Danish Study Shows Association Between Treated Infections and Risk of Mental Disorders in Children
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https://madisonarealymesupportgroup.com/2018/07/28/stories-of-pandas/
DALLAS – Nov. 29, 2018 – Glen Carter woke up on a white linen bed inside a psychiatric unit, the excruciating pain in his shoulder mingling with a growing sense of alarm.
How had he arrived here? What was wrong with his shoulder?
Mr. Carter later learned he had driven to UT Southwestern for help and had been acting erratically – hearing voices, seeing visions, and sputtering to doctors thoughts of his imminent death.
“I had no recollection of any of it,” said Mr. Carter, 58.
The uncharacteristic behavior indicated a potential case of schizophrenia, yet his doctor noticed a few factors that didn’t add up. For instance, the longtime husband and father of two had no history of mental illness and had a severely dislocated shoulder usually only seen after major trauma such as car accidents or seizures.
The doctor ordered X-rays, brain imaging, and other tests that confirmed his suspicion: Mr. Carter did not have schizophrenia but rather a rare form of brain inflammation that would not have been reversed with antipsychotic medication.
“The shoulder was a big clue, then we noticed a bite mark on the side of his tongue that indicated he probably had a seizure,” said Dr. Robert Weir, who last December diagnosed Mr. Carter with a neurological condition called autoimmune encephalitis. “He responded remarkably well within a day of putting him on high-dose steroids, and he was soon able to resume his life as normal.”
Mr. Carter was the beneficiary of a blend of medical training that until recently was only offered to a select group of doctors on the East Coast: combined certification in psychiatry and neurology. Following a lengthy national moratorium that prevented medical schools from adding the dual training, the country’s newest such program at UT Southwestern represents a modest but notable step in filling a lingering national shortage of physicians skilled in the two fields.
The effects of the shortage are sometimes as benign as a slightly delayed diagnosis, but in extreme cases, patients may bounce from clinic to clinic and meander through a series of misdiagnoses and ineffective treatments, wreaking havoc on their personal and professional lives. A similar ordeal was publicized in the autobiography and subsequent film “Brain on Fire,” the story of a journalist who was mislabeled as having a primary psychotic disorder until she – like Mr. Carter – was diagnosed with autoimmune encephalitis.
Coming up on the one-year anniversary of Mr. Carter’s diagnosis, the bond broker is enjoying a holiday season much different than the last, when his normally joyous time with family and friends was riddled with emotional distress and medical mystery.
Dr. Weir is encouraged to hear about the impact his expertise had on Mr. Carter, who no longer needs treatment for the condition and hasn’t missed any significant time from work this year.
“The term ‘mental illness’ is thrown around a lot and frequently misused,” said Dr. Weir, who helped develop the curriculum for UT Southwestern’s combined residency program for neurology and psychiatry. “People with certain conditions are sometimes misdiagnosed and undertreated because we can’t tell them on a biomolecular level what’s really happening to them.”
Only five medical centers across the country offer the combined training, each one producing less than a handful of doctors a year – not nearly enough to cover the country’s vast expanse of patients who could benefit from their integrated skills.
UT Southwestern took its first step to create the curriculum after the national board that certifies these programs lifted a five-year moratorium on submitting applications in 2014, due to a change in certification protocol.
The addition of the Dallas-based program – the only one approved since the freeze was lifted – will only slightly help the overall physician numbers. However, it will likely play a crucial role in expanding access for patients who don’t live out East. Other programs are at places such as Brown University and the University of Massachusetts.
“That’s one of the reasons why we’re so excited about creating this combined residency,” said Dr. Adam Brenner, Co-Director of UT Southwestern’s program. “The odds are greater that doctors will stay near where they’re trained, which is important because this training hasn’t existed in Texas and most other parts of the country.”
UT Southwestern offers a six-year combined residency for doctors that includes a clinical track dividing time between neurology and psychiatry. The expertise has been helpful in diagnosing patients like Mr. Carter with rare autoimmune disorders, as well as a number of other conditions with overlapping symptoms, including epilepsy, Alzheimer’s disease, multiple sclerosis, and Parkinson’s disease.
The creation of the country’s newest program comes amid a growing push to utilize neurology tools in psychiatry, including an award-winning approach to objectively diagnose and treat different types of psychoses through evaluating neural images and electrical activity in the brain, among other strategies. National clinical trials are also providing early glimpses into how these high-tech tools – including magnetic seizure therapy – may impact treatment in depression and psychosis.
