Towards a breakthrough in the understanding of serious mental disorders, and especially psychosis,

from Jan Olav Johannesen in the ISPS newsletter December 2016

The enigma of psychotic disorders and their "causes" is nearer to being solved, or at least, understood. ISPS builds on a dimensional understanding of mental disorders and psychosis, i.e. that these disorders develop in stages, and that there are no such things as mental "illnesses", within the functional, non-neurological, part of what we usually deal with in psychiatry. This view is also the very rationale for the idea of early intervention in mental disorders, and not only in the psychosis-spectrum disorders, but in all disorders across diagnostic categories. The early intervention research has clearly demonstrated the very favorable effects of intervening earlier in the course of mental disorders, and clearly shown that the prognosis improves if you are able to detect and treat these disorders in the early stages. It has also now been shown for a fact that it is possible to prevent people at risk for developing psychosis, from developing a psychotic condition.

The research on early intervention has now brought us even further in the understanding of how, and why, mental disorders develop, and why this apparently progressive development is preventable.

Environmental stress has for long now been demonstrated to play a crucial role in the development, and causation, of mental disorders. This stress is mediated in our bodies through the so-called "stress-axis" the HPA-axis (a hormonal messenger system). The external stress is translated into hormones, which in their turn activate heart-rates, blood-pressure, sweating, muscle-tension, etc. It has now been demonstrated that this external stress, via this stress-axis, also activates the dopamine-production in our brain. Dopamin and glutamate is part of the "messenger-system" in our brain. The brain apparently starts producing "excess" dopamine and glutamate (and you all know that the antipsychotic drugs ameliorate this overproduction of dopamine. Until this time we have not understood how they work).

So, what is the really hot news? Yes, we finally now know that this overproduction activates the body's immune system within the brain. Until now we had thought that the immune system didn't transcend the blood-brain barrier. However, what we see is what we call an autoimmune reaction, i.e. the immune system within the brain "attacks" this overproduction of messenger-compounds within the "production sites".

Research has now suggested that this autoimmune reaction, and the damage it causes, is reversible in "at risk for psychosis" states, in first-episode psychosis, but that in long-standing (more chronic) psychotic states it seems to become less reversible. Just when this turns into something less reversible is not known, and we have many stories from patients that this apparently irreversible condition is not so. Recovery seems to be possible, always.

And, what is just as important is that the reactivity in the "stress-axis" is different from person to person, depending on the stress we have experienced throughout pregnancy and our early years, i.e. that the so-called "adverse life events (A.L.E.)" in early childhood play a crucial role in the development of later mental difficulties, through a in some aspects, hyper-reactive stress-system. Serious traumas like abuse, neglect, violence, drug-abuse etc. are of course the most important ALEs, and determinants for the hyper-reactivity.

So, we have finally managed to establish the connection between external stress in adolescence and adulthood, with stress in early years, and the physical mirroring of these stressors in our bodies and our brain.

And in other words, this makes the case for trauma-prevention, and the possible prevention of psychosis through early intervention even stronger.

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