OpenHealth Q&A

Exploring Potential Autoimmune Causes for Unexplained Psychiatric and Neurological Symptoms in a 31-Year-Old Male

**Age and gender:** 31, Male **My diagnoses:** I have been diagnosed with Type 1 bipolar disorder, which began when I was 13 and confirmed at 17 years old. Additionally, there’s an enigmatic condition that emerged at 24, causing a plethora of psychiatric and neurological manifestations, many of which are challenging to articulate. This condition shows no response to over 30 psychiatric and epilepsy medications I've attempted, resulting in ongoing struggles with my health. **Current medications:** I am prescribed 450mg of Extended Release Lithium Carbonate every 12 hours, alongside 10mg of Abilify once daily for managing my bipolar disorder. My lithium levels are at 0.5, which is considered on the lower side, although the Abilify seems to enhance its effects. **Non-prescription supplements:** I take 360mg of Omega-3 Fatty acids twice daily to support my brain and cardiovascular well-being, along with 1000 IU of vitamin D3 every 12 hours to address a mild deficiency. **Family medical history:** My maternal lineage includes several autoimmune challenges; my mother and one of her first cousins are both affected by rheumatoid arthritis. Another cousin had an undiagnosed autoimmune condition, and her brother suffered from encephalitis. My aunt has been diagnosed with psoriatic arthritis along with psoriasis, and her daughter has scleroderma. I once experienced mild psoriasis, localized on my elbows, but it resolved without treatment. My mother is on long-term Prednisone therapy due to severe rheumatoid arthritis starting at age 35, and she experiences significant exacerbation of her symptoms if she weans off the medication. My paternal grandfather also has a history of Type 1 bipolar disorder. Interestingly, I’ve noticed that Lithium treatment causes dandruff, with the Immediate Release form seemingly producing more severe symptoms than the Extended Release version at the same dosage, raising questions about any connection to my previous psoriasis. **Background:** At age 24, while navigating the Washington D.C. metro, I encountered a bizarre episode characterized by symptoms reminiscent of schizophrenia — such as hallucinations involving faces emerging from ads — along with signs akin to Parkinson's disease, including cramped, tiny handwriting and a rigid expression. This episode was quite alarming. Over time, symptoms alternated between intensifying and subsiding repeatedly. I have experienced a wide array of psychiatric and neurological symptoms over these seven years, yet nothing has fully alleviated my distress. Despite trying over 30 different medications, spanning various classes — including antipsychotics, epilepsy treatments that double as mood stabilizers, and a handful of antidepressants — there has been negligible improvement. Episodes of symptoms persist without any sustained remission, merely cycling through phases of worsening and temporary relief. Given my extensive family history of autoimmune diseases along with the cyclical nature of my symptoms, I am beginning to suspect an autoimmune origin behind my condition. **Request for guidance:** What steps should I take next? Is it advisable for me to consult a rheumatologist, potentially one at a research institution? Would they conduct necessary tests or consider immunosuppressive therapy to see if it could enhance my mysterious condition? Alternatively, could a neurologist assist with this, or should I primarily seek rheumatological expertise? My past evaluations by psychiatrists and neurologists, including EEGs and MRI scans, have revealed only minor abnormalities, such as slight hippocampal asymmetry, leaving me searching for answers. Any recommendations would be greatly appreciated.

Answers (1)

9/7/2025, 1:40:50 PM

OpenHealth AI

It's understandable that you're feeling overwhelmed by your symptoms and the lack of clarity regarding your health condition. Given your complex medical history, the extensive family history of autoimmune diseases, and the cyclical nature of your psychiatric and neurological symptoms, exploring potential autoimmune causes is a logical next step.

Explanation

Your symptoms and family background suggest there may be an underlying autoimmune disorder contributing to your distress. Autoimmune diseases can sometimes present with psychiatric and neurological issues, mimicking or exacerbating existing mental health conditions. Furthermore, your experience with medications not providing relief, combined with historical episodes of significant symptoms, raises the importance of a thorough evaluation by specialists.

Next Steps

1. Consult a Rheumatologist: Given your family history and your concerns about autoimmune conditions, connecting with a rheumatologist is a key priority. They can evaluate your symptoms through a detailed physical examination and specific blood tests to check for autoimmune markers (like ANA, rheumatoid factor, or others), which can help identify any underlying conditions.

2. Document Your Symptoms: Maintain a detailed diary of your symptoms, noting when they occur, their severity, and any potential triggers. This information will be valuable for any specialist you see and can help in diagnosing your condition more accurately.

3. Consider a Neurologist's Input: Since you have experienced significant neurological symptoms, a consultation with a neurologist can also be beneficial. They can offer insights into whether your symptoms might be neurological in nature and may suggest additional imaging or tests.

4. Addressing Current Medications: Discuss with your healthcare providers the potential impact of your current medications (like lithium) on your skin and any connection to your previous psoriasis. There may be options to adjust your treatment plan that could alleviate symptoms like dandruff while still managing your bipolar disorder effectively.

5. Explore Immunosuppressive Therapy: Depending on the outcome of rheumatological evaluations, the specialist may discuss the possibility of immunosuppressive therapy if an autoimmune condition is diagnosed. This would be based on a careful assessment and not something to pursue without specialist guidance.

In Summary

Taking the proactive step to consult a rheumatologist while continuing to track your symptoms could bring you closer to understanding the potential autoimmune elements that may be at play in your health challenges. Gathering comprehensive information and collaborating with specialists will provide a more structured pathway toward better managing your condition. Let me know if I can assist you further!