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 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 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, a supporter of the Treatment Advocacy Center.
