke when in fact this condition not only hinders them in an ableist world, but also brings violence and discrimination against them because of the condition.

Such also is the case for personality disorders and complex disorders like schizophrenia. Using "psychotic" as an insult or a modifier erases the fact that it's a condition which most aversely affects the psychotic person, it stigmatises them as dangerous when in fact psychotic people are the ones more likely to receive violence than inflict it statistically and historically.

Saying psychopath when you mean a serial killer and sociopath when you mean someone who is cruel is also wrong in that same vein because these are ((now redundant)) subtypes of anti social personality disorder, which does not make people more likely to cause harm or to be "evil" or abusive, but rather causes issues in their own lives due to a lack of empathy, which must also not be confused with a lack of compassion.

Narcissistic personality disorder similarly is a cluster of self esteem issues, identity crisis, and a fragmented sense of self that shows itself in certain behaviours. Borderline personality disorder also is similarly stigmatised, when in fact people with this disorder are far more likely to be victims of abuse. Terms like "narcissistic abuse" or "borderline abuse" suggest that these people abused you because of their disorder, which is not at all true, and any idea of abuse can already be encompassed simply by calling it "abuse" plain and simple rather than stigmatizing a bunch of people in the process of this.

All of these disorders, though not curable, still are treatable in that people are trying to get help and adjust to life despite their symptoms. This only becomes possible as long as these symptoms and terminologies are not stigmatized any further by an ableist society. The terms used to describe these disorders are meant to HELP the people with those disorders. Not to become an excuse to treat these people worse and make them feel unwelcome.

[misstwisted]

EXACTLY WHAT I WAS THINKING! Thank you!!!

it’s such a terrible message to send that mental illness will only go away when the right person comes around and helps “fix” it. Dangerous, even.

I remember looking at mental health rep in romance books and thinking, “hm, anxiety and depression is sure represented a lot.” and then I realize: “wait a minute, it’s pretty much ALL anxiety and depression!”

I’ve come to realize they also have been using them as plot devices to help create romantic scenes and shit. Like having the mc have a anxiety attack, leading to the love interest comforting them. Or having a “depression episode” and the love interest doing things to cheer them up, and it works immediately, getting rid of their sadness.

it never shows the ugly side. The side where you can barely get out of bed. The side where you can barely go outside. The side where you go for days, weeks, or even months in some people’s cases being unhygienic. The side where you’re constantly crying and are a mess, wanting to shun people away. The side where you are on the verge of considering horrible things. You know why? Because it’s not appealing. They rather romanticize it, making having anxiety seem more like just being a shy person (which they see as cute), and making depression seem like a once a month kind of issue. Its fucked up.

I know it’s a romance book, and people don’t wanna read about characters going through it because they want escape from their own lives, but if you’re reading mental health rep in books, it’s not supposed to be fun, easy, and curable. And I know that it’s not exactly fun to write for authors, but if they really WANT to go through with the mental health rep, they need to be accurate. If they really cared, they’d stop beating around the bush and stop focusing on the more “appealing” parts of disorders in their eyes.

but let’s be honest, they just want to write cardboard cutout characters to make bang. The mental health rep is just a bonus to get more readers, and possibly be looked at as having more substance and depth than it actually does. They don’t actually care about portraying mental illness.

maybe it’s a good thing they don’t represent disorders like schizophrenia or BPD. I’m sure the authors would only give those kinds to the villain love interests.

question:

idk if it’s just me, but does it seem like a lot of romance books with “mental health/illness” rep only use illnesses like anxiety because it’s easier to romanticize and seems more appealing…? Not only that but they also air brush over the symptoms and severity of the illness. I’m genuinely curious about what people think and wanna have a discussion about it more!

