5 ms·

This is a long read, so to summarize: A woman developed what we call schizophrenia. She hid it reasonably well, but eventually was hospitalized for it. Later

This is a long read, so to summarize: A woman developed what we call schizophrenia. She hid it reasonably well, but eventually was hospitalized for it. Later they found cancer. While treating the cancer, her schizophrenia "magically" disappeared. Seemingly for good. The article points that this isn't a unique case, and that schizophrenia, as a "hopeless disease," doesn't get enough attention... And there's no real sub classification to determine what lead to a set of symptoms (which is the only current diagnostic criteria). So the speculation is that autoimmune treatments might cure or help some forms of schizophrenia. Read the full article if this story sounds interesting!

tmaly 1y ago
It seems like we still have a lot to learn in this field of science.
nwienert 1y ago
The GLP-1 drugs are strong auto-immune regulators and neuroprotective and show promise with related disease: https://www.mdpi.com/1422-0067/26/6/2741 https://www.mdpi.com/1422-0067/26/6/2741 https://aaic.alz.org/releases-2024/glp-drug-liraglutide-may-protect-against-dementia.asp https://aaic.alz.org/releases-2024/glp-drug-liraglutide-may-... https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.14313 https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz... https://pmc.ncbi.nlm.nih.gov/articles/PMC11242057/ https://pmc.ncbi.nlm.nih.gov/articles/PMC11242057/ Some promise for autism and depression, though little with schizophrenia: https://www.psychiatrist.com/pcc/efficacy-glp-1-agonists-psychiatric-illnesses-scoping-review/ https://www.psychiatrist.com/pcc/efficacy-glp-1-agonists-psy... https://www.news-medical.net/news/20250511/GLP-1-receptor-agonists-improve-mood-and-metabolic-health-in-adults-with-mental-illness.aspx https://www.news-medical.net/news/20250511/GLP-1-receptor-ag...
- quantumwoke 1y ago
  Alzheimer's disease is not schizophrenia.
RC_ITR 1y ago
I also wonder if just that microglia are activated during chemo. Maybe this is just the most useful case of 'chemo brain' ever.
- hinkley 1y ago
  Probably why we keep looking at electroconvulsive ‘therapy’ again and again. Triggering the body’s systems to do something often cleans up other situations at the same time. There was a phenomenon where sometimes a high fever would cure STDs like syphilis. We generally use antibiotics now that we have them, because they are less dangerous.
  - AStonesThrow 1y ago
    [dead]
  - peterfirefly 1y ago
    > would cure STDs like syphilis. And sometimes certain cancers.
- pitpatagain 1y ago
  The article is mostly about how there are now recognized to be certain schizophrenia-like conditions that are clearly autoimmune diseases. Mentioned in the article are anti-NMDA-receptor encephalitis, which responds to immunotherapy, and a previously published case of a woman mid-diagnosed with catatonic schizophrenia fully recovering after being treated for lupus with immunosuppressive therapy. Based on this, the article suggests that the rituximab Mary was given along with chemo was the key. However, they were unable to test conclusively for antibody evidence of this theory after the fact.
  - mgh95 1y ago
    I have a family member with an incidence of autoimmune encephalitis secondary to other conditions (my entire family is an autoimmune cluster) who is actually hospitalized for it now. This almost matches my experience to a tee, though anti-NMDAR was tested for and not found. The neurologists wanted to discharge prior to attempting immunotherapy and thankfully we were able to ensure they tried (pulse steroids). It's certainly an area which can be characterized as rare disease, whether paraneoplastic or otherwise.
fny 1y ago
She did not have "schizophrenia" in the first place. The the DSM criteria may have overlapped, but bonafide schizophrenia comes with gray matter changes seen over fMRI. The biggest clue is that she was never responsive to antipsychotics.
