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RESEARCH WEEKLY: A Case Study of Mr. T: Suicidal, Violent, and Treatment Resistant
Schizophrenia

This edition of Research Weekly highlights a recent case study on the treatment
of a man with severe mental illness. Published in this month's issue of the journal
Current Psychiatry, the difficult clinical case of "Mr. T" illustrates how utilizing
innovative therapies to reduce inflammation in the brain can help transform the
lives of those struggling with treatment-resistant serious mental illness. It
showcases the work of Treatment Advocacy Center founder Dr. E. Fuller Torrey and
board member Dr. Robert Yolken, which examines the role of infections in schizophrenia
and how treating them can significantly impact outcomes for individuals suffering
from diseases of the brain.
Mr. T
Mr. T is a middle-aged man with schizoaffective disorder, the serious brain illness
that combines the delusions and hallucinations of a psychotic disorder with the
manic and depressive symptoms of a mood disorder.
Over the course of his illness, Mr. T made several suicide attempts. He consistently
struggled with treatment adherence, both due to impaired insight into his condition
as well as a lack of response to standard antipsychotic approaches. At times, he
drank alcohol heavily. During a psychotic episode, he attacked his mother with
a knife when she came to take him to a psychiatric appointment because he believed
she and the CIA were conspiring against him. Mr. T was arrested and taken to jail.
Treatment resistance
While in jail, Mr. T was found incompetent to stand trial due to his psychiatric
illness and sent to the state hospital in California to receive competency restoration.
After three years, it was determined that Mr. T was unable to be restored due to
repeated decompensations of his illness and was sent back to jail. In jail. he
decompensated further and began showing signs of catatonia, refusing food and medications
and becoming mute. After a particularly severe episode, Mr. T was sent to a local
hospital.
Mr. T was started on clozapine, the most effective antipsychotic medication for
treatment-resistant schizophrenia. His catatonic symptoms improved, and he was transferred
to a mental health rehabilitation center.
Pharmacogenetics and brain inflammation
Mr T. agreed to pharmacogenetic testing that allows his treatment team to adjust
his dose of clozapine to achieve the best response. Further testing for infections
of the brain showed that Mr. T tested positive for Toxoplasma Gondii, a parasite
spread by feral cats. Research has shown that persons with schizophrenia who have
latent Toxoplasma Gondii infection have a more severe from of the illness compared
to persons with schizophrenia who do not have the infection.
In addition to clozapine and a medication for depression, Mr. T was prescribed minocycline,
a potent anti-inflammatory drug. Afterwards, Mr. T begins a slow but steady improvement
in symptoms, with inflammation markers in his blood decreasing.
Despite making improvement, Mr. T. continued to periodically experience periods
of intense anxiety during which he repeats the same sentence over and over again.
During one of these episodes, he is re-hospitalized. Afterwards, Mr. T expresses
interest in trying a natural agent and is given ginger root extract in addition
to valproic acid, both known to target toxoplasmosis infection.
One month after the initiation of this new treatment regimen, Mr. T's test results
reflected his immune system was better controlling the toxoplasmosis infection.
He continued to show significant symptom improvement and stopped cycling into periods
of perseverative thought and intense anxiety. Eventually, Mr. T's criminal charges
were dismissed and he was discharged to a less restrictive level of care. Currently,
he is volunteering in a peer support program, will soon begin working there part-time,
and plans to move into his own apartment. He spends weekends with his family members
and friends.
For more information about toxoplasmosis infection and schizophrenia, see this post
[[link removed]]
written by Dr. E. Fuller Torrey last year. To learn more about the work being done
on the biological impact of infections in the development of severe mental illness,
check out the website of the Stanley Medical Research Institute [[link removed]],
a supporter of the Treatment Advocacy Center.
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References:

*

Adabie, N. E., et al. (2019). Suicidal, violent, and treatment resistant [[link removed]].
Current Psychiatry.
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Elizabeth Sinclair
Director of Research
Treatment Advocacy Center
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Research Weekly is a summary published as a public service of the Treatment Advocacy
Center and does not necessarily reflect the findings or positions of the organization
or its staff. Full access to research summarized may require a fee or paid subscription
to the publications.
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The Treatment Advocacy Center does not solicit or accept funds from pharmaceutical
companies.
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