[garakshowhole]

ik i joke abt memory beta past tense schizophrenia page but the whole air of oh we can cure that now surrounding certain aspects of mental illness in star trek is obviously not good and there’s this kind of. duality of star trek that comes into play where in some situations they act as if (certain aspects of) mental illness are curable and don’t exist anymore even tho there r characters who clearly embody them. which to be fair is something that’s always present when it comes to what medicine can and can’t do in star trek (bc the most important thing is that it fits the plot) but like…… zephram cochrane being ‘cured’ of bipolar + miles o’brien being told medication will fix his psychotic symptoms but not his depression has obvious implications abt which parts of mental illness ppl accept as part of the human experience and natural responses to experiences and which are external/unnatural/to be completely eradicated. this wasn’t what i set out to say which is even if mental illnesses were able to be completely cured in the future only ppl whose symptoms were picked up by and considered unacceptable to them and/or to medical professionals would receive that treatment so there would still be a bunch of people with covert/subclinical symptoms who weren’t treated and exist in a world where they’re basically being told the problems they’re experiencing don’t exist anymore and if they were mentally ill they would have been cured like there would be SO many ppl walking around telling themselves they Can’t be mentally ill and truly believing it and having no idea why they were experiencing the things they are or if they assume everyone does why it causes them problems

[chronicallyblogged]

Well when I read about healthy relationships where 2 adults respected eachother a young part said "that can't happen" they sounded upset that someone would be trying to make these claims. We had to explain that it can its just hard and hard for a lot of people. I dont know that they really believed me. Many of us think its a rare thing to happen. I dont know that I disagree.

Read a bit about high esteem. I dont think I've ever seen it in a personal relationship. Everyone I've known had used external sources for self esteem. A part got angry and felt like this was one of those unachievable lies that doctors tell you. Like how a doctor told my mom my schizophrenia was curable. Tbh I dont really know if I believe it. It sounds completely fake and I can't relate it to anything. I might ask a therapist about it.

[peopleproblemsolver]

Mental Health In A Bottle

i have aspergers which is a neurological social disorder and the only mental illness symptom i have is anxiety from the mental health system itself for the past 17 or so years. diagnostic test for autism is 45 out of 50 positive, or 90 percent.

when i take schizophrenia diagnostic tests and a schizophrenia MRI back in 2006, they both end up negative, with the diagnostic being 90 percent negative, totals 12 out of 105.

when i ask my former psychiatrist about changing schizophrenia medications because they have never worked, largely because i have never had hallucinations anyway, but have side effects, they change it back to one i have already been on even though it never did anything either.

when that dose is raised and i have physical side effects, the psych doctor advises to take over the counter physical symptom reducers, even though this is unreasonable to take every day with schizophrenia medications unless you want to overdose and kill yourself.

so i finally tell them if they dont work maybe just try anxiety medication? i know i have anxiety at least. their answer is that they would be willing to switch to bipolar medications instead, even though that has nothing to do with anything and wont do anything, same as the schizophrenia medications for 17 years.

it is even a challenge to find female therapists who will counsel mental illness anyway, even though most therapists are female.

system wise itself, government counseling lines that are fully paid and staffed that do not require you to be somewhat suicidal are hard to find if they exist.

the actual mobile crisis dispatch line is not useful for this either, as 30 day mental hospitals usually dont have counseling either, only medicine changing and group lecture classes.

the biggest issue or challenge in mental illness health is not patients who refuse treatment, it is patients who search for treatment but cannot find it because medical mental health professionals decline some of them or the services do not exist.

the national alliance for mental illness, or NAMI, does not represent mental ill patients lobby wise. they represent the mental health workers and professionals, and only lobby for change to the budget for mental health programs, not fixing the system itself.

if you tell them you are declined by therapist and psychiatric service providers for reasons such as disability, gender, or race discrimination, they will tell you that they represent the mental health workers and do no lobby for requiring medical professionals to see you under "scope of practice" type laws.

most professionals and workers involved in mental health services argue about unprovable opinions more than most people do in a year or lifetime. i do not talk to my family about medical issues becuase they are too touchy and most therapists have issues with being easily offended and touchy as well.

i need to have an accurate diagnosis for purposes of medicine and treatments. it is unhealthy to be on medicines that have no effect and no purpose for 17 years. it seems inappropriate to be neurologically issued with a social disorder that is permanent and unmedicatable and for psychiatrists to instead pretend that you have a more voluntary, temporary type of issue like mental illness that can be removed with medication. this is because after 5 years, 10 years, 17 years later, they can just pretend the medications just havent worked out yet.

