Posted on Wed, 24 Aug 16
A recent report in the New England Journal of Medicine describes a case of adult-onset psychosis, which turned out to be due to celiac disease.
A woman was previously admitted to a psychiatric hospital for adult-onset psychosis for 1-month and placed on medication. At a routine check up 6-months after she was discharged from hospital she was found to have thyroid illness and was was later scheduled for treatment and surgery. After thyroid surgery she was placed on thyroid hormones but was not responding well so the dose was increased. Her psychiatric symptoms were also not improving with the anti-psychotic mediations.
Eventually an endocrinologist noticed symptoms suggestive of celiac disease, in particular signs of malabsorption, her history of thyroid illness and lack of response to medication. Investigations confirmed celiac disease and she was placed on a gluten-free diet which reduced her psychotic symptoms over 3-months, until eventually they disappeared. At this time her celiac disease was in remission and she was later taken of medication with the help of her psychiatrist.
Sadly, she later inadvertently ingested gluten and her symptoms came back. She is no longer following a gluten-free diet because of a delusion that the diagnosis of celiac disease is incorrect.
This is an important case report for health professionals because it demonstrates the importance of considering celiac disease as a possible cause of neuropsychiatric symptoms.
Traditionally celiac disease was thought to be a gastrointestinal condition, however it is now described as “an autoimmune disorder that can affect persons of any age or race and can involve any tissue or organ of the body.” Celiac disease can affect mental health in the absence of traditional gastrointestinal symptoms.
Neuropsychiatric Symptoms Associated with Celiac Disease:
- Loss of short-term memory
- Anxiety and depression
- Chronic headache
- Attention deficit–hyperactivity disorder
Commenting on the case, Dr Alessio Fasano, from Massachusetts General Hospital and Harvard Medical School, said “extraintestinal manifestations of celiac disease may be more common than gastrointestinal manifestations, and physicians should have a low threshold to test patients for IgA tissue transglutaminase antibodies in order to establish a diagnosis of celiac disease.”
Delichatsios HK, Leonard MM, Fasano A, Nosé V. CASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL. Case 14-2016. A 37-Year-Old Woman with Adult-Onset Psychosis. N Engl J Med. 2016 May 12;374(19):1875-83.