Why “Brain on Fire” has important implications for the schizophrenias

Brain on Fire, by Susannah Cahalan
review by Mehmet Oz, M.D.
“Engrossing. . . . Unquestionably, an important book on both a human and a medical level. Cahalan’s elegantly-written memoir of her dramatic descent into madness opens up discussion of the cutting-edge neuroscience behind a disease that may affect thousands of people around the world, and it offers powerful insight into the subjective workings of our minds.”

—Mehmet Oz, M.D., Professor and Vice Chair, Department of Surgery, New York Presbyterian-Columbia Medical Center (Mehmet Oz, M.D. )  

From Psychiatric Times Cahalan interview

HF: Everyone who reads Brain on Fire is going to experience an exceedingly well-written piece of medical journalism that is only made better by your being the reporter and the subject. In addition to simply being on the lookout for rare but thankfully treatable conditions with psychiatric presentations, do you think there are any special lessons for psychiatrists who read your book?

SC: This is a great question. Obviously, the implications of this disease and others like it (there are many other types of autoimmune encephalitis that have been consequently discovered) are that neurological diseases can cause behaviors that are nearly indistinguishable from psychiatric diseases. I think greater vigilance on the part of psychiatrists about ruling out neurological causes is exceedingly important.

Another, less obvious outcome is that early on in my treatment, when I was thought to be suffering from a psychiatric disorder, my care was less sympathetic than it was later, when I was diagnosed with a neurological disease. Why is this? And how can we remove this stigma attached to mental illness? At the height of my disease, nothing distinguished me from a person with schizoaffective disorder or schizophrenia—the only difference came later: when I was cured. I don’t know how we change the systematic treatment of mental illness in this country, but clearly it needs to be rethought.

Excerpt from Cahalan’s book:
By the time I was a patient at NYU, Dr. Dalmau had fine-tuned his approach, designing two tests that could swiftly and accurately diagnose the disease. As soon as he received my samples, he could test the spinal fluid. If he found that I had anti-NMDA-receptor autoimmune encephalitis, it would make me the 217th person worldwide to be diagnosed since 2007. It just begged the question: If it took so long for one of the best hospitals in the world to get to this step, how many other people were going untreated, diagnosed with a mental illness or condemned to a life in a nursing home or a psychiatric ward?

Excerpt from Cahalan interview in The Guardian
“If an autoimmune disease can create symptoms that look exactly like schizophrenia, that raises the question, what is schizophrenia? And are there forms of schizophrenia that are caused by other types of autoimmune disease? Or other diseases that we haven’t discovered yet? It’s all neurological. We separate problems with the brain into neurological and psychiatric, and it’s because it’s stigmatised still. Mental illness is still stigmatised.

And, finally, the more traditional answer:

From ZocDoc (Get real answers to your health questions from real doctors)

Does schizophrenia cause seizures?

Q: My son, in his mid 20s, was just diagnosed with schizophrenia. Could this explain the seizures that he began having 6 months ago? I haven’t read anything about schizophrenia causing seizures, but if it does, then should we use another type of medication to treat them?

A. You have my sympathy about your son’s recent diagnosis. What you have read has been correct, schizophrenia does not typically cause real seizures. Therefore, if the schizophrenia diagnosis is correct, then the two are not likely to be related. While schizophrenia typically does not cause seizures, epilepsy can sometimes produce symptoms that are similar to schizophrenia. Therefore, one must be careful when diagnosing someone who has seizures with schizophrenia (you must make sure that the epilepsy is not causing the symptoms). The vast majority of time, epilepsy does not cause these symptoms. Without knowing anything about his case, I can say that it is possible that his seizures could have been pseudoseizures. These are convulsions that are not caused by epileptic brain activity. They can occur from during times of severe stress, something that schizophrenics can go through. Since pseudoseizures are not true seizures, they are very difficult to treat. I suggest that you schedule an appointment with your son’s neurologist (or whoever cares for his seizures). Make sure that he or she feels that your son’s seizure treatment is appropriate for his new diagnosis (unless this physician is aware already). It is also important for this physician to review his new list of medications because some psychoactive medications that can increase the likelihood of seizures. Good luck.

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