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Sep
30
2016

The Inflamed Mind
by

the-inflamed-mind-scansThere is a growing amount of evidence that some mental health problems may be due in part to the brain becoming ‘inflamed’. In August BBC Radio 4 broadcast a programme about this titled ‘The inflamed Mind’. You can listen to the programme by clicking here. I loved it.  It has interviews with some of the key figures in the world of research into the immune system and mental illness.

Pleasingly the radio programme and the accompanying BBC news article include the perspectives of service users.

But what does ‘inflamed’ actually mean? I sometimes get knee pain. Usually the advice I get is to do some stretching, take some ibuprofen, and not to exercise for a couple of days. Apparently, the problem is that my knee is inflamed and ibuprofen will help because it’s an ‘anti’-inflammatory. But coming back to my question. The Oxford English Dictionary provides a few definitions. The most relevant seemed to be ‘a morbid process affecting some organ or part of the body, characterized by excessive heat, swelling, pain, and redness’. In the case of my knee, if it’s swollen, a bit red, and it hurts, then I am told that it looks a bit inflamed.

Inflammation itself is caused by the body’s immune system. The immune system is meant to protect us from infections and other invaders like viruses. But the immune system can over-react or attack healthy cells leading to a whole range of serious diseases from arthritis to lupus.

So what happens when the brain becomes inflamed? Well, some very bad things can happen. To some extent it depends on how the brain becomes inflamed. If it’s due to the immune system fighting a viral infection you could get Encephalitis. It’s pretty serious. From this, people sometimes develop psychosis and they usually need to be treated in an intensive care unit.

A dysfunctional immune system might cause psychosis in its own right. Belinda Lennox, from Oxford University is quoted by the BBC health reporter James Gallagher as saying that up to “one in ten” people with psychosis for the first time have antibodies “targeting part of their brain circuitry”. Antibodies are a key part of the immune system. They help identify and destroy harmful invaders such as bacteria and virus. These antibodies disrupt the way that cells in the brain communicate with each other and psychosis follows. It’s a bit akin to a motorway pile-up going on in your brain. The McPin Foundation is supporting a study called SINAPPS which is looking into a possible new treatment for these people.

Evidence is slowly emerging that the brain becoming inflamed may have a role to play in depression as well. Carmine Pariante of Kings College London is quoted in the programme as saying that “nearly 30% to 40% of depressed patients have high levels of inflammation and in these people we think it is part of the causal process”.

Within the world of research there is a lot of excitement about all of this. This is reflected in the title of the BBC news article (‘depression: A revolution in treatment?’). The excitement seems to be for two reasons. Firstly, there is a clear indication about what might be contributing to someone’s depression or psychosis (inflammation of the brain). Little is really known about the exact causes of mental illness. Anything that throws light on the causes of mental illness is exciting.

And secondly, there are approaches that are already in use to treat inflammation. Could these approaches help people with mental illness?   One approach is anti-inflammatory medications.  In the SINAPPS study it’s a procedure called IVIG together with a drug called rituximab. It’s too early to say if any of these approaches will work. But at the very least identifying people with mental health problems suffering from inflammation might help doctors and others to tailor more personalised treatments for them. This was one of the conclusions from a recent paper from Carmine Pariante’s research group.

Three things struck me when I listened to the Radio 4 programme. First of all is the connection between physical and mental health. The two are connected. Perhaps they should be treated as such instead of NHS services being broadly separated along ‘physical’ and ‘mental’ health lines with GP’s being left bridging the gap. Secondly, the amount of excitement within the research community. A 2015 Lancet Psychiatry article makes an interesting point. This is not the first time that a possible physical cause of mental illness has caused excitement: “Early in the 20th century, there was great excitement when general paresis of the insane was shown to be due to syphilis and curable with penicillin, inspiring hope that similar organic causes might be found for other types of mental illness”. Why is the physical basis of mental health so exciting? Indeed this is the main focus of the last few minutes of the radio programme.

And lastly, that there are already treatments that are used in a physical health context that might help people with mental health problems. The SINAPPS study is due to start soon. I’ll let you know how we get on…