The patients told they are depressed or anxious when a simple virus is to blame, By Cara Lee, Daily Mail, 20 January 2015
Ross Buggins, 30, from Norwich, was sent to mental health ward
- Had form of encephalitis – brain inflammation – but had been misdiagnosed
- Condition was only discovered three months after he was sectioned
- Encephalitis symptoms include depression and anxiety
Looking back on last autumn, Ross Buggins can scarcely believe what happened.
Four weeks after developing insomnia, he was suffering from panic attacks and suicidal thoughts. He was then sectioned and sent to a mental health ward for two months.
But he wasn’t mentally ill. Ross, 30, had a form of encephalitis – brain inflammation – caused when his own immune system started attacking a protein in the brain, affecting its function. It’s thought that a simple virus might have kicked his immune system into overdrive.
Yet his condition was only correctly diagnosed last November, three months after he’d been sectioned – despite him showing classic signs of encephalitis, such as memory loss. Worryingly, many experts believe encephalitis, as well as other common neurological disorders such as dementia and even migraines, are often misdiagnosed as mental health problems because their symptoms include depression and anxiety.
‘Dozens of neurological conditions can be missed as purely mental health illnesses,’ says Duncan Banks, a lecturer in biomedical science at the Open University and director of the British Neuroscience Association.
‘These include mini strokes [transient ischaemic attacks], which can change behaviour, for example by making people more impulsive or emotional, depending on the affected part of the brain.’
Last week a study published in the journal Neurology reported that depression, anxiety and irritability can be early signs of Alzheimer’s before the more typical memory loss and confusion appear.
Meanwhile, Parkinson’s can result in depression, anxiety and psychosis.
And many patients suffering headaches are diagnosed with anxiety, panic attacks, depression or fatigue, yet it’s actually migraine that’s likely to be causing these symptoms, says Dr Nick Silver, of the NHS Walton Centre for Neuroscience and Neurosurgery in Liverpool.
‘Migraine can cause a huge variety of symptoms, including low mood, poor sleep and fatigue. Those patients can be given antidepressants, which may not be the appropriate treatment,’ says Dr Silver.
If patients have no mental health symptoms when they are ‘crystal-clear and headache-free’, it may suggest migraine is to blame – whereas depression would cause these symptoms consistently. Around 40 per cent of migraine sufferers find eliminating all painkillers and caffeine and eating and drinking regularly will banish all or most of those associated symptoms.
Meanwhile, antidepressants can actually reduce the quality of sleep, and may worsen migraine. Certain types of epilepsy can lead to confusion and odd behaviour because seizures can damage different parts of the brain, while brain tumours and parasitic diseases such as Lyme disease – a bacterial infection spread to humans by infected ticks – can also cause mental health symptoms, such as low mood and erratic behaviour.
And problems with the parathyroid glands (which control calcium levels) can cause irrational behaviour, because excessively high calcium levels affect the function of the brain and central nervous system.
‘GPs aren’t always aware of different symptoms associated with these conditions, and the easy option is to give patients antidepressants. So they aren’t getting the right treatments,’ says Dr Banks.
This means patients may not be referred to a neurologist, who could make the correct diagnosis, and are instead under the care of a mental health team.
Ross’s problems started last April, when he caught a virus that caused mouth ulcers, sickness, diarrhoea and led to poor sleep. A month later he developed insomnia, rashes on his arms, legs and waist, and his hands and feet started to blister. He saw a GP in June.
‘I thought my body was just struggling to fight off an infection,’ says Ross, an IT consultant who lives with his partner, Emma, 27, in Norwich. His GP took blood, stool and urine samples but the results came back clear. The GP handed him a leaflet on anxiety management.
Ross, who’d otherwise been a fit and healthy young man, then started having panicked thoughts. ‘I’d convince myself I’d die from a heart attack after a run, or a plane would fall out of the sky on to me. I’d never been a worrier before, but I was fixated on irrational fears.’
After having a panic attack and experiencing suicidal thoughts, he was prescribed antidepressants and a sedative, diazepam – his GP also recommended a private therapist as there was a long waiting list on the NHS. Initially, the therapist helped, but shortly after this Ross had a massive panic attack. ‘My head felt as if it was burning and my muscles locked up. I couldn’t breathe properly but was screaming,’ he says.
His parents, who he was visiting at the time, called an ambulance. He had blood tests, a chest X-ray and CT scan in hospital before doctors declared the problem was ‘truly psychological’ and discharged him. ‘I thought I was having a mental breakdown, which felt awful as it was so unlike me,’ says Ross.
He then started having memory problems, forgetting who his relatives were, for example. After another panic attack, he was taken back to hospital. This time mental health services were called and he was given stronger antidepressants. But they had no effect – and weeks later Ross tried to hang himself. ‘I felt life was not worth living. I’m so lucky the belt snapped.’
He was then sectioned and taken to a mental health hospital in Nottingham, roughly 120 miles from his home, because there were no closer beds available.
‘I can’t remember much after this point,’ says Ross. ‘Apparently, I tried escaping, and told people I didn’t need to be there.’ A week later he was transferred to the mental health ward at Hellesdon Hospital in Norwich, where he stayed for seven weeks.
‘In my notes, which months later I asked for, doctors kept noting my lack of memory, but never considered a neurological explanation.’ He was referred to a sleep clinic at Norfolk and Norwich University Hospital for his poor sleep, but then he started falling asleep all the time – even while eating. The sleep expert recognised something else was wrong with him, and urged his doctors at Hellesdon to revisit his case.
A week later his sodium levels plummeted – because the brain regulates sodium, anything affecting the brain can alter levels – and he went into a coma-like state.
He was taken to Norfolk and Norwich University Hospital where he was seen by a neurologist for the first time. Three-and-a-half weeks later in November, after a series of tests, Ross was finally diagnosed with anti-NMDA receptor encephalitis.
This is a rare form of the disease, caused by antibodies produced by the immune system targeting the NMDA protein in the brain. Symptoms include seizures, confusion and problems with cognitive function.
Dr Sarosh Irani, a consultant neurologist and senior research fellow at Oxford University Hospitals, says: ‘Typical forms of psychosis and depression occur over months, while in these auto-immune forms of encephalitis the symptoms can appear over days or weeks.’
Ross was given steroids and intravenous immune globulin (infusions of antibodies from donors). Two days later he became fully conscious for the first time since August. ‘I couldn’t believe it was November. Doctors said inflammation in my brain had affected parts of it controlling memory and emotions, causing my symptoms. It was incredible how normal I felt.’ Five days later he was discharged.
The big issue is the split between psychiatry and other areas of medicine, says Paul Goldsmith, a consultant neurologist at the Royal Victoria Infirmary in Newcastle. ‘It would help if psychiatrists and neurologists had closer working practices, but largely that doesn’t happen.’
Increasingly, patients are being seen not by psychiatrists, but by mental health nurses, psychologists and cognitive behavioural therapists, who may not always be able to recognise these disorders, adds Dr Silver.
Ross has a one in ten chance of relapse, but now knows the signs so he can get treatment quickly. ‘It’s scary that there are probably other people in the mental health system who are not really psychotic and have a physical cause for their symptoms that they aren’t being treated for,’ he says. ‘I’m amazed Emma stood by me through all this – she’s my rock.’
February 22 is World Encephalitis Day
For more information: Encephalitis Society
