By Jay Desai
Disorders of most human bodily systems are handled by one type of medical specialist. For example, Cardiologists for heart diseases or Pulmonologists for lung diseases. When it comes to the brain its Psychiatrists and Neurologists! Psychiatrists are consulted for diseases that are often referred to as “functional” or “non-organic” and neurologists are supposedly the specialists for diseases that are considered “organic”. This is an arbitrary distinction to an extent. After all, it is the same brain, and moreover, “psychiatric” diseases are also hypothesized to have a biologic basis, for example low levels of the neuro-transmitter serotonin in depression. Plus, the most famous “psychiatrist” of all time, Sigmund Freud, was in fact a Neurologist. Unfortunately, psychiatric diseases have acquired a stigma, in part due to the negative connotation of the word functional attached to them.
The clinical manifestations of psychiatric and neurological diseases differ but there is often a certain overlap. One such example is an interesting disease that has been recognized in recent years called the anti-N-Methyl-D-Aspartic acid receptor encephalitis (anti-NMDAR encephalitis). This was a largely unknown and poorly understood entity before the year 2007. But in last 6 years, there has been a skyrocketing interest and improved characterization of this disease with recognition of many cases around the world including in India.
This disease often presents in previously healthy young adults who develop acute onset of psychosis with bizarre behavior and often a loss of sexual inhibition. The psychosis may evolve to alteration of consciousness, seizures and abnormal involuntary movements. The condition most commonly affects females and is often due to an abnormal response of the body to a benign tumor of the ovaries called teratoma. The proposed hypothesis is that the body produces antibodies to fight this tumor, but a phenomenon of cross reactivity of these antibodies with N-Methyl-D-Aspartic acid receptors in a part of the brain called hippocampus leads to the myriad of psychiatric and neurological manifestations. The disease often comes to the attention of psychiatrists first and not the neurologists because of the nature of symptoms. The removal of the tumor leads to complete recovery in many cases. In others, the recovery is less dramatic and these patients may need to be treated with medications that alter immune function. It is important to know that this particular tumor is not uncommon, and does not always lead to this condition. Also, anti-NMDAR encephalitis can occur without the tumor or with other cancers. It affects children and males as well.
A suspicion is that this disease existed all along and is not a new one but went unrecognized. Is it possible that some of those who were sent to the psychiatric asylum many years back were suffering from this disease or a similar one on the same spectrum? Most likely, yes. The disorders of human brain represent the last frontier in medicine and in recent years the advances in neuro-sciences are occurring at a scorching pace.
The recognition of new diseases that are treatable like the anti-NMDAR encephalitis is exciting, and fuels research in mastering this often obscure and esoteric science. The hope is that the biologic basis of the so called psychiatric diseases will be better elucidated in the coming years, thus improving the treatment options. In the mean time, our society should work towards removing the stigma associated with psychiatric illnesses.
(Jay Desai is a diplomate of the American Board of Psychiatry & Neurology)