The review highlights five infectious diseases linked to mental illness: toxoplasmosis, COVID-19, Lyme borreliosis, and streptococcal infections/PANDAS/PANS. It emphasizes the significant role of indirect infection mechanisms, such as inflammation, neuroinflammation, autoimmunity, and neurophysiological changes, in the development and progression of some mental illnesses. The persistence of these processes can lead to chronic effects on brain structure and function. Recognizing the microbial impact on mental health is crucial, and understanding this association may lead to increased use of antimicrobial and immune-modulating agents in psychiatric treatment, preventing and reducing mental illness morbidity, disability, and mortality. Clinicians must consider infectious diseases in explaining mental health symptoms, especially in cases of treatment-resistant conditions.
Treatment approaches must be individualized and often involve a multidisciplinary strategy to include three fundamental areas: addressing infections or contributors, implementing immune interventions, and managing resulting symptoms. Intervention choices depend on understanding the disease process, the interplay of disease contributors, and the primary driver of disease perpetuation and progression. Consider antimicrobials in cases of inadequate psychotropic response and potential infection. Immune-modulating interventions may be necessary for immune-mediated symptoms from active or prior infections or non-infection immune provocation. Factors like immune suppression, excessive inflammation, autoimmunity, and adaptive immunity failure influence immune intervention choices. Non-infection environmental factors, including toxin exposure, should be considered and minimized. For relapses, revisit effective past treatments; treatment-resistant cases may require exploring unused options. Regular treatment revisions are essential, guided by symptom improvement or disease changes. Ongoing assessment is crucial, recognizing that the initial cause may differ from what perpetuates the condition, leading to necessary treatment approach adjustments.
