Mary Had Schizophrenia—Then Suddenly She Didn’t

Schizophrenia is not a single disease, it is a very consuming one, taking up large numbers of both medical resources, research, and of course, millions of shattered lives. In the April 25, 2025 New Yorker, Rachel Aviv (Mary Had Schizophrenia—Then Suddenly She Didn’t) follows the trajectory of a woman with a 20 year history of mental illnesses, who is finally “cured” of her delusions when she undergoes chemotherapy with rituximab, a medication that targets antibodies involved in the body’s immune response. Over the course of a few months, she is returned to her family and was facing a long plan to restore her shattered health.
Aviv also cites research done in Spain in 2007 on patients with

“delusions, hallucinations, and sudden changes in their behavior, like agitation and inappropriate giggling. Within days or weeks, they deteriorated, developing seizures, losing consciousness, or struggling to breathe. Dalmau discovered that they had a form of encephalitis, inflammation of the brain. Their immune systems had misidentified the NMDA receptor—a protein in the brain that affects mood and memory—as foreign and produced antibodies that attacked it. When these patients were treated with immunotherapy, the majority of them recovered completely, sometimes within a month.”

The essay mentions other studies, one where the catatonic patient were discovered to have lupis and the autoimmune therapies were able to restore them to consciousness.
Aviv is clear that the percentage of those thought to have an immunological caused psychosis is very low, estimated to be around 1% of the cases diagnosed.

Bartley estimates that between one and five per cent of people who have been diagnosed with schizophrenia actually have an autoimmune condition—a figure he based on his own lab’s research, which has not yet been published, and also on a German study of a thousand patients, the most extensive study of autoimmune psychosis so far. “Even one per cent ends up being almost a million people in the world who should be treated with a different kind of medicine,” he said.

I found the essay to be well written and though provoking. If this branch of research broadens, it could help so many people.

the Stavros Niarchos Foundation (S.N.F.) Center for Precision Psychiatry and Mental Health, at Columbia, which is working to uncover biologically distinct subtypes of illness that have been obscured by the broad categories in the DSM.

A search for autoimmune schizophrenia returned a long list to select from, here are two:
https://www.kcl.ac.uk/archive/news/…-autoimmune-disorders-and-psychosis-confirmed
https://www.the-scientist.com/is-the-immune-system-to-blame-for-schizophrenia-69871

In all cases, more research is needed.