- thaumasiotes 1y ago
  > but bonafide schizophrenia comes with gray matter changes seen over fMRI According to who?
  - genewitch 1y ago
    https://psychiatryonline.org/doi/10.1176/appi.ajp.2008.07101562 https://www.sciencedirect.com/science/article/pii/S2213158216301000 https://www.sciencedirect.com/science/article/abs/pii/S0022395621005793 it wasn't hard to find these, they're like secondary cites in things like https://pmc.ncbi.nlm.nih.gov/articles/PMC9706110/ https://pmc.ncbi.nlm.nih.gov/articles/PMC9706110/
    - Kittensmittens3 1y ago
      These clearly state in the abstract that there is gray matter loss in differing stages of schizophrenia, however it is unclear if it is as a result of common medications or the disease itself. It doesn't indicate that you can scan a person without any other knowledge and diagnose them with the disease. Gray matter loss can happen for other reasons as well.
      - genewitch 1y ago
        i wonder if that has anything to do with putting someone with paranoid delusions into a loud machine that you explicitly state is going to scan their brain? maybe that's why there's no good imaging studies prior to drug intervention? further i am having a hard time coming up with medical conditions that have a single test pass/fail like this.
genewitch 1y ago
> And there's no real sub classification to determine what lead to a set of symptoms (which is the only current diagnostic criteria). Is this not true of all things in the DSM, though? there's no "easy" test for ADHD or depression, for examples; fMRI might be able to distinguish, if the literature is to be believed. But generally you have to rely on what a patient self-reports, what caretakers/professionals observe, and what effects, if any, medication has on the symptoms.
shkkmo 1y ago
I think the article is far more interesting than you make it out to be. There is pretty clear evidence that some subset of schizophrenic diagnosis are due to autoimmune issues. If we can use antibodies in the spinal fluid to detect when autoimmune treatments can be effective in treating schizophrenia, that alone will be huge. However, the even bigger insight to be drawn from all of this is the potential for other psychological problems that psychiatry has struggled to treat, to also have autoimmune causes. When you try to treat something that has multiple, quite different causes, with a single treatment, it makes sense that it would be hard to find that treatment that works reliably (as is the case for many psychiatric medicines.) I predict we may eventually see immune antibody tests (or some functional successor) become a standard part of all mental health care.
- quantumwoke 1y ago
  Immune antibody tests are already a standard part of a lot of mental health care, particularly psychosis. My wife tells me depending on the centre it may be mandated for all new diagnoses of psychosis. It is called an "organic screen".
  - shkkmo 1y ago
    I'm guessing that "organic screen" doesn't currently usually include antibody testing of CSF from a lumbar puncture since the article implies that only a limited number places do that screening currently. > To find psychiatric patients who might benefit from immunotherapy, researchers have set up centers, roughly similar to the one at Columbia, at Baylor University Medical Center, in Texas; King’s College London; Uppsala University, in Sweden; and the University of Freiburg, in Germany, among other places. Some of the best research into the phenomenon has been conducted in Germany, where it’s more common for patients in a first episode of psychosis to have lumbar punctures to access their spinal fluid, which can reveal the presence of antibodies.
- intuitionist 1y ago
  For my money Rachel Aviv is the best and most interesting writer currently on the New Yorker staff (give or take a David Grann, who is pretty much just writing books these days it seems). I go out of my way to read whatever has her byline.