this is inappropriate and should not be mixed or double diagnosed, as autism is permanent and not “curable”. also, most individuals with autism develop the same symptoms, such as hallucinations, as schizophrenics, at the same young adult age period. why mix two things up that have the same symptoms, or say you have both, when that is redundant?

if you have a permanent and temporary condition with the same symptoms, the permanent should override the temporary, as the permanent existed first. autism is a childhood condition. it only developed schizophrenic symptoms in young adulthood, the same as schizophrenia mental illness itself. thus, autism is first.

i have no need to discuss this anymore with any specialists in psychiatry or anyone relevant to me but unable to figure things out enough to discuss it, such as my family members. it is better if i dont, from an anxiety standpoint, and also from a slight trauma standpoint, as talking to argumentative persons who act controlly gives me a suffocation feeling in my upper chest and neck as my breathing becomes too shallow to continue talk about anything with psychiatric "conversationalists."

there is not really any generic social worker advocates for disabled persons, nor really any autism diagnosis specialists for adults. if aspergers as a child included not talking much to others, especially in larger groups, or looking downwards instead of socialising with peers, or having a specific interest in numbers or numerical statistics such as historical years, event, persons birth and death year, wars, composers, historical leaders, or 1980s songs per year, then yes, i had or have those.

allen ralph

[boundarycrossings]

On Pellagra

Excerpt from case series, “Pellagra at the Connecticut Hospital for the Insane”

By William C. Sandy, M.D., Middletown, Conn Assistant Superintendent, Connecticut Hospital for the Insane 

From the American Journal of Insanity published by American Medico-Psychological Association, Volume 75, 1918-1919

“…The third case, one of dementia praecox, after some years of hospital residence in several institutions, developed pellagra symptoms. For several months prior to this she had persistently refused food and was tube fed. She failed to respond to treatment, death occurring about a month after the appearance of characteristic symptoms. 

Case 3. No. 15632. Admitted November 16 1915. Female, white, born in Pennsylvania, age 43, married. Congregationalist, housewife. 

Father developed epilepsy after 40 years of age. Otherwise family history negative. 

Early life and development not unusual. Graduated from Wellesley College and taught school until her marriage in 1900. Has had four children, three male, one female, the youngest being born in June 20 1908. In this position she was very sociable and sunny, not easily irritated. Never showed great capacity for work. She has said to have been rather eccentric and of a romantic nature. Following the birth of her last child in 1908, she neglected her household duties, wrote letters in which she prophesied many dangers in the serious happenings. She did queer things such as endeavoring to have an acquaintance adopt her youngest child, taking her father from a private sanitarium to try to heal him herself, trying to exercise healing power over a strange child, burning her children’s books and play things, at times becoming excited, and violent if opposed. Received treatment in several private institutions and the Norwich state hospital. She showed market religious trends of a peculiar nature. On admission, weight 116 pounds, height 5’3”. Poorly nourished. Sallow complexion. Wassermann negative (note: this was a test for syphilis before being replaced by the VDRL/RPR tests). She entered readily into the hospital routine. After a while, at times performed peculiar ask such as undressing and going to bed directly after breakfast, which she said she did in obedience “ to the spirit.” She often talked to her self and reacted constantly to auditory hallucinations, being direct commands from God. spoke of “wondermen of the world” through whom she communicated her ideas. General mental organization good. Insight and judgment defective.

Following admission she remained seclusive, neat and tidy, occupied in her room and embroidery. Constantly hallucinating, the false voices often directed her so that at times for long periods She would be absolutely mute, inactive, with eyes closed, holding herself in bed with a rigid position, refusing food and necessitating tube feeding.

In December 1917, she developed an erythema on the backs of her hands and wrists which was symmetrical, and which later became a dermatitis with ulcerations. There were also a roughness of elbows, a seborrhea of the face, salivation, redness of the tongue, and towards the end, diarrhea. In December 1917,  She became greatly emaciated. Although given special diet and other appropriate treatments she failed rapidly and died January 10, 1918. The eruption had become considerably less marked before her death but the general symptomatology pointed to pellagra.”

