psychosis

Psychiatric Complications of Primary Hyperparathyroidism and Mild Hypercalcemia: anxiety, depression, anger, irritability, delusions and impaired cognition

July 7, 2023 By Trudy Scott 38 Comments

In samples of patients undergoing parathyroidectomy for primary hyperparathyroidism (PHPT), these disturbances have been identified at a rate of 43.1%–53.0% for anxiety, 33.0%–62.1% for depression, 22.0% for thoughts of death or suicide, 51.9% for anger and irritability, 5.0%–20.0% for hallucinations and delusions, and 37.3%–46.5% for impaired cognition.

In fact, it has been noted that there are more neuropsychiatric phenomena in PHPT than is often recognized and that these symptoms are easily missed, particularly in the elderly population.

This excerpt is from, Psychiatric Complications of Primary Hyperparathyroidism and Mild Hypercalcemia, published in Psychiatry Online.

I’ve recently been reading as much as I can about this condition, for personal and professional reasons. As soon as I learn about something new I go digging to see if there is an anxiety connection. And I must say I was very surprised to read these stats. It’s not something I’ve heard discussed or taught at mental health conferences.

The authors also state this about the condition:

The incidence of primary hyperparathyroidism (PHPT) is about 21 cases per 100,000 person-years, and the disorder is usually caused by a solitary parathyroid adenoma. PHPT has traditionally been recognized by its characteristic symptoms, including urolithiasis (“stones”); osteopenia and osteoporosis (“bones”); abdominal cramping, nausea, and peptic ulceration (“moans”); and depression, anxiety, cognitive dysfunction, insomnia, confusion, and personality changes (“psychiatric overtones”).

How do changes in serum calcium levels contribute to mental health and cognitive symptoms?

It’s always helpful to understand the mechanism and it was the first thought that went through my mind – how does hyperparathyroidism and changes in serum calcium levels cause these mental health and cognitive symptoms? The authors share this:

Although the pathogenesis [or cause] of psychiatric symptoms in primary hyperparathyroidism remains unclear, calcium is thought to figure prominently in determining changes in monoamine metabolism in the central nervous system(CNS), thereby modifying neurotransmission and resulting in alterations in mood and cognition.

I went digging and found this paper – Acute psychosis secondary to suspected hyperparathyroidism: A case report and literature review.

The authors also state that the mechanism isn’t known for certain. And although they are referring specifically to psychosis, the explanation could be applied to other symptoms too: “It is thought that the changes in serum calcium level slow down nerve function and neurotransmission rate, inducing psychosis (and other symptoms like anxiety, depression, anger, irritability and suicidal thoughts).

Understanding this possible mechanism helps us find a temporary solution for these symptoms until the hyperparathyroidism is addressed with surgery i.e. using amino acids as supplements.

Using amino acids to ease symptoms while you are seeking the root cause/s

If you’ve been following my work and have read my book The Antianxiety Food Solution, you’ll be familiar with using targeted amino acids as supplements to support low levels of neurotransmitters. These provide quick relief of symptoms (in a day or less) while you are seeking the root cause.

If we look at the above symptoms:

Anxiety can be a sign of low serotonin (worry type of anxiety) and/or low GABA (physical type of anxiety) – and tryptophan/5-HTP and/or GABA help ease symptoms.
Depression can be a sign of low serotonin (negativity), low dopamine (curl-up-in-bed depression) an/or low endorphins (weepy depression) – and tryptophan/5-HTP, tyrosine and/or DPA help ease symptoms.
Irritability and anger are common with low serotonin – and tryptophan/5-HTP helps to ease symptoms.
Low GABA can also be involved with anger and rage
Cognitive issues can be caused by low dopamine and low GABA – and tyrosine and/or GABA help ease symptoms

(You can find the symptoms questionnaire here. As always, amino acids are used based on symptom clusters and dosed according to your unique needs.)

