Autoimmune diseases raise risk of developing psychosis by 40%

A few weeks ago, I noticed my psoriasis rash had started to flare up and at the same time I had increasing pain in my hips and hands. Then a few days ago I started to get very dizzy and felt unusually fatigued, so I went to see my GP however I was told the dizziness appeared neurological and was sent for blood tests, which revealed that I was producing elevated antibodies, although the tests were somewhat limited by what my local NHS trust can provide. I did ask my GP if she had any thoughts on why I was having symptoms, especially as I'd slipped up on my diet, however she was completely unaware of the link between autoimmunity, psychosis and environmental triggers. I guess my problem is, as usual, I appear better informed than most doctors.

Unfortunately things got worse, last weekend I developed a severe migraine and back and neck pain. This led to a very low mood and phosphene hallucinations as well as severe nausea. This is an early warning sign of encephalopathy; I’m taking this very seriously.

Now I must confess I’ve been so busy lately I’ve not been as careful as I normally would be with sticking 100% to the AIP diet with the occasional legume, cornflour, rice and excess of dried fruit slipping through, although to the average person my diet was still incredibly restrictive and healthy. However as far as I know I’ve not consumed any gluten or dairy whatsoever.

So, what is going on? How could I start to develop autoimmune symptoms while not actively provoking my immune system and more importantly, why did I start to notice issues with my brain? Could those tiny cheats have really provoked this reaction? Could the autoimmune symptoms have also led to my brain symptoms?

New research 

There is still a great deal of uncertainty about the relationship between autoimmune disorders and brain related symptoms, particularly psychosis, however there is a growing research interest in this area. Researchers at Kings College University in London have just published the results of a research review and meta-analysis – a method in which data from several studies are combined and analysed together to give a more statistically robust result than individual studies can provide.

The research focused on autoimmune disorders that affect the peripheral system, such as type 1 diabetes to establish whether autoimmune disorders that target the body, as opposed to the brain, could still influence the development of psychosis.

Findings

The researchers found that, overall, people with any autoimmune disorder were 40% more likely to have a psychotic disorder, such as schizophrenia.

Just stop and think about that for a moment. 40% is a significant finding, and correlates with the research showing increased schizophrenia risk associated with coeliac disease. Of course the link between psychiatric illness and autoimmune dysfunction has been known about for years and was first reported in a schizophrenia patient in the 1930’s, however this new study has established a clear correlation and I hope that this leads to further research into the prevention of psychotic illnesses.

The researchers also examined individual autoimmune disorders. They found the likelihood of having psychosis was higher for pernicious anaemia, pemphigoid (a disease characterised by skin blisters), psoriasis, coeliac disease and Graves’ disease, but it was lower for rheumatoid arthritis and ankylosing spondylitis (a type of arthritis that mainly affects the spine), suggesting that these disorders are protective.

Looking for causes

So let's examine the findings and explore the possible mechanisms that might underlie the relationships found. Given that people with psychosis have also been found to show higher levels of inflammatory markers in the blood than healthy people, and that inflammation is a core feature of autoimmune disorders, inflammation is a likely candidate.

But rheumatoid arthritis and ankylosing spondylitis are also characterised by higher levels of inflammation, so this would not explain the negative relationships we found with these disorders. Although all autoimmune disorders activate the body’s immune system, the exact response differs depending on the disorder. This might go some way to explaining why the researchers found different relationships for individual autoimmune disorders and suggests that inflammation cannot be the only mechanism.

The researchers state that it is possible that there might be a genetic link between autoimmune disorders and psychosis. In fact, research has recently shown that variations within specific genes are associated with both schizophrenia and rheumatoid arthritis. That is, people with one variation of the gene are at risk for schizophrenia, while people with the other variation are at risk for rheumatoid arthritis. This might explain why rheumatoid arthritis appears to be protective for psychosis.

Newly discovered antibodies that go rogue and mistakenly attack brain cells might also explain the link. The research that Prof Lennox and her team at Oxford is conducting in this area is leading the way in finding new treatments for this mechanism of illness. These sorts of antibodies are thought to cause psychotic symptoms, such as paranoia and hallucinations, in some people.

Unfortunately the researchers failed to explore the environmental factors often associated with autoimmunity so yet again the opportunity to offer a holistic and lifestyle driven preventative solution has been missed.

Early intervention

So, what is the real-world application of these findings? The researchers suggest that perhaps doctors ought to monitor people with certain autoimmune disorders for early signs of psychosis – especially pernicious anaemia, Graves’ disease and pemphigoid, which showed the most consistent relationships with psychosis and remind us that early intervention is important in halting the progress of autoimmune diseases. However as I mentioned earlier, there is no mention of the lifestyle factors in preventing and treating autoimmunity.

My take on this research is that this further strengthens the argument for adopting lifestyle changes known to improve the outcomes of inflammatory and autoimmune diseases. Diet, nutrition, exercise, stress amelioration and quality sleep are an excellent place to start.

For me the solution to my current flare up is very clear – I am fastidious in my diet again, dropping my carb intake and raising anaerobic exercise to put myself into a mild ketogenic state and clear all inflammation from my body quickly, while eliminating all possible environmental triggers. I’ve booked some vacation and I’m going to rest up and take it easy. I’ll be back to my normal self in a few days - I’m feeling better already!