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Thus commenced years of trial-and-error therapy, conducted mostly in a psychiatric ward.
Frankovich and her colleague, psychiatrist Margo Thienemann, first prescribed steroids to dial down Paul Michael’s immune response.
At Stanford and elsewhere, the hunt is on for treatment cocktails that quell the inflammation and new strategies to keep a rogue immune system at bay.
Confronting a Mystery Scientists have long known that infection can cause neuropsychiatric disease.
When these symptoms are caused by immune disorders, standard psychiatric therapies that balance neurotransmitters are unlikely to work alone.
Instead, immune therapies are the first line of treatment.
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At 7 years old, Paul Michael Nelson was the kind of quiet, brilliant kid you were likely to find in Silicon Valley — captivated by Legos, self-taught in origami, loving and sweet.
For years, scientists had focused on a single infection — group A streptococcal disease — that produced antibodies that attacked the part of the forebrain involved in forming habits, resulting in OCD.
Today, the paradigm has widened into a much bigger idea that expands our understanding of psychiatric disease: A whole host of infections and other unknown triggers lead to the production of antibodies and immune cells that can cross into the brain.
To boost it back up and keep inflammation down, they added intravenous immunoglobulin, or IVIG, a total immune system-replacement made from the blood of thousands of healthy individuals.
Frankovich hoped the approach would work, but Paul Michael’s brain was potentially damaged, she warned, and it could take years to repair.
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But on March 2, 2009, he woke up in the middle of the night, monstrously changed. He got hold of a knife and stabbed holes through his door. His parents hustled their son to the psychiatrist, leading to an alphabet soup of diagnoses: ADHD (attention deficit hyperactivity disorder), OCD (obsessive-compulsive disorder), ODD (oppositional defiant disorder), bipolar disorder, autism and, ultimately, straight-up psychosis.