Co-managing with young people and families immunotherapy for atypical major mood or psychotic disorders

Over the last decade there has been an increasing recognition that a proportion of young people with atypical major mood or psychotic disorders may actually be experiencing very unusual syndromes that are underpinned by an overactive immune system attacking their brain. This has led to the exploration of whether various rather non-specific immunosuppressive therapies or more targeted new immune therapies may be a better treatment approach than conventional antidepressant or antipsychotic medications.

However, these new approaches are not without their risks to the short and longer-term health of the young person involved. This is particularly challenging as usually there are no definitive laboratory tests or brain scans to be certain that the cause of the syndrome is a dysregulated immune system.

The journey to obtain a reasonably certain diagnosis is often a complex one, relying on very close co-operation and trust between the young person affected, their family members and the various psychiatrists, immunologists and neurologists who often lead the treatment team. Our team in Sydney has developed a clinical approach to diagnosis and ongoing treatment that relies on:

i) very close clinical partnerships between the treating team and the young person and their family;

ii) a willingness to discuss openly what is known and not known; and,

iii) an open and transparent approach to describing potential risks and benefits of going down this unconventional treatment path.

Over 40 young people have now been down this collaborative path, with some remarkably positive outcomes in situations that were really life-threatening. However, the ongoing personal and clinical issues are challenging, and a positive approach to working collaboratively is essential for this field to continue to grow and provide real benefits to a much wider group of young people. 


Co-managing with young people and families immunotherapy for atypical major mood or psychotic disorders

Young people with common mood disorders face the prospect of shortened life expectancy largely due to premature cardiovascular disease. Metabolic dysfunction is a risk factor for premature cardiovascular disease. There is an ongoing debate whether metabolic dysfunction can be simply explained by weight gain secondary to psychotropic medications or whether shared genetic vulnerability, intrinsic immune-metabolic disturbances or other system perturbations (e.g. dysregulated sympathetic nervous system, circadian dysfunction) are more relevant determinants of premature cardiovascular disease. This work found that in addition to BMI, other non-specific markers of inflammation are associated with early metabolic dysfunction in young people with emerging affective and major mood disorders.

Identifying pathways to early-onset metabolic dysfunction, insulin resistance and inflammation in young adult inpatients with emerging affective and major mood disorders

This study aims to track the early period of mental disorders among young people presenting to Australian mental health services to facilitate more streamlined transdiagnostic processes, highly personalised and measurement-based care, secondary prevention and enhanced long-term outcomes. The data will be used to: (1) determine prospectively the course of multidimensional functional outcomes, based on the differential impact of demographics, medication, psychological interventions and other key potentially modifiable moderator variables and (2) map pathophysiological mechanisms and clinical illness trajectories to determine transition rates of young people to more severe illness forms.


Immunotherapy Overview

Understanding immune system related psychotic and mood disorders

Immunotherapy Case Study

Immune system related psychotic and mood disorders