If you find you have been using the amino acids long term and have explored all the possible root causes described in my book and summarized here, it may be worth investigating primary hyperthyroidism especially if you’re menopausal.

Case: “I had to have a parathyroid gland removed a few years ago… I literally felt better from the moment I came round from the surgery”

We always want to find the root cause when we have various symptoms. With this condition, it’s common to observe very quick resolution of symptoms after parathyroid surgery to remove the adenoma/s. Someone in our community shared this:

I had to have a parathyroid gland removed a few years ago … I literally felt better from the moment I came round from the surgery. It’s a miserable disease. I thought I was going to die! Lots of people get so low that they don’t feel like they can go on.

Bone pain was awful. Fatigue, depression etc.

I had had some dental issues around that time. One of my teeth crumbled. My Vitamin D went down to 9 so I am sure that was a large part of the puzzle.

I was actually diagnosed fairly quickly but was retested many times. I self-referred to a surgeon that was in-network in the end as my insurance wouldn’t cover various surgeons that my doctor wanted me to go too.

I had had breast cancer a few years ago and so had had weekly blood tests and, when I went back and looked, my calcium had been high for years. So important to read our own results.

The surgery was so easy.

What an amazing outcome for this woman and I appreciate her for sharing so we all get to learn and benefit from her journey. And yes, I agree, we need to advocate for ourselves and ask for and keep copies of all our labs. And get educated and ask questions. It’s really unfortunate that high calcium and hyperparathyroidism is so often missed.

Not everyone has all the listed symptoms of primary hyperparathyroidism. This woman did experience fatigue, depression and bone pain. She did not experience anxiety and didn’t have kidney stones. I do suspect dietary oxalate issues (without kidney stones) can be an issue for some folks because of the calcium disruption.

Some reasons why hyperparathyroidism is underdiagnosed

In the last few months I have learned that primary hyperparathyroidism is underdiagnosed. PTH (parathyroid hormone) is not routinely tested and I believe that it should be. Also, as you read above, elevated calcium levels are often ignored or brushed off as being a non-issue. And to complicate things further calcium is not always elevated. Hyperparathyroidism is also underdiagnosed and undertreated in the elderly.

For many women (and men) the discovery happens after they are diagnosed with osteoporosis and then calcium and PTH are tested, and/or past elevated calcium levels are “discovered.” If the hyperparathyroidism diagnosis happens first then osteoporosis screening is not always done and I believe it should be. And don’t get me started on when I believe osteoporosis screening should start (at 45 and not 65 or 70 years old) and issues with DEXA screening (more to come on this).

The good news is that primary hyperparathyroidism is a well-established cause of secondary osteoporosis which starts to resolve after the surgery too.

I’m still very much in learning mode

Primary hyperparathyroidism only recently appeared on my radar as a result of the 2023 osteoporosis summit, hosted by my friend and colleague, Margie Bissinger, Physical Therapist and osteoporosis coach. Dr. Deva Boone was a speaker on this condition on the summit and her site is a wealth of information. I appreciate them both.

As I mentioned above, I am also amazed it’s not something I’ve heard about at mental health or integrative health conferences and when doing continuing education.

I will admit I’m no expert and I’m still very much in learning mode – for myself and for you and this community. But, as you know, I like to share what I learn. As I continue to learn, I plan to share additional perspectives and the osteoporosis/menopause and oxalate links.

I am also in the process of creating a hyperparathyroidism questionnaire to use with my clients. Not everyone has all the above symptoms and not all the papers and resources list all the symptoms covered here today. For example, fatigue is listed on many sites but not in the above two papers and very few sites emphasize the mental health symptoms.

I’m also learning there are clues to look for – like forearm results on the DEXA scan and a good TBS/trabecular bone score has some significance. Stay tuned.

Resources if you are new to using amino acids as supplements

If you are new to using amino acids as supplements, here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution (you can see all the symptoms of neurotransmitter imbalances, including low GABA, low serotonin, low dopamine and low endorphins).

