Woman awakens after 20 years in catatonic state. The reason may change psychiatry forever.
Julie Hambleton - Wednesday
Woman awakens after 20 years in catatonic state. The reason may change psychiatry forever.© Provided by The Premier Daily
it was in the year 2000 when medical student Sanders Markx first met April Burrell. At that point, April had already been living in a psychiatric institution for nearly six years. Diagnosed with a severe form of schizophrenia at age 21, she was in what the medical world calls a catatonic state. Twenty years later, Markx was now a doctor when he met her again – and managed to save her, pulling her out of that state and back into the real world. Her story can potentially change how we approach and treat psychiatric patients.
The Catatonic State
April’s family describes her as having been an extremely intelligent, curious, and clever child. Even as a young girl she was already balancing her father’s books and was voted valedictorian of her graduating high school class. Outgoing and cheerful, the straight-A student was the definition of an overachiever. She was studying accounting at the University of Maryland Eastern Shore when, one night, her family received a call from her professors. (1)In 1995, when she was 21 years old, April had experienced a traumatizing event. In order to protect her privacy, the details of this event are not being shared. This event suddenly brought on a state of psychosis. Almost overnight, she went from being a top student to being unable to communicate, bathe, or take care of herself in any way. (2)
Her devastated family did their best but quickly realized they were ill-equipped to care for her. They moved her to the Pilgrim Psychiatric Center for Long-Term care, where she would live for nearly two decades. The family visited as often as they could, despite that April could not interact with them or recognize them in any way. They had all but lost hope that their daughter, sister, and friend would ever be “returned” to them.
The Re-encounter
As already mentioned, Dr. Markx first met April in the year 2000 when he did a stint at Pilgrim as a medical student. The son of two psychiatrists, Markx spent much time in his childhood around psychiatric patients, therefore, he wasn’t afraid of them the way many people often are. He decided to study to become a psychiatrist himself.Of course, when he first met April as a student, he was unable to help her. Two decades later, however, their paths crossed again. He suggested that one of his lab fellows go and spend some time at Pilgrim as he had all those years before. When the student came back, he spoke to Dr. Markx about the woman he saw there, who just seemed to stare.
He immediately knew he had to help. With the family’s consent, he ordered a full medical work-up. Right away, in her bloodwork, he noticed that her immune system was producing an incredibly high amount of antibodies. These were attacking her body and, most importantly, her brain. They could see evidence in her brain scan that these were attacking her temporal lobes, which are implicated in schizophrenia and psychosis.
The Real Cause
He believed the underlying cause of her trouble was Lupus. This is an autoimmune disorder in which the immune system turns on its own body, producing many antibodies that attack the skin, joints, kidneys or other organs. In April’s case, however, the disease seemed to only be affecting her brain. With his team, they began an intensive immunotherapy treatment for neuropsychiatric lupus.The Awakening
The treatment is not easy and requires the patient to take a month-long break between each of the six rounds. This is to allow the immune system to recover. Thankfully, April showed signs of improvement almost immediately. Using the Montreal Cognitive Assessment, they asked her to draw a clock. Pre-treatment she was able to only draw what were essentially scribbles. By the second round, she could draw a half-clock. After the third round, she could draw a nearly perfect clock.Still, however, she was unable to communicate. Some members of the team wanted to return her to Pilgrim. Needing to fly home to his home country of The Netherlands, Markx was worried that they might take her back in his absence. On the day he was to fly home, he went to check on his patient before going to the airport. When he walked in, he didn’t recognize April. It was as if an entirely different person was in there. It was if she had suddenly just woken up.
Family Reunion
Her family, of course, was overjoyed. They got their daughter, sister, aunt, and cousin back – something they never thought that they would achieve. She moved to a rehabilitation center, eventually reuniting with her family.A bit frail and timid at first, she recognized all of her family members, even her now-adult niece. She was hugging her family and laughing, something that they had been able to do with her in 20 years.
The Implications
Burrell’s case can potentially change how we approach and treat psychiatric patients. It is possible that some cases of catatonia may be caused by autoimmune diseases that affect the brain. If this is the case, then treatments that target the immune system may be effective in treating these patients.After bringing back April, the medical team called the hospital system to identify more patients with the same antibody markers that she had. A few months later, Anca Askanase, a rheumatologist and director of the Columbia Lupus Center, who had been on April's treatment team, found another similar patient. This patient was now 19-year-old Devine Cruz, who had been in her psychotic state for 10 years. They treated her as they had April, and sure enough, they also brought Devine back.
April and Devine’s stories were integral in the development of the SNF Center for Precision Psychiatry and Mental Health at Columbia. There, Markx has begun treating about 40 patients. The medical team’s goal is to develop new treatments based on specific genetic and autoimmune causes of psychiatric illness. These are incredible breakthroughs that have the potential to change the way we look at and treat mental illness.
Source:https://www.msn.com/en-us/health/me...son-may-change-psychiatry-forever/ar-AA1cdeIv