“It’s an exciting time to be involved in psychiatry and neurology,” said Dr. Weir, who is in the fourth year of the combined residency program he spearheaded. “Our technology is finally catching up to our curiosity.”
Mr. Carter had been a pillar of stability for his family. The breadwinner, the caring husband, the father who helped raise two children.
Then his life unraveled last year when he began having hallucinations. He took anxiety medications, but his condition only worsened in the following months. On one occasion he thought he was having a heart attack. Another time he asked his wife if she could hear God talking to her too.
“He was asking to go to the hospital, but even after a few trips to the emergency room we couldn’t put our finger on it,” said Janet Carter, Mr. Carter’s wife of 28 years. “This was nothing like Glen Carter.”
Her husband reached a breaking point on Dec. 8, 2017. Shortly after arriving at work, he drove himself to UT Southwestern and was admitted into the psychiatric unit, where Dr. Weir was on rotation that month.
Dr. Weir recalls Mr. Carter acting strangely, taking his clothes off and putting them in the shower, predicting his own death within 12 hours, and hearing voices in his head.
“None of that is very odd with psychotic behavior, but some things just didn’t add up,” Dr. Weir said. “He had been previously healthy and had a very abrupt change in behavior.”
Mr. Carter’s injured shoulder, likely dislocated during a seizure, set Dr. Weir on the path to solve the mystery that had perplexed the family for months. He was not schizophrenic after all. He suffered from autoimmune encephalitis, which occurs when the body’s immune system attacks healthy brain cells and inflames the brain, sometimes prompting psychiatric symptoms.
Mr. Carter was given steroids – a treatment that normally could be harmful to a hallucinating patient – and was back to normal within several days.
“I was in a desperate need,” Mr. Carter said during a recent visit to UT Southwestern to share his story. “I honestly don’t know how I got through this without losing my dignity. … We’re very grateful for what took place here.”
Mr. Carter’s case is not unique.
One study indicates at least 3 to 5 percent of psychotic behavior first seen in patients is due to an autoimmune condition.
How many of those patients are accurately diagnosed the first time and put on proper treatment is more difficult to determine.
Although awareness of autoimmune encephalitis has improved since the “Brain on Fire” book published in 2012, some doctors anticipate the demand will only grow for combined training in neurology and psychiatry.
“These two specialties have an area of overlap,” said Dr. Brenner, Professor of Psychiatry at UT Southwestern’s Peter O’Donnell Jr. Brain Institute. “And patients with conditions in this overlap sometimes really benefit from having one doctor who can encompass the whole picture. I’m confident that when Dr. Weir and others finish their residency, other medical students will see their work and want to follow in their path.”
About UT Southwestern Medical Center
UT Southwestern, one of the premier academic medical centers in the nation, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty has received six Nobel Prizes, and includes 22 members of the National Academy of Sciences, 17 members of the National Academy of Medicine, and 15 Howard Hughes Medical Institute Investigators. The faculty of more than 2,700 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide care in about 80 specialties to more than 105,000 hospitalized patients, nearly 370,000 emergency room cases, and oversee approximately 2.4 million outpatient visits a year.
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**Comment**
This is wonderful news. There has been a dearth of specialized doctors qualified to diagnose this condition which has been known to be a part of the Lyme/MSIDS picture: https://madisonarealymesupportgroup.com/2017/10/01/panspandas-steroids-autoimmune-disease-lymemsids-the-need-for-medical-collaboration/
Within this link boy’s Lyme Disease Morphs into Autoimmune encephalopathy. It took 10 years and 20 doctors to find out 12-year-old Patrik had Lyme disease. Just 4 months later the doctors discovered he also has a condition where his immune system attacks his brain. Dr. Souhel Najjar, Cahalan’s doctor, heroically saves the day again. (Video within link)
According to a prominent Wisconsin LLMD, 80% of his patients have tick borne illness along with PANS/PANDAS as well as Autism. If a child has an abrupt change in behavior such as the man in the main article, please consider this and get him to someone trained in this area.
The treatment for autoimmune encephalitis can vary based on the trigger, but timing is always key. If doctors treat whatever is triggering the condition, many people with the disease can go on to lead fairly normal, full lives.