Norwich State Hospital (Spring 2020)

Pellagra is a disease resulting from a deficiency of Vitamin B3 (Niacin), characterized by the “four D’s” - diarrhea, dermatitis, dementia, and death. The indigenous people who first domesticated and cultivated corn were able to prevent pellagra by treating maize with nixtamalization to make niacin nutritionally available. Nixtamalization did not spread along with cultivation of corn, leading to pellagra epidemics where corn became a dietary staple in Europe and Africa. In America, it reached a peak in the South in the early 1900s. At the time of this case series, hundreds of thousands of people were affected (more than 100,000 would die between 1906-1940 of pellagra, and millions would be affected by 1940). The exact cause of pellagra was not yet known but widely suspected to be a pathogen or a toxin in corn. Because the cause was thought to be infectious, patients and families of these patients were highly stigmatized. 

Dr. Joseph Goldberger, epidemiologist, was the first to shed light on the true origins of the disease. Through observations of pellagra cases in orphanages and psychiatric institutions, and various experiments on prisoners and patient populations, he was able to demonstrate the link between poor nutrition and pellagra, and that pellagra could be prevented and cured with an improved diet. One experiment at the Georgia State Sanitarium (better known as the Central State Hospital) was so successful that the study suffered from high drop out rates, with many of the patients improving to the point of being able to be discharged from the hospital, unlike Ms. No. 15632 above.

Unfortunately, his explanation was unpopular - both because of the relative popularity of germ theory (the prevailing explanation for pellagra), and for the political implications of a northerner blaming the disease on the poverty and poor living conditions in the south. In a frustrated attempt to prove that pellagra was not an infectious disease, Dr. Goldberger injected 16 volunteers including himself and his wife with blood drawn from patients with pellagra, and showed that none developed the disease. He was nominated 4 times for the Nobel prize in medicine and physiology (1916, 1925, 2 nominations in 1929) for his discovery “that pellegra is completely preventable by means of a proper diet” but did not win. After his death in 1929, his wife received a pension of $125 per month (equivalent to $1465 in 2020) from a congressional bill recognizing his scientific contributions. Dr. Conrad Elvehjem would go on to identify niacin as the specific deficiency responsible for pellagra in 1937.  

In the case study above, Ms. No. 15632 likely suffered from postpartum psychosis (or depression with psychotic features), or dementia praecox (older term for schizophrenia). She may have even developed catatonia, based on the description of excitability, agitation, withdrawal (closing her eyes, remaining mute), and motor symptoms (rigidity). Combined with poor understanding of nutrition and severe withdrawal symptoms from her underlying psychiatric illness, she would have been at a high risk of developing pellagra and also at a high risk of recurrence even if she were to recover. 

In the US, pellagra is now rarely seen, thanks to fortification of food. When it does occur, these patients tend to be treated on medical floors, rather than psychiatric ones. 

Throughout the history of psychiatry, once the underlying causes of disorders become elucidated or a treatment is discovered, they slowly become subsumed into other fields - neurosyphilis, epilepsy, pellagra. I had my first patient with autoimmune encephalitis early in my intern year, who was initially diagnosed with unspecified psychosis. I wasn’t the one to heroically find the diagnosis. The true diagnosis would only come after repeated admissions, when the patient eventually developed autonomic instability, leading to further investigation, beyond the rather unrevealing baseline labs. Ultimately the patient received high dose steroids and IVIG, and recovered. I became - and suppose, may still be - hypervigilant in seeking out these potential “organic” etiologies. There were many discussions about the utility of a LP, or MRI, and truthfully, the numbers needed to treat were not on my side, but I couldn’t help but think of what it would mean for someone to be diagnosed with a potentially curable disorder rather than a treatable one. Later, during my rotations at the state hospital, on the quiet days without admissions, I would go down to the medical records office and read through the paper charts on some of my old-timer patients, with admissions predating the electronic medical record by decades. Surrounded by floor to ceiling metal shelving with almost a century of paper records, my heart would sink a little, thinking of how many other “curable” cases we missed.