P 149 Bioethical discussion of the mild encephalitis hypothesis of Schizophrenia

Abstract

Listen

Translate article

Schizophrenia is a serious mental disease with a high mortality rate and severe social consequences. Due to insufficient knowledge about its etiopathogenesis, curative treatments are not available. One of the most promising new research concepts is the Mild Encephalitis Hypothesis of schizophrenia, developed mainly by Karl Bechter and Norbert Müller. According to this hypothesis, a significant subgroup of schizophrenia patients suffer from a chronic, but mild form of encephalitis which can have quite different etiologies ranging from viral infections, traumas to autoimmune diseases. More and more evidence is gathered that in a subgroup of schizophrenia patients, inflammatory processes occur in the beginning or during the course of the disease. We investigate which consequences could be expected if the mild encephalitis hypothesis of schizophrenia was verified and broadly accepted by the scientific community, and evaluate these consequences ethically. If the mild encephalitis hypothesis became broadly accepted, schizophrenia would no longer be considered as an incurable psychiatric disorder with increasing disability and social exclusion but as a chronic, treatable neurological disease. This shift would assumingly have major consequences: (1) Major reforms would be necessary in the theoretical conceptualization of schizophrenia, which would challenge the psychiatric diagnostic systems DSM-5 and ICD-10. (2) Psychotic patients should be treated in interdisciplinary teams, optimally in neuropsychiatric units; additionally, specialists for endocrinology, diabetology and cardiology should be consulted for the frequent somatic morbidities. (3) The diagnostic procedures and (4) therapies would have to be modified significantly. (5) There might be different consequences for the pharmaceutical industry, first because old drugs with expired patent protection (e.g., NAC) could partly replace expensive drugs, second because there would be a demand for the development of new anti-inflammatory drugs. (6) If causal instead of only symptomatic treatments were available, the German Federal Constitutional Court probably would decide in a different way about compulsory drug treatments. Although the acceptance for compulsory treatments might be increased, the number of compulsory treatments would probably be reduced. (7) The stigmatization of patients and their relatives might decrease. For both scientific and ethical reasons, further research on the role of inflammation in the etiology of schizophrenia and further psychiatric disorders is urgently needed. Psychotic patients should be treated by interdisziplinary teams, optimally in neuropsychiatric units. Paired serum-CSF analyses should become standard investigations for all psychotic patients in order to detect or exclude autoimmune encephalitis and to find the best treatment strategy for the individual patient, e.g. anti-inflammatory drugs and immune therapies. Research on both old and new drugs for treating mild encephalitis should be funded by public Riedmüller and Müller, submitted for publication, Müller and Riedmüller, submitted for publication.