Can people with schizophrenia actually see demons?

We overcome Limits

A similar, also real case was filmed in the USA and will be running on Friday, June 22, 2018, on the online streaming service Netflix under the title "Fire in the head".

Symptoms of schizophrenia

Even before Saskia R. comes to the Freiburg University Medical Center, she is being examined intensively in several hospitals and psychiatric clinics. The repeatedly asked and confirmed finding: schizophrenia. But therapy with antipsychotic drugs does not last long. “The psychoses returned and became so strong that the young woman could hardly eat, drink or take care of herself on her own. At that time she was referred to us at the clinic, ”says Prof. Dr. Ludger Tebartz van Elst, Deputy Medical Director of the Clinic for Psychiatry and Psychotherapy at the University Medical Center Freiburg.

An idea that is almost 100 years old provides the solution

The doctors at the University Medical Center in Freiburg are re-examining all possible causes, including an inflammation of the brain. “The idea that inflammation of the brain can cause schizophrenia has been around since the 1930s. But it was not until the early 2000s that there was the first evidence that this was really the case, ”says Prof. Tebartz van Elst, who heads the Freiburg research group“ Immunological Encephalopathies ”.

Malfunctioning immune system responsible for changes in personality

In extensive laboratory tests, the Freiburg researchers found a disruption of the blood-brain barrier in the patient, which means that substances can enter the brain in an uncontrolled manner. Doctors also find special immune antibodies in the blood that block a docking point for the messenger substance NMDA in the brain. An elaborate metabolic imaging examination of the brain finally shows that parts of the brain are inflamed. "That was the crucial piece of the puzzle in order to be able to treat the patient in a targeted and successful manner," says the Freiburg psychiatrist. The new diagnosis: NMDA receptor encephalitis.

Therapy works within weeks

The Freiburg doctors use high-dose cortisone therapy and other immunotherapies to reduce the inflammation of the brain. "We were able to see a clear improvement after just a few days," says Prof. Tebartz van Elst. After a few weeks, the therapy can be reduced and Saskia R. can be discharged home. Eventually, the patient can resume normal life. “It was fantastic to see that the therapy works so quickly and convincingly, even with such a long-term illness,” says Prof. Tebartz van Elst.

Inflammatory processes as the cause of schizophrenic forms

How common schizophrenic symptoms are due to inflammation of the brain is difficult to quantify. Diagnostics has so far only been carried out routinely at a few clinics and is very complex. “There is a great need for clinical research here,” says Prof. Tebartz van Elst.

The cause of inflammatory brain diseases that cause schizophrenic or other psychiatrically conspicuous symptoms cannot always be clearly clarified. In some cases the change in personality is preceded by cancer. One suspicion is that the immune system subsequently attacks structures that exist in the tumor and in the brain. If the blood-brain barrier is then permeable, the brain can become inflamed.

The film "Fire in the Head" describes a similar case

The film "Fire in the Head", which will air on Netflix on Thursday, June 22, 2018, describes the equally true story of the young journalist Susanna Cahalan, who developed severe symptoms of schizophrenia within a short period of time. After long stays in hospital and psychiatry, she is also diagnosed with NMDA receptor encephalitis and treated successfully.

Overall concept of schizophrenia called into question

Experiences like these could have far-reaching consequences not only for individual patients but also for the field of psychiatry. For example, Prof. Tebartz van Elst represents in his most recent book “From the beginning and the end of schizophrenia. A neuropsychiatric perspective on the concept of schizophrenia "(2017) the opinion:" We know numerous different causes of diseases that we call schizophrenia. In other words: schizophrenia is a collective term for many different diseases. If we take this into account, we could treat patients more successfully, as in the present case. "

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Additional Information:

Special consultation for immunological encephalopathies