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+--- Thread: Article How psychosis may arise when the body attacks itself (/thread-21426.html)
How psychosis may arise when the body attacks itself - C C - Sep 25, 2026
https://knowablemagazine.org/content/article/mind/2026/new-research-on-autoimmune-causes-of-psychosis
INTRO: Peter Jones once treated a patient with strikingly vivid hallucinations of animals. During ward visits, the patient would stroke and interact with the critters “in as real a way as he was with me,” says Jones, an academic psychiatrist at the University of Cambridge in England.
Antipsychotic drugs did nothing to dissolve these Snow White-esque visions. But when the patient received plasma exchange –– a treatment normally reserved for a misbehaving immune system –– his hallucinations dissipated.
Clearly, this was not a textbook case of schizophrenia. Rather, the patient’s symptoms stemmed from autoimmune encephalitis, a rare form of brain inflammation that can, in some cases, cause hallucinations and other symptoms of psychosis. When these patients are treated with drugs that tamp down the immune system, the psychotic symptoms often disappear.
Could the immune system be key to Alzheimer’s disease?
Autoimmune encephalitis is usually first identified through testing blood or spinal fluid for certain types of antibodies. If patients test positive for these antibodies, it’s a sign that their immune system may be attacking the brain. Other signs can help to solidify diagnosis: bright patches of inflammation on MRI scans, quickly worsening psychotic symptoms and — importantly — clear neurological symptoms such as seizures.
But Jones’ patient didn’t have those obvious neurological symptoms. If Jones hadn’t suspected an autoimmune cause, the case likely would have been missed.
Some experts suspect that the field of psychiatry is overlooking a small number of patients like this, and they are working to find more of them. They’re considering screening a broader array of psychiatric patients and seeking out new antibodies that may be involved in autoimmune encephalitis.
At the same time, many worry that there’s a risk of planting false hopes and diverting patients from the psychiatric treatments the vast majority will actually need, should autoimmune encephalitis become overdiagnosed...
[...] Autoimmune encephalitis is commonly caused by antibodies that bind to the NMDA receptor, known as NMDAR antibodies. But researchers have uncovered dozens more antibody types that are associated with encephalitis, some of which also appear to produce psychiatric symptoms.
[...] University of Oxford psychiatrist Belinda Lennox has observed similarly striking transformations. Around the time of the 2007 paper, she began conducting antibody tests on psychiatric patients whose symptoms seemed to overlap with signs of autoimmune encephalitis, such as quickly shifting psychotic symptoms or neurological features like seizures.
[...] Researchers are also continuing to search for new brain-targeting antibodies. Their hope is to understand patients who don’t have known antibodies but do have symptoms that look like autoimmune encephalitis. Detecting such new antibodies doesn’t prove they are driving the symptoms — cause and effect takes time to disentangle. But it gives researchers clues.
[...] The initiative, Kushner says, is starting to identify a few cases and to treat them with immune-suppressing drugs, after multiple rounds of testing. He says that so far, they’ve screened a few hundred people.
At some point in the future, Kushner says his team will share how many patients they’re finding with autoimmune conditions, and how those patients are faring after treatment. But he says that the primary goal of the project isn’t science; it’s patient care. “We’re trying to help people,” he says... (MORE - missing details)