tmaly 1y ago

It seems like we still have a lot to learn in this field of science.

nwienert 1y ago

The GLP-1 drugs are strong auto-immune regulators and neuroprotective and show promise with related disease: https://www.mdpi.com/1422-0067/26/6/2741 https://www.mdpi.com/1422-0067/26/6/2741 https://aaic.alz.org/releases-2024/glp-drug-liraglutide-may-protect-against-dementia.asp https://aaic.alz.org/releases-2024/glp-drug-liraglutide-may-... https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.14313 https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz... https://pmc.ncbi.nlm.nih.gov/articles/PMC11242057/ https://pmc.ncbi.nlm.nih.gov/articles/PMC11242057/ Some promise for autism and depression, though little with schizophrenia: https://www.psychiatrist.com/pcc/efficacy-glp-1-agonists-psychiatric-illnesses-scoping-review/ https://www.psychiatrist.com/pcc/efficacy-glp-1-agonists-psy... https://www.news-medical.net/news/20250511/GLP-1-receptor-agonists-improve-mood-and-metabolic-health-in-adults-with-mental-illness.aspx https://www.news-medical.net/news/20250511/GLP-1-receptor-ag...

quantumwoke 1y ago
Alzheimer's disease is not schizophrenia.

RC_ITR 1y ago

I also wonder if just that microglia are activated during chemo. Maybe this is just the most useful case of 'chemo brain' ever.

hinkley 1y ago
Probably why we keep looking at electroconvulsive ‘therapy’ again and again. Triggering the body’s systems to do something often cleans up other situations at the same time. There was a phenomenon where sometimes a high fever would cure STDs like syphilis. We generally use antibiotics now that we have them, because they are less dangerous.
- AStonesThrow 1y ago
  [dead]
- peterfirefly 1y ago
  > would cure STDs like syphilis. And sometimes certain cancers.
pitpatagain 1y ago
The article is mostly about how there are now recognized to be certain schizophrenia-like conditions that are clearly autoimmune diseases. Mentioned in the article are anti-NMDA-receptor encephalitis, which responds to immunotherapy, and a previously published case of a woman mid-diagnosed with catatonic schizophrenia fully recovering after being treated for lupus with immunosuppressive therapy. Based on this, the article suggests that the rituximab Mary was given along with chemo was the key. However, they were unable to test conclusively for antibody evidence of this theory after the fact.
- mgh95 1y ago
  I have a family member with an incidence of autoimmune encephalitis secondary to other conditions (my entire family is an autoimmune cluster) who is actually hospitalized for it now. This almost matches my experience to a tee, though anti-NMDAR was tested for and not found. The neurologists wanted to discharge prior to attempting immunotherapy and thankfully we were able to ensure they tried (pulse steroids). It's certainly an area which can be characterized as rare disease, whether paraneoplastic or otherwise.

fny 1y ago

She did not have "schizophrenia" in the first place. The the DSM criteria may have overlapped, but bonafide schizophrenia comes with gray matter changes seen over fMRI. The biggest clue is that she was never responsive to antipsychotics.

thaumasiotes 1y ago
> but bonafide schizophrenia comes with gray matter changes seen over fMRI According to who?
- genewitch 1y ago
  https://psychiatryonline.org/doi/10.1176/appi.ajp.2008.07101562 https://www.sciencedirect.com/science/article/pii/S2213158216301000 https://www.sciencedirect.com/science/article/abs/pii/S0022395621005793 it wasn't hard to find these, they're like secondary cites in things like https://pmc.ncbi.nlm.nih.gov/articles/PMC9706110/ https://pmc.ncbi.nlm.nih.gov/articles/PMC9706110/
  - Kittensmittens3 1y ago
    These clearly state in the abstract that there is gray matter loss in differing stages of schizophrenia, however it is unclear if it is as a result of common medications or the disease itself. It doesn't indicate that you can scan a person without any other knowledge and diagnose them with the disease. Gray matter loss can happen for other reasons as well.
    - genewitch 1y ago
      i wonder if that has anything to do with putting someone with paranoid delusions into a loud machine that you explicitly state is going to scan their brain? maybe that's why there's no good imaging studies prior to drug intervention? further i am having a hard time coming up with medical conditions that have a single test pass/fail like this.

genewitch 1y ago

> And there's no real sub classification to determine what lead to a set of symptoms (which is the only current diagnostic criteria). Is this not true of all things in the DSM, though? there's no "easy" test for ADHD or depression, for examples; fMRI might be able to distinguish, if the literature is to be believed. But generally you have to rely on what a patient self-reports, what caretakers/professionals observe, and what effects, if any, medication has on the symptoms.

shkkmo 1y ago

I think the article is far more interesting than you make it out to be. There is pretty clear evidence that some subset of schizophrenic diagnosis are due to autoimmune issues. If we can use antibodies in the spinal fluid to detect when autoimmune treatments can be effective in treating schizophrenia, that alone will be huge. However, the even bigger insight to be drawn from all of this is the potential for other psychological problems that psychiatry has struggled to treat, to also have autoimmune causes. When you try to treat something that has multiple, quite different causes, with a single treatment, it makes sense that it would be hard to find that treatment that works reliably (as is the case for many psychiatric medicines.) I predict we may eventually see immune antibody tests (or some functional successor) become a standard part of all mental health care.

quantumwoke 1y ago
Immune antibody tests are already a standard part of a lot of mental health care, particularly psychosis. My wife tells me depending on the centre it may be mandated for all new diagnoses of psychosis. It is called an "organic screen".
- shkkmo 1y ago
  I'm guessing that "organic screen" doesn't currently usually include antibody testing of CSF from a lumbar puncture since the article implies that only a limited number places do that screening currently. > To find psychiatric patients who might benefit from immunotherapy, researchers have set up centers, roughly similar to the one at Columbia, at Baylor University Medical Center, in Texas; King’s College London; Uppsala University, in Sweden; and the University of Freiburg, in Germany, among other places. Some of the best research into the phenomenon has been conducted in Germany, where it’s more common for patients in a first episode of psychosis to have lumbar punctures to access their spinal fluid, which can reveal the presence of antibodies.
intuitionist 1y ago
For my money Rachel Aviv is the best and most interesting writer currently on the New Yorker staff (give or take a David Grann, who is pretty much just writing books these days it seems). I go out of my way to read whatever has her byline.