If you suspect low levels of any of the neurotransmitters and do not yet have my book, The Antianxiety Food Solution – How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood, and End Cravings, I highly recommend getting it and reading it before jumping in and using amino acids on your own so you are knowledgeable. And be sure to share it with the practitioner/health team you or your loved one is working with.

There is an entire chapter on the amino acids and they are discussed throughout the book in the sections on gut health, gluten, blood sugar control, sugar cravings, anxiety and mood issues.

The book doesn’t include product names (per the publisher’s request) so this blog, The Antianxiety Food Solution Amino Acid and Pyroluria Supplements, lists the amino acids that I use with my individual clients and those in my group programs. You can find them all in my online store.

If, after reading this blog and my book, you don’t feel comfortable figuring things out on your own (i.e. doing the symptoms questionnaire and respective amino acids trials), a good place to get help is the GABA QuickStart Program (if you have low GABA symptoms too). This is a paid online/virtual group program where you get my guidance and community support.

If you are a practitioner, join us in The Balancing Neurotransmitters: the Fundamentals program. This is also a paid online/virtual program with an opportunity to interact with me and other practitioners who are also using the amino acids.

If you’ve been diagnosed with hyperparathyroidism (or a family member has been) you can likely relate to much of this. Please share your/their journey. I’d love to hear how long it took for a diagnosis and treatment and what symptoms resolved after surgery, and how quickly.

Did you find the amino acids helped anxiety, mood and cognition symptoms in the short term, and then were no longer needed after surgery?

If you’re new to hyperparathyroidism, feel free to ask your questions and share what you’d like to hear more about in the follow-up blog.

If you are a practitioner, is primary hyperparathyroidism on your radar and do you recommend PTH testing in addition to calcium testing? Have you found the amino acids to be a good short-term solution for your clients/patients?

And if hyperparathyroidism is your area of expertise, feel free to add to the discussion.

Feel free to post your feedback here in the comments.

“A catatonic woman awakened after 20 years. Her story may change psychiatry.” (Her schizophrenia was an untreated autoimmune disease)

June 16, 2023 By Trudy Scott 8 Comments

Today I’m sharing some highlights from a recent eye-opening article in the Washington Post: A catatonic woman awakened after 20 years. Her story may change psychiatry

Before she became a patient, April had been an outgoing, straight-A student majoring in accounting at the University of Maryland Eastern Shore. But after a traumatic event when she was 21, April suddenly developed psychosis and became lost in a constant state of visual and auditory hallucinations. The former high school valedictorian could no longer communicate, bathe or take care of herself.

April was diagnosed with a severe form of schizophrenia

April was hospitalized, medicated and eventually institutionalized. It got to the point where she no longer recognized her family and she became catatonic, “unmoving, unblinking and unknowing of where or who she was.”

Twenty years after April’s original diagnosis it was discovered that she has an autoimmune condition. Dr. Sander Markx is director of precision psychiatry at Columbia University and I have so much admiration for his dedication to the field and the fact that he facilitated this testing and discovery so long after meeting April, when he was a student:

Markx and his colleagues discovered that although April’s illness was clinically indistinguishable from schizophrenia, she also had lupus, an underlying and treatable autoimmune condition that was attacking her brain.

After months of targeted treatments – and more than two decades trapped in her mind – April woke up.

April’s transformation is truly heartwarming and it’s wonderful that the doctors plan to do similar testing and offer similar treatments for others living with schizophrenia who are in mental health institutions in New York State.

Researchers in other countries are making similar connections and it’s really exciting to read that they are recognizing that “underlying autoimmune and inflammatory processes may be more common in patients with a variety of psychiatric syndromes than previously believed.”

