Evaluation of Brain-Body Health in Individuals With Common Neuropsychiatric Disorders, 2023, Mosley et al

Evaluation of Brain-Body Health in Individuals With Common Neuropsychiatric Disorders
https://jamanetwork.com/journals/ja...ccessKey=1b2a2eb2-ffa6-4ec1-b702-fc9b8eb4c840
JAMA Psychiatry. Published online April 26, 2023. doi:10.1001/jamapsychiatry.2023.0791

Findings
This multicenter population-based cohort study including 85 748 adults with neuropsychiatric disorders and 87 420 healthy control individuals found that poor body health, particularly of the metabolic, hepatic, and immune systems, was a more marked manifestation of mental illness than brain changes. However, neuroimaging phenotypes enabled differentiation between distinct neuropsychiatric diagnoses.

Results
There were 85 748 participants with preselected neuropsychiatric disorders (36 324 male) and 87 420 healthy control individuals (40 560 male) included in this study. Body health, especially scores indexing metabolic, hepatic, and immune health, deviated from normative reference ranges for all 4 neuropsychiatric disorders studied. Poor body health was a more pronounced illness manifestation compared to brain changes in schizophrenia (AUC for body = 0.81 [95% CI, 0.79-0.82]; AUC for brain = 0.79 [95% CI, 0.79-0.79]), bipolar disorder (AUC for body = 0.67 [95% CI, 0.67-0.68]; AUC for brain = 0.58 [95% CI, 0.57-0.58]), depression (AUC for body = 0.67 [95% CI, 0.67-0.68]; AUC for brain = 0.58 [95% CI, 0.58-0.58]), and anxiety (AUC for body = 0.63 [95% CI, 0.63-0.63]; AUC for brain = 0.57 [95% CI, 0.57-0.58]). However, brain health enabled more accurate differentiation between distinct neuropsychiatric diagnoses than body health (schizophrenia-other: mean AUC for body = 0.70 [95% CI, 0.70-0.71] and mean AUC for brain = 0.79 [95% CI, 0.79-0.80]; bipolar disorder-other: mean AUC for body = 0.60 [95% CI, 0.59-0.60] and mean AUC for brain = 0.65 [95% CI, 0.65-0.65]; depression-other: mean AUC for body = 0.61 [95% CI, 0.60-0.63] and mean AUC for brain = 0.65 [95% CI, 0.65-0.66]; anxiety-other: mean AUC for body = 0.63 [95% CI, 0.62-0.63] and mean AUC for brain = 0.66 [95% CI, 0.65-0.66).

Conclusions and Relevance
In this cross-sectional study, neuropsychiatric disorders shared a substantial and largely overlapping imprint of poor body health. Routinely monitoring body health and integrated physical and mental health care may help reduce the adverse effect of physical comorbidity in people with mental illness.

 

Psychiatry finding the hard way that a human body is an organism, not a bunch of independent organs with a brain-in-a-jar working just the same as one in an actual body.

The main finding seems to be that little of those deviations match any observed changes in the brain, although that may simply be because of how limited the technology is for this.

Oddly enough, on Reddit most of the discussion focused on attributing this to being overweight (I'm not even sure if there's anything about weight in the study) and marveling at how powerful mental illness can be that it can affect the body this way. Somehow. This mindless psychosomatic ideology has really perverted all thinking about overall health.

Everything the brain uses comes from other parts of the body. The so-called "brain-gut axis" can be fully explained by the fact that the gut is the entry point for every single nutrient and molecule the brain will use other than oxygen.

So basically this could mean that in order to make actual progress in mental health may require an actual, for a lack of a better term, whole body medical specialty, trained in overall function and overlaps between the various systems and their dynamics. Which is either very far in the future, or only possible with AI, because this is way too hard for the modern medical profession. Because right now "whole body" medicine means holistic means woo. Foundations made out of the idea of quick sand.

 

Of course, as a cost cutting exercise, it's possible that by the time this hits the medical front lines, this will all be simplified to people who are not fit and 100% health being mentally ill, so treat accordingly, and follow a random mental health pathway, giving essentially random drugs 'to see if that helps'.

 

I haven't read the whole thing but can't imagine that this study was done without the individuals with most of the conditions being on their medications, and certainly they would have been on these for the years before (which tends to be where any differences will take place).

So how on earth are these claims - if they are meaningful much at all, because what does '0.2' on what scale actually mean anyway - not about the treatment rather than the condition, nevermind the person themselves and their body make-up.

And therefore doesn't it say criticism of psychiatry for not understanding better the implications of their treatments, as well as perhaps - as we are clearly seeing for depression being linked to inflammation rather than the SSRI 'brain chemical' - their 'psychiatric' not really being psychiatric but a biomedical issue that affects the whole body and could therefore have been more properly treated that way instead of via the psychiatric focus.

I've always quite felt for those with schizophrenia as I've had gut feelings about the medications there not being as good as they could be if someone thought about the side-effect burden as much as the stopping certain symptoms (behaviour-focus). Really isn't it time that certain medical areas stepped out of their obsession with changing behaviours instead of actual medicine that makes someone healthy, or happy/actually finds out what is the biophysical issue underneath. This presumption that if someone 'acts more normal' the latter happens is nothing more than a weird ideology I never understood where it came from - particularly given what said people define as 'normal' seems to be arbitrary to their culture and upbringings rather than any evidence it is 'health-giving'.

 

I used to be very depressed (with good reason). Every physical ailment I saw doctors about was blamed on my depression, unless what I was complaining about was something that was actually visible. This means that some really serious conditions were ignored, sometimes for years, or misinterpreted as mental health problems.

So the quote is saying that poor body health is a manifestation of mental illness, when really it is a manifestation of doctors assuming that people with mental health problems can't be physically ill and don't deserve to be properly assessed.

 

I've noticed quite a few studies lately about the complexity of the brain: neurons, glia, blood and glyph networks, various chemical and other messaging (I suppose those tiny lipid bubbles are just delivery packaging for chemicals). All that complexity, and much of it highly localized, and without convenient access for study. I expect you could have fairly blatant symptoms from a subtle change in the number of certain molecules on a glial process, or the number of certain molecules in an exosome that travels less than a mm. Of course that won't show up on a simple blood test or even an MRI. Yet a subtle change in a few critical cells could have major cascading effects on the body, which could in turn cause more dysfunction in the brain.

 

I can't claim especial insight but this looks like a solid piece of work to me. As far as I can see there's no patient blaming and the conclusion is that people with mental health conditions are being poorly served by health services. Lifestyle is clearly a mediating factor - high rates of smoking, alcohