Mental illness may really be infectious disease

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Mental illness may really be infectious disease - Letters to the Editor

Frank Strick

 

Editor:

 

I'm going to give my psychoanalyst one more year then I'm going to

Lourdes .... Woody Allen

 

Psychological treatment of chronic " mental illnesses " is often lengthy

and of limited efficacy. Carolyn Raser was a healthy, energetic and

upbeat Psychologist who delighted in world travel and adventure. Yet

after a trip last year to Bhutan she returned to her home in

California with severe depression, exhaustion and joints so swollen

she could not open her hotel room door. Her third physician finally

diagnosed her with Rheumatoid Arthritis and put her on multiple drugs,

but the depression, lethargy and exhaustion persisted, even after

nearly 100 subsequent treatments from Acupuncturists, Chiropractors

and rehabilitation specialists. She had spent a small fortune and was

feeling quite desperate and discouraged when she heard about a

researcher at the Research Institute for Infectious Mental Illness and

decided to give him a call. After interviewing her, the researcher

suggested a workup for parasites and digestive disorders which

revealed the previously undetected presence of three protozoan

parasites and a compromised secretory IGA system. Three weeks later,

after following his suggestions for eliminating the infections, her

depression and chronic exhaustion were gone and her energy and zest

for life had returned, just in time to help her daughter with the

delivery of her new baby.

 

In considering an infectious etiology to any chronic or acute mental

illness there are at least four categories to consider. First are

those infections already recognized to induce psychiatric symptoms.

These include Pneumonia, Urinary tract infection, Sepsis, Malaria,

Legionaires disease, Syphillis, Chlamydia, Typhoid, Diptheria, HIV,

Rheumatic fever and Herpes (Chuang). While the psychiatric sequelae to

these infections are noncontroversial, even so, they are rarely

screened for if the initial presentation is made to a mental health

professional. Moreover, the significance of some of these infections

may date back to prenatal development. Research done at the Johns

Hopkins Children's Center and published in the Archives of General

Psychiatry in 2001 found that mothers with evidence of Herpes Simplex

Type 2 infection at the time of pregnancy had children almost six

times more likely to later develop Schizophrenia. And in the US,

Europe and Japan, the birth excesses of those individuals who develop

Schizophrenia later in life closely mirrors the seasonal distribution

of Ixodes ticks at the time of conception. (Lyme disease).

 

Second are those parasitic infections such as Neurocysticercosis where

the brain is directly invaded by the infective agent through a well

established imagable mechanism (cysts, lesions, encephalitis, cerebral

swelling etc.) Signs of Psychiatric disease (depression and psychosis)

were found in over 65% of Neurocysticercosis cases (caused by a

tapeworm whose incidence in the US is rising due to demographic

increases in foreign immigrant populations.) (Forlenza). While the

mechanisms for psychiatric manifestations are easy to demonstrate when

brain tissue is directly affected, there are also multiple reports in

the literature of psychiatric symptoms associated with other parasites

like Giardiasis, Ascaris Psychosis (roundworm), Trichinosis and Lyme

Borealisis and documentation of these patients' " psychiatric " symptoms

resolving when the underlying hidden infection is treated. Dr. J.

Packman of Yale University wrote over ten years ago that " Patients

with parasitic loads are more likely to exhibit mental status changes

and there is an improvement in mental status of a subset of

psychiatric patients following treatment for parasites. " In fact, a

review of 1300 human cases of trichinosis in Germany found CNS

involvement in up to 24% of the cases (Menningeal inflammation or

encephalitis). (Froscher).

 

Clinically, in cases like Neurocysticercosis, the problem is not the

lack of a well defined mechanism but the lack of mental health

practitioners qualified to make such a diagnosis or even suspect it.

Even infectious disease specialists tend to underestimate the scope of

the problem, in part due to underreporting (Neurocysticercosis is not

a reportable condition in most states and the incidence of trichinosis

is, we believe, vastly underestimated according to newly developed

antibody assays only made available within the past six months).

 

Next are those parasitic, bacterial and viral infections like

Toxoplasmosis, Strep, Borna Virus and CMV where a strong statistical

link to mental illness has been demonstrated but research is underway

to establish a causal connection. In humans acute infection with

Toxoplasmosis Gondii can cause brain lesions, changes in personality

and symptoms of psychosis including delusions and auditory

hallucinations, and researchers at Rockefeller University and NIMH

have suggested that after Streptococcal infection, some children may

develop abrupt onset Obsessive Compulsive Disorder within a matter of

weeks (Swedo-NIH). Toxoplasma Gondii can alter behavior and

neurotransmitter function, and since 1953 eighteen out of 19 studies

of T. gondii antibodies in persons with schizophrenia and other severe

psychiatric disorders have reported a higher percentage of T. gondii

antibodies in the affected persons. (For example, in one large study

Toxoplasmosis infection was twice as common in mentally handicapped

patients as in healthy controls and in a recent German study of

" individuals with first episode schizophrenia compared to matched

controls, 42% of the former compared to just 11% of the latter had

antibodies to Toxoplasma " ). Two other studies found that exposure to

cats (the primary carrier for toxoplasmosis transmission) in childhood

was a risk factor for the development of Schizophrenia. Furthermore,

certain antipsychotic and moodstabilizer drugs such as Halperidol and

Valproic acid inhibited this parasite in vitro at a concentration

below that found in the cerebrospinal fluid and blood of individuals

being treated with this medication, suggesting that some medications

used to treat schizophrenia and bipolar disorder may actually work by

inhibiting the replication of Toxoplasmosis Gondii. (Jones-brando,

Torrey, Yolken).

 

Other studies have shown that antipsychotic drugs like thorazine,

haldol and clozapine inhibit viral replication and that the

cerebrospinal fluid of patients with recent onset schizophrenia shows

a 400% increase in Reverse Transcriptase activity--which is an

important component of infectious retroviruses. Furthermore, when the

CSF from these patients was used to inoculate a New World monkey cell

line there was a tenfold increase in Reverse Transcriptase activity,

which suggests the presence of a replicating virus. Independently, Dr.

Darren Hart of Tulane University School of Medicine found evidence of

antibodies to retrovirus in the blood of half the patients he tested

who were diagnosed with schizophrenia and Bipolar disorder. Malhotra,

looking at genetic predisposition factors, has demonstrated the

absence of CCR5?32 homozygotes in over 200 schizophrenic

patients--which dramatically increase susceptibility to retroviral

infection. (F.Yee). (Yet bad genes alone cannot explain severe

conditions like schizophrenia because such illnesses dramatically

reduce the subjects' reproductive fitness and would ultimately fall

victim to natural selection. Instead, schizophrenia rates keep

rising.) It is research like this that has led Johns Hopkins

Virologist Robert Yolken and Psychiatry Professor and former special

assistant to the Director of the National Institute for Mental Health,

Dr. E. Fuller Torrey to believe that Toxoplasmosis is one of several

infectious agents that causes most cases Schizophrenia and Bipolar

disorder. The idea is not new, in fact as far back as 1922 the famous

Psychiatrist Karl Menninger hypothesized that Schizophrenia was " in

most instances the biproduct of viral encephalitis. " Torrey notes that

in the late 19th century schizophrenia and bipolar disorder went from

being rare diseases to relatively common ones at the same time that

cat ownership became popular. And Yolken designed a retrospective

study of 2500 families showing that mothers of children who later

developed psychoses were 4.5 times more likely to have antibodies to

toxoplasmosis than the mothers of healthy controls. (For those looking

for a novel defense in traffic court, recent research suggests that

people with toxoplasma have slower reaction times and are almost three

times as likely to be involved in a traffic accident.) Yolken was also

the principal investigator in a recent study of patients who had

suffered from Schizophrenia for an average of over 22 years. In 21

Schizophrenic patients who also tested positive for Cytomegalovirus,

there was a significant improvement in overall " psychiatric symptoms "

when the subjects were given oral Valacyclovir, an antiviral

medication, for eight weeks. (American Journal of Psychiatry: December

2003). Another antiviral, Amantadine, has been used in German studies

to bring about greatly shortened hospitalizations and rapid remission

of psychiatric manifestations in many of the 4 to 15% of psychiatric

patients who tested positive for Borna Disease Virus (compared to 0-2%

of normal subjects.--Bode, Luvig.) Smaller US studies found up to half

of Bipolar and Schizophrenic patients to be Borna-positive compared to

none of the healthy controls. (Lipkin). BDV is thought to be

transmitted via the salivary and nasal secretions of horses, sheep,

cattle, rabbits, goats, deer, cats and other animals. It is well known

to cause encephalitis and behavioral disturbances in horses and other

mammals, has tropism for limbic system and dopamine circuits, strongly

correlates with depressive, bipolar, schizophrenic and dysthymic

disorders in humans, and Borna viral markers, isolated from the

monocytes of patients with mood disorders, coincide with acute

episodes of those mood disorders. (In fact, it may yet turn out that

the activity against envelope viruses demonstrated by St Johns wort is

an element in its antidepressive effects.)

 

Due to the frequency of cat ownership a large percentage of the US

population (up to 50%) has been exposed to Toxoplasmosis but most

immunocompetent carriers remain asymptomatic until another

immuno-logical burden such as HIV or a separate parasite weakens the

host defenses and precipitates pathogenic expression. That is what

makes interpretation of the chronic state so tricky and at the

Research Institute for Infectious Mental Illness we try to identify

any parasitic coinfections before deciding on an appropriate course of

treatment.

 

Finally, while Toxoplasmosis gets a lot of attention due to Torrey and

Yolken's pioneering studies and the known mechanism of brain lesions,

there are many other infective agents that may not target the brain

specifically but can severely affect mental function through the

cumulative downstream consequences of chronic infection. While the

importance of this link in the etiopathogenesis of mental illness is

rarely recognized, these focal and systemic infections are very common

and their psychiatric sequelae often severe. (Parasites are the most

common causes of mortality and morbidity in the world.) In this

nonspecific category are scores of parasites, protozoa, helminths,

bacteria, fungi and viruses which, if not directly invading and

disabling brain tissue and neurotransmitter function, do so indirectly

by depleting the host of essential nutrients, interfering with enzyme

and neuroimmune functions, and releasing a massive load of waste

products, enteric poisons and toxins which disrupt brain metabolism.

(A single mature adult tapeworm can lay a million eggs a day and

roundworms, which infect about 25% of the world's population, lay

200,000 daily). Remember, the brain is your body's most

energy-intensive organ. It represents only 3% of your body weight but

utilizes 25% of your body's oxygen, nutrients and circulating glucose.

Therefore any significant metabolic disruptions can impact brain

function first. This link is borne out statistically. Mental patients

have much higher rates of parasitic infection than the general

population. Between 1995 and 1996, researchers at the University of

Ancona did stool tests on 238 residents of four Italian psychiatric

institutions and found parasites in 53.8% of the residents, including

all of those residents with behavioral aberrations (Giacometti). In

our experience parasites are often implicated in cognitive dysfunction

and chronic emotional stress disorders and to the untrained eye

classic symptoms like apathy, exhaustion, confusion, appetite and

memory loss, " nervous stomach, " social withdrawal, lethargy and loss

of sex drive and motivation are frequently assumed to signal a

depressive disorder without an adequate differential diagnosis being

made or even attempted. Adding to the confusion, classic indicators of

acute infection such as fever or elevated antibodies often reverse

themselves in chronic cases due to secondary hypothyroidism and

immunodepression. The problem with a " psychiatric " diagnosis is that

while it attempts to describe a symptom or set of symptoms, it yields

no clue as to the root cause(s). Unfortunately, until Western

Psychiatry further recognizes that the mind/body connection goes in

both directions, patients will continue to suffer from a de facto lack

of differential diagnostic criteria in clinically identical syndromes.

 

Even for those clinicians who recognize the devastating psychological

effects that chronic intestinal, focal and even dental infections can

have on normal brain function, accurate diagnosis presents formidable

challenges. In fact some standard parasite stool test procedures

identify less than 10% of active infections and even the " politically

correct " holistic specialty labs miss many infections that are

nondetectable in fecal specimens, have inconsistent shedding patterns,

are extraintestinal or otherwise hard to identify. For example,

according to the World Health Organization, over two billion people

are infected with worms, yet rarely will they show up in stool assays.

(These numbers are not surprising once you realize that the exposure

vectors are potentially everything you eat, drink, breathe and touch.

If you think you have to leave the country to be exposed to exotic

parasites in food, think again. In fact try walking into the kitchen

of your favorite restaurants and see if the cook speaks English.)

 

At the Research Institute for Infectious Mental Illness we use

multiple labs with complementary strengths and a combination of

advanced scientific diagnostic procedures including O & P microscopy,

multifluid antigen and antibody detection, stool cultures, enzyme

immunoassay, mucosal markers, inflammation assays, imaging techniques

and other indirect laboratory indicators combined with extensive

historical and clinical evaluations to identify chronic infectious

stressors. (Patients previously diagnosed with " Chronic Candidiasis "

often find that Candida was merely a cofactor or consequence of more

significant infections and infestations which created obstacles to

longterm cure.) " Mental " symptoms often improve dramatically when

hidden neuroimmune infections are treated successfully and normal

brain metabolism resumes, especially in " sudden-onset " syndromes.

After identifying and treating the primary infections we focus on

rebuilding the host's immunological defenses and mucosal integrity to

prevent relapse. Premature nutritional supplementation, even in frank

anemia, can be counterproductive since some vitamins and minerals

(i.e. iron) can be growth factors for microorganisms which the body

intentionally downregulates the uptake of during active infection. But

individually formulated subsequent nutritional supplementation is

often helpful for full recovery. We also screen clients for heavy

metals, environmental chemicals, molds and electromagnetic stressors,

blood sugar problems, " Brain allergies, " food sensitivities, Seasonal

Affective Disorder, hormone disorders, neurotransmitter imbalances,

nutritional deficiencies, diet and numerous other variables which can

influence cognitive and affective function. To speed recovery, our

evidence-based Integral Medicine approach may include auxiliary

treatments from consulting nutritionists, homeopaths, acupuncturists,

herbalists or bodyworkers.

 

The erosion or loss of brain function is arguably the most frightening

and disabling experience a person can have. Almost by definition,

standard psychological or Psychiatric intervention postulates a

dichotomy between disorders of the body and those of the mind and has

a long way to go in recognizing the importance of infectious

etiologies in mental health care. The Research Institute for

Infectious Mental Illness, the first comprehensive institute of its

kind in the US provides testing, clinical and consulting services to

clients from all over the world and educates professionals in this

critical area. Long distance phone consultations are also available.

They can be reached by calling 800-699-2466 then press pound (#)

831-425-5555 (patient scheduling inquiries only) or by emailing

riimi.

 

This article may be reprinted by anyone if the RIIMI clinic contact

information above is listed. We are located in Santa Cruz, California

but also do phone consultations with patients from all over the US and

abroad.

 

Frank Strick, Clinical Research Director

 

Research Institute for

 

Infectious Mental Illness

 

riimi

 

COPYRIGHT 2004 The Townsend Letter Group