We can and should be doing better when looking for root causes

I believe we can and should be doing better when it comes to looking for root causes. Many individuals may have an autoimmune/inflammatory condition and many may have other root cause/s. If I was on an advisory panel these would be my recommendations:

Use this powerful outcome to really turn psychiatry on its head and screen for lupus and other autoimmune conditions in every single person with schizophrenia. Dr. Markx “believes highly sensitive and inexpensive blood tests to detect different antibodies should become part of the standard screening protocol for psychosis.”
Do the same for every single person with mental illnesses and illnesses with a behavioral aspect – including anxiety, depression, bipolar, OCD/obsessive compulsive disorder. ADD/ADHD, autism/ASD (autism spectrum disorders), developmental disorders and neurological disorders.
Go beyond autoimmune screening and do a comprehensive functional medicine and nutritional deficiency assessment for every single person, including low serotonin, low GABA, low vitamin D, low zinc, low vitamin B6, hormone imbalances (sex hormones, adrenals, thyroid health), gut health, liver health etc. This includes testing for infections (such as Lyme and strep), looking at toxin exposure (phthalates, mold, heavy metals) and medication side effects.

If you’re new to the concept of root causes and functional medicine/nutritional testing these two blogs will be helpful. They are specific to anxiety because I work with anxious individuals but much of it can also be applied to other mental health and even physical health conditions (like rheumatoid arthritis and say multiple sclerosis):

Functional medicine and nutrition for maintaining symptom resolution in the long term

As you read in the article, April received “short, but powerful “pulses” of intravenous steroids for five days, plus a single dose of cyclophosphamide, a heavy-duty immunosuppressive drug typically used in chemotherapy and borrowed from the field of oncology. She was also treated with rituximab, a drug initially developed for lymphoma.”

Incredibly, she recovered completely and was eventually discharged from the psychiatric hospital and has been living in a rehab center for 3 years. Unfortunately “she has recently regressed because she was not receiving adequate maintenance care.”

I see the next step for April and others like her, is maintaining resolution of symptoms in the long term. This is where functional medicine and nutrition shines.

The ISNPR shared this about Nutritional psychiatry in 2015 in a letter published in World Psychiatry, the official journal of the World Psychiatric Association:

In addition to dietary modification, we recognize that nutrient-based (nutraceutical) prescription has the potential to assist in the management of mental disorders at the individual and population level.

In other words, diet and nutrient-based approaches need to be included for mental health treatment and for prevention. One of many examples is the ketogenic diet which has been shown to reduce auditory hallucinations and delusions in those with schizophrenia. Another is the low carb diet helping to reduce bizarre intrusive thoughts. And the SMILES trial was the first randomized controlled trial to show that dietary improvement can actually treat depression.

Specific nutrients can be very powerful too. One example is a case where a woman in my community experienced a drastic reduction in intrusive thoughts, anxiety and fears (and better sleep) with GABA, tryptophan, 5-HTP and the pyroluria protocol (zinc, vitamin B6 and evening primrose oil). More on the blog. Intrusive thoughts can be alleviated with a similar combination of nutrients and by addressing hormonal imbalances too.

These blogs/research illustrate a few of the many root causes of schizophrenia and psychosis other than lupus:

When it comes to autoimmunity in general I refer you to the work of Dr. Tom O’Bryan, Dr. Izabella Wentz, Dr. Terry Wahls, Dr. Amy Myers and others who teach about using functional medicine and diet for reversing a number of different autoimmune conditions.

The above approaches can all be explored and used when individuals are initially diagnosed too. But keep in mind that there is no one size fits all and it’s a matter of finding the root causes for each person.

We are moving in the right direction and there is hope but…

We are moving in this direction, awareness is growing and there is hope. But I know we can get there sooner.

What Dr. Markx and his colleagues have discovered and shared with the world will hopefully help us get there much more quickly.

(You can read the whole story here and a similar transformation experienced by Devine Cruz.)

I’m thrilled for April and Devine and their families, and appreciate them sharing these stories with the world. Let’s hope their stories do change psychiatry!

Resources if you are new to using amino acids as supplements

There is an entire chapter on the amino acids and they are discussed throughout the book in the sections on gut health, gluten, blood sugar control, sugar cravings, anxiety and mood issues.