For more:
https://madisonarealymesupportgroup.com/2018/07/28/stories-of-pandas/
https://madisonarealymesupportgroup.com/2018/10/10/pans-pandas-awareness/
This article is spot on. A hearty thanks to all of you spouses, mothers, fathers, children, family, and friends who stand by those with tick-borne illness. You are more important than you will ever know. And to all of you single patients, please know we have absorbed you into the family. You are ALL valued and needed. Chins up!
https://www.lymedisease.org/unsung-heroes-lyme-disease/

By Donna Falcone
Picture a couple raising two sons, hundreds of miles from any other family. The husband comes home from work and finds his wife lying in bed right where he left her that morning… again. He asks “What did you do today?”
Because she is feeling inadequate, the wife hears unspoken commentary on the mountains of laundry downstairs, the loss of income she’s caused, a reminder that tonight is Open House at school and dinner isn’t ready and homework hasn’t been done, and on and on and on. They argue. She cries. The children cook dinner.
Life with Lyme goes on and, with the help of treatment and a really good therapist, she begins to flip her perspective. She considers that while her life had been completely derailed, his life was also feeling quite over… quite disrupted… quite out of control.
She realizes that his question of “what did you do today” was courageous, framed in the stubborn hope of hearing she did anything other than stay in bed all day, even if it was just getting the mail… any glimmer to indicate his bride was starting to rebound.
He is terrified, but he doesn’t want to burden her with that. Everything is slipping away and there is nothing to do that isn’t being done, and he wonders how he will raise the boys alone because it’s looking more and more possible that her heart will simply stop beating. They both think it, but neither will say it, fearing that even uttering these words will break a fragile magic spell that is keeping her alive.
Lyme disease takes a toll on more than the body of the inflicted. It’s a family journey.
There was a new normal, and it kept changing and I imagine it’s that way for a lot of Lyme patients. Maybe you started going to bed earlier and earlier after work and eventually stopped waiting for night to fall.
Maybe you couldn’t go to work anymore, or grocery shop, or make dinner. Maybe you couldn’t hold a baby because your arms kept falling asleep. Maybe it took all day to fold a single load of laundry because that missing sock sent you into a sobbing rage.
Maybe family finances were dwindling as your medical expenses climbed.
When life changes so drastically, it’s hard on everyone, and the downward spiral seems endless. We find ourselves caught up in an illness that the medical world is warring over while we grow sicker by the day so, some of us wonder – are we losing our minds or dying, or both?
In the face of medical denial, the wounding of illness is magnified. Perhaps the worst part about having Lyme disease is that it is Lyme disease and not something else, equally horrific.
By the time we find a doctor willing to dig deeply for a diagnosis and offer treatment, we are exhausted, feeling increasingly isolated. More than a little stunned while also filled with hope, we forge ahead into treatment and recovery.
In my case, my husband (also stunned and hopeful) forged ahead right along with me, helping to navigate the minefield that is Lyme disease.
To say it was disorienting would be an understatement, and it was difficult to for me to fully appreciate my husband’s struggle. I unrealistically and desperately needed him to understand what was happening to me. I needed him to believe this disease was real.
Over time, this new normal terrified me and I ached for him to stay but was so afraid he wouldn’t. Was I at all like the girl he married way back in 1991?
There were times I would translate his inability to know exactly what I was going through as an unwillingness to walk in my shoes even though, in rational thought, I knew he would walk through fire in my shoes if it meant I wouldn’t have to wear them again.
I translated words that used to make me blush, like “you look beautiful,” as assaults on my credibility. “What did you do today?” was misinterpreted as code for did you even bother to leave the sofa this afternoon you lazy freeloading sloth?
In such upheaval, my view of everything was distorted through thick Lyme-green lenses. I was, at times, unreasonable and explosive towards him and our sons, which filled me with shame and a powerful need to protect them from me – the person who loved them more than life.
While it’s true that my sense of competence and security had been hit with substantial blows, it took some time for me to deeply recognize that my husband had absorbed some pretty big hits as well.
With the help of a therapist, I began observing our life together, seeing the whole surreal scene with all the players. I could see that even though I felt isolated, I wasn’t alone – my husband had been traveling alongside me the whole time.
My husband is my hero.
Not every relationship outlived my illness. I’ve given up trying to figure out why or how this happens, but the truth is we all carry burdens no one can see.
I grieve these losses, naturally, but no longer harbor ill will. Instead, I see our parting as an unavoidable consequence of circumstances, knowing that at any moment life may or may not bring us back together again. It’s out of my hands.
In some cases, the better option has been to re-envision important relationships, adjust expectations, and hope to preserve something precious still remaining.
But, where would we be without our heroes? Whether they drive us to appointments, decipher dosing schedules, catch us up on the latest gossip, offer treatment at their own professional peril, or just sit and sip tea now and then, those who stay are the unsung heroes of the Lyme Wars.
Donna Falcone was diagnosed with Lyme and other tick-borne diseases in 2008. She is illustrator of the children’s book, A is for Azure: the Alphabet in Colors, written by L.L. Barkat; contributor to Lyme INFECTED/INSPIRED: Lyme Disease Art Anthology by Christina Baggett; and, founder of The Brighter Side Blog. You can find Donna on Twitter as @poetryofLyme and her website: www.DonnaZFalcone.com
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**Comment**
Beautifully and heart-fully written. I need a Kleenex…..
Approx. 15 min.
Published on Nov 24, 2018
https://gnc.gu.se/english/gillberg-s-blog/gone-baby-gone?

post by Christopher Gillberg 2nd October 2018
It has been 25 years since Susan Swedo described the condition now referred to as PANDAS* (which, more recently, has come to be included as a subgroup of the somewhat larger group PANS**). Swedo had herself previously examined children who after bouts of rheumatic fever (brought on by streptococcus infection) had developed Sydenham’s chorea, a condition characterised by abnormal motor movements of the face, hands and feet, and in many cases speech difficulties, slowed cognitive processing, obsessive-compulsive thoughts, concentration difficulties, hyperactivity and other psychiatric symptoms as well. Onset of Sydenham’s chorea is usually quite acute, but typically only occurs many months after a streptococcus infection has concluded.
PANDAS/PANS is similar to Sydenham’s chorea in all relevant aspects where mental symptoms are concerned, but they manifest more dramatically; motor control issues, however, are much less pronounced or completely absent. Onset is often extremely acute – from one day to the next, or at the very least from one week to the next. A child who has previously only shown minimal or moderate signs of autism, ADHD or other ESSENCE problems (problems mild enough to generally not warrant any diagnosis) are suddenly stricken with severe separation anxiety, obsessive-compulsive thoughts and actions, tics, concentration difficulties, emotional withdrawal, tantrums, crying spells or even severe psychosis-like symptoms. Quite often they also start wetting themselves and acting as though their development has regressed by several years. Some children with this dramatic symptomatology have recently gone through a streptococcus infection (in which case it might be reasonable to consider PANDAS), whereas in other cases there is no proven link to infection whatsoever (whether streptococcus or otherwise). There are some cases where, even without any clear link to streptococcus infection, penicillin treatment still appears to reduce symptoms. However, the reason for this is unknown.
There are a number of things that I would like to strongly emphasise now that we have completed this study on PANS, the first Swedish study of its kind aimed only at children, adolescents and their families:
1. PANS exists and is not “a hoax” or “fabricated”.
2. PANS has nothing to do with Münchhausen syndrome, which is to say that this is not something that sick or weird parents have come up with.
3. The child has usually had some minor problems before the frightening deterioration occurs.
4. Immune diseases among close family members are not uncommon.
5. We know almost nothing about the causes behind it.
6. We do not know how common it is.
7. We do not know how closely related it is to regressive autism, Sydenham’s chorea or Landau-Kleffner syndrome.
All of this means that continued research on PANS should be a top priority, especially at institutions equipped with both knowledge and an interest in expanding that knowledge base, such as the CNC/GNC in Gothenburg and the OCD team/Astrid Lindgren Children’s Hospital in Stockholm.
Anyone who feels that their child has suddenly been “spirited away” without any explanation must have some avenue towards help and understanding. Most importantly, we need to figure out what is best for all the children who one day start acting in an unrecognisable manner, almost as if their old selves were “gone”. Almost nothing can be worse in this situation than to meet so-called experts who do nothing but mistrust and question one’s account of the symptoms and the circumstances surrounding their onset.
Families living with PANS know how terrible it can be to suddenly feel as though they have “lost a healthy child”. By allowing these families to meet doctors and psychologists who are knowledgeable in the field, we can at least give them a chance to feel like they “got their child back”.
*PANDAS=Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infection
**PANS=Pediatric Acute-onset Neuropsychiatric Syndrome
Christopher Gillberg will be one of the speakers at the SANE Sweden 2019 PANS Conference. For more information, please visit the following link!
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More on PANDAS/PANS: https://madisonarealymesupportgroup.com/2018/07/28/stories-of-pandas/
https://madisonarealymesupportgroup.com/2018/10/10/pans-pandas-awareness/
https://madisonarealymesupportgroup.com/2018/08/01/the-3-pans-myths-that-are-ruining-lives/