Autoimmune Disorders That Can Resemble Schizophrenia

Psychiatric illness is not always what it seems. In psychoneuroendocrinology, we study the complex ways in which hormones, the immune system, and brain function interact to produce psychiatric symptoms. Conditions that at first glance resemble schizophrenia or bipolar disorder may in fact be driven by autoimmune or endocrine disturbances. For example, inflammation directed against brain receptors or antibodies related to thyroid disease can cause sudden psychosis, confusion, or catatonia. These illnesses often respond poorly to conventional antipsychotic medications but may improve dramatically with immune-based or endocrine-directed treatments. As an endocrine psychiatrist, I approach each case with the awareness that psychiatric symptoms may reflect deeper biological processes. Careful history-taking and targeted testing are essential before committing a patient to long-term conventional psychiatric treatment.

The most recognized of these conditions is autoimmune encephalitis (AE), where the immune system mistakenly attacks brain receptors such as the NMDA receptor. People may develop hallucinations, paranoia, mood swings, memory loss, seizures, or catatonia. Because psychiatric symptoms can dominate early, AE is often misdiagnosed as a primary mental disorder. Unlike schizophrenia, however, AE frequently improves with immune-based treatments such as steroids, IV infusions, or antibody-targeted therapies.