Does this heartwarming story give you hope for psychiatry?

What do you feel we should be doing to advance nutritional psychiatry even more quickly?

Can you or a family member relate to this and what did you discover in terms of testing and nutritional support/functional medicine?

Feel free to post your feedback and questions here in the comments.

Non-celiac gluten sensitivity manifestations outside the gut: foggy mind, depression, anxiety, neuropathy, joint pain, headache, fatigue and IBS

July 1, 2022 By Trudy Scott 2 Comments

Celiac disease is “a digestive and autoimmune disorder that can damage your small intestine. People with celiac disease might experience symptoms like diarrhea, bloating, gas, anemia and growth issues. Celiac disease can be triggered by a protein called gluten. Gluten is found in grains, like wheat, barley and rye” (and oats that are contaminated with gluten). This description by the Cleveland Clinic is well-understood and recognized.

However, what is less recognized and understood, is extra-intestinal (or outside the gut) manifestations of non-celiac gluten sensitivity. A paper published in 2018, Extra-intestinal manifestations of non-celiac gluten sensitivity: An expanding paradigm lists a number of symptoms and conditions that gluten consumption may cause and/or contribute to, even when you do not have celiac disease.

These can include: ‘foggy mind’; psychiatric diseases such as depression, anxiety and even psychosis; gluten ataxia, gluten neuropathy and gluten encephalopathy (causing memory and cognitive problems); joint and muscle pain, and leg or arm numbness; headache and fatigue; irritable bowel syndrome (IBS); autoimmune disorders; and and fibromyalgia.

This blog post highlights excerpts from the 2018 non-celiac gluten sensitivity paper and stories from real people who have experienced relief when removing gluten from their diets. And resources if you find you need neurotransmitter support to help break the addiction and not feel deprived.

This is from the abstract of the above paper:

Non celiac gluten sensitivity (NCGS) is a syndrome characterized by a cohort of symptoms related to the ingestion of gluten-containing food in subjects who are not affected by celiac disease (CD) or wheat allergy. The possibility of systemic manifestations in this condition has been suggested by some reports.

In most cases they are characterized by vague symptoms such as ‘foggy mind’, headache, fatigue, joint and muscle pain, leg or arm numbness even if more specific complaints have been described.

NCGS has an immune-related background. Indeed there is strong evidence that a selective activation of innate immunity may be the trigger for NCGS inflammatory response. The most common autoimmune disorders associated with NCGS are Hashimoto thyroiditis, dermatitis herpetiformis, psoriasis and rheumatologic diseases.

A possible neurological involvement has been underlined by NCGS association with gluten ataxia, gluten neuropathy and gluten encephalopathy.

NCGS patients may show even psychiatric diseases such as depression, anxiety and psychosis.

Finally, a link with functional disorders (irritable bowel syndrome and fibromyalgia) is a topic under discussion.

We see all this clinically so it’s wonderful to see this being addressed in the research. However, the authors are saying we need more research and better studies:

the novelty of this matter has generated an expansion of literature data with the unavoidable consequence that some reports are often based on low levels of evidence. Therefore, only studies performed on large samples with the inclusion of control groups will be able to clearly establish whether the large information from the literature regarding extra-intestinal NCGS manifestations could be supported by evidence-based agreements.

Until then we use what we know works clinically: a gluten-free diet and observation of symptom resolution. We also use amino acids to balance brain chemicals so we break the addiction and don’t feel deprived (more on that below). Nutritional deficiencies caused by damage to the gut/leaky gut also need to be addressed, as well as healing the leaky gut and dysbiosis.

I shared the study abstract on Facebook asking for feedback and the response was so overwhelming that I can only share some of the feedback. I will do follow-up posts sharing more detailed information from their healing journeys.

Caroline had bloating, pain and chronic sadness, and discovered “joie de vivre”

Caroline confirmed that she has gluten sensitivity saying she stopped eating wheat in 2011:

Within a few months, my chronic sadness disappeared and I discovered the “joie de vivre”. It also allowed me to get rid of my swelling belly (bloating). Every evening I looked like a woman 2-3 months pregnant. [this likely falls into the irritable bowel syndrome category mentioned in the paper]
The pain in my joints also ended up disappearing.

I read so much about gluten once I started to realize it had changed my life to quit eating that stuff that now I’m convinced grains shouldn’t be part of human food, and I mean all grains (botanically speaking).

I think grains should at least be taken off all the menus in all hospitals, especially the psychiatric ones.

I adore her “joie de vivre” feedback and am so happy for her! I had this same feeling of pure joy when I went gluten-free. And I get so much feedback like this from clients who had no idea life could be so much better.

I also agree with her sentiment about gluten and grains being an issue too, especially in psychiatric settings.

Daphne was emotionally dysregulated with negative feelings and a pressure headache

Daphne shared what she calls an odd effect that she gets soon after eating bread: roiling emotions:

I get emotionally dysregulated. Negative feelings surface in various degrees, for me primarily anger and the reviewing of the incidents that caused it (aka ruminating thoughts?); less often sadness, disappointment, and overwhelm (that usually surfaces on its own anyway).

I also get what I call ‘bread head.’ I get a pressure headache from between my eyebrows, up the center of my head to my crown.

An additional effect: ‘the hangover’. Overnight the pressure headache subsides and the next day my whole head feels heavy and I am slower physically and mentally, and my hands in particular are achy

Also, I have had chicken bumps on my skin my whole life, until I stopped eating bread. I still have some, maybe from rice, potato and corn reactions. Starch is not my friend.

As I mentioned above, many folks are surprised at the emotional changes they see when eating gluten. Daphne called it an odd effect but her response is a very typical extra-intestinal (outside the gut) psychiatric response. And yes starches and grains are an issue for many folks.

Other feedback: fibromyalgia pain, brain fog, depression, cystic acne, anxiety, body aches, fatigue, PCOS and hypothyroidism

Here is some feedback from a few other women. As you can see the symptoms can vary per person:

“Removal of gluten and all grains has improved my fibromyalgia pain symptoms … The difference in pain was so dramatic that it was worth it.”
“It makes such a difference with my brain fog and depression! And cystic acne. If I have gluten, I have cystic acne for about 2 weeks.”
“My joint pain, anxiety, and depression are much improved when I avoid gluten (and corn.)”
“Yes! Within 15 min of ingesting gluten containing food I get all over body aches, fatigue and brain fog. It’s very unpleasant. I cut gluten out of my diet simply because I can’t function properly while eating it. I also have had episodes of reactive hypoglycemia from it too.”
“Removing gluten has cured my hypothyroidism. Also has improved my PCOS, anxiety and depression.”

Stay tuned for a follow-up blog with more from their healing journeys and additional insights from me.

Using the amino acids to help break the gluten addiction and feel less deprived

Sometimes it’s difficult to figure out why you crave or are addicted to gluten. It can be challenging to determine which part of your brain chemistry it’s affecting, and you may not associate cravings with mood issues.

Your drug-of-choice is something you self-medicate with and it is something that makes you feel good or “normal.” It could be starchy gluten-containing foods like bread or pasta or cookies. It could also be candy, chocolate, ice-cream, coffee, sodas, wine/beer, cigarettes, marijuana, a prescription medication like Prozac, street drugs, or even shopping or exercise.

Cravings for these substances (or behaviors) typically indicate a brain chemistry imbalance, so it’s very helpful to identify how the substances you crave affect you. This will help you determine which amino acids you might supplement to address the imbalance.

Use your “drug-of-choice” from your gluten or grain list (perhaps you love bread or chocolate chip muffins) and the chart below to help you determine what brain chemistry imbalance may be affecting you and which amino acid you may benefit from.

How you feel before	How you feel after	Brain chemistry imbalance	Amino acid to supplement
Anxious or stressed	Calm or relaxed	Low GABA	GABA
Depressed or anxious	Happy or content	Low serotonin	Tryptophan or 5-HTP
Tired or unfocused	Energetic, alert, or focused	Low catecholamines	Tyrosine
Wanting a reward or sad	Rewarded or comforted	Low endorphins	DPA (d-phenylalanine)
Irritable and shaky	Grounded or stable	Low blood sugar	Glutamine

Once you address that brain chemical imbalance, it’s easy to quit and you won’t feel deprived.

You can read more about why you crave on this blog post

Resources if you are new to using the amino acids as supplements

If you are new to using any of the amino acids as supplements, here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution (you can see all the symptoms of neurotransmitter imbalances).

There is an entire chapter on the amino acids and they are discussed throughout the book in the sections on gut health, gluten, blood sugar control, sugar cravings, self-medicating with alcohol and more. There is also an entire chapter on gluten and grains if this is new to you.

If, after reading this blog and my book, you don’t feel comfortable figuring things out on your own (i.e. doing the symptoms questionnaire and respective amino acids trials), a good place to get help is the GABA Quickstart Program (if you have low GABA symptoms). This is a paid online/virtual group program where you get my guidance and community support. There are many moms in the program who are having much success with their kids.

With much appreciation for these women for sharing their stories. I’d love to get some of these published as case studies to further add to the evidence.

Do you have (or suspect you may have) non celiac gluten sensitivity (NCGS)?

And has gluten removal resolved any of the above issues? And have you seen an improvement in gut issues too?

Have you observed other improvements since eating gluten and/or grain-free?

Did you find the amino acids helped you break your addiction and feel less deprived?

Or are you stuck and still eating gluten and have no idea where to start on quitting? If this is you, would a webinar series help?

If you have questions please share them here too.

Case Study: Bartonella and Sudden-Onset Adolescent Schizophrenia

March 22, 2019 By Trudy Scott 26 Comments

According to a press release from North Carolina State University, researchers share a case study describing an adolescent human patient diagnosed with rapid onset schizophrenia who was found instead to have a Bartonella henselae infection. This study adds to the growing body of evidence that Bartonella infection can mimic a host of chronic illnesses, including mental illness, and could open up new avenues of research into bacterial or microbial causes of mental disorders.

Bartonella is a bacteria most commonly associated with cat scratch disease, which until recently was thought to be a short-lived (or self-limiting) infection. There are at least 30 different known species of Bartonella, and 13 of those have been found to infect human beings. The ability to find and diagnose Bartonella infection in animals and humans – it is notorious for “hiding” in the linings of blood vessels – has led to its identification in patients with a host of chronic illnesses ranging from migraines to seizures to rheumatoid illnesses that the medical community previously hadn’t been able to attribute to a specific cause.

In the case study published in the Journal of Central Nervous Disease, an adolescent with sudden onset psychotic behavior – diagnosed as schizophrenia – was seen and treated by numerous specialists and therapists over an 18-month period. All conventional treatments for both psychosis and autoimmune disorders failed. Finally, a physician recognized lesions on the patient’s skin that are often associated with Bartonella, and the patient tested positive for the infection. Combination antimicrobial chemotherapy led to full recovery.

According to the case report above, Bartonella henselae Bloodstream Infection in a Boy With Pediatric Acute-Onset Neuropsychiatric Syndrome, these are some of the many symptoms he experienced over the 18-month period:

He reported feeling overwhelmed, confused, depressed, and agitated.
He said that he was an “evil, damned son of the devil” and wanted to kill himself because he was afraid of his new-onset homicidal thoughts toward those he cared about
Weeks after initial hospitalization in October, he became more dysfunctional; school was not possible; he developed progressively severe psychiatric symptoms including obsessional intrusive thoughts, phobias, irrational fears, emotional lability, unpredictable rage outbursts, and increased psychotic thinking. He believed that he had special powers and that a family cat wanted to kill him.
By December 2015, his illness had progressed in severity, causing his mother to quit her job to provide full-time supervision. In addition to persecutory delusions related to his pets, he developed auditory, visual, and tactile hallucinations and began refusing to leave the house.
In January 2016, following discharge after a week-long hospitalization, he developed non-specific somatic symptoms, including excessive fatigue, daily headaches, chest pains, shortness of breath (possible panic anxiety), and urinary frequency

I suspect some of his later symptoms were related to side-effects from many of the medications he was prescribed over the course of his treatment. Some symptoms may also be attributed to withdrawal from some of these medications. One example mentioned in the case study was “abrupt withdrawal of clozapine and tramadol” where “he experienced severe anorexia, nausea, and vomiting, which resulted in hospitalization and a 20.5-kg weight loss over 40 days.” It’s well- documented that withdrawal signs and symptoms of antipsychotic medications such as clozapine “may include insomnia, nausea, vomiting, anxiety, and agitation.”

This figure lists the medications he was prescribed during his treatment. The pink area was during his psychotic 18-month period and the yellow area was during his antimicrobial treatment of the Bartonella.

Figure 2. Drug administration timeline for the boy, reprinted from the study

The skin lesions or “stretch mark-like” lesions on his thigh (A) and armpit (B) are tell-tale signs of a Bartonella bacterial infection or neurobartonellosis. Here are photographs taken by his parents.

A successful outcome for this young boy came about as a result of antimicrobial treatment in the way of antibiotics and antifungals. His skin lesions healed, his psychosis and other symptoms resolved, he was able to quit his psychiatric medications and go back to being a typical young boy. How wonderful for this young boy! And this gives me so much hope for others who may be in a similar situation and looking for solutions.

Other than the hope I felt, these are my other thoughts that came to my mind as I read this case study:

How many people are being prescribed psychiatric medications when they actually have an infection or physiological condition? The authors state: “Beyond suggesting that Bartonella infection itself could contribute to progressive neuropsychiatric disorders like schizophrenia, it raises the question of how often infection may be involved with psychiatric disorders generally.”
How can a young boy of this age be prescribed this many psychiatric medications over an 18-month period? I’m sure his doctors were doing their best but what is it going to take for doctors to look for infectious (and/or physiological or biological or nutritional or environmental) causes for psychiatric symptoms as the first approach or certainly at the same time in a situation like this where psychosis was a factor?
What will it take for mainstream practitioners to get up to speed with this epidemic of Lyme disease? And when will testing for Lyme disease and co-infections be used by all doctors and not just Lyme-literate doctors and functional medicine doctors like Dr. Darin Ingels. the author of “The Lyme Solution.” (Here is my review of his excellent book.) It is worth noting that Dr. Ingels uses very successful treatments that are purely herbal, dietary and immune-supportive, and don’t require antibiotics.

We already know there is a huge psychiatric connection with Lyme disease and co-infections: anxiety, depression, panic attacks, and OCD too. This case adds to the evidence. Even though neuropsychiatric Lyme disease is well-recognized in the world of functional medicine, keep in mind that Lyme disease bacteria such as Borrelia and co-infections such as Bartonella are only one of many possible trigger/root cause of symptoms like this young boy experienced.

Other infectious causes of psychiatric conditions include chronic strep (in the case of PANDAS/PANS) and toxoplasma gondii.

Other physiological root causes of psychiatric conditions like schizophrenia, anxiety, bipolar disorder and depression could include a thyroid condition, heavy metal toxicity from say lead or mercury, mycotoxins, and even gluten.

We need to be shouting case studies like this from the rooftops so more doctors, more psychologists, more functional medicine practitioners, and more parents are aware and start to look for infectious/physiological/biological/nutritional/environmental root causes.

We appreciate those involved in publishing this case and the family for giving permission. Hopefully, case studies like these will drive future research and treatment approaches.

What do you think and what came to your mind when you read this case study?

Feel free to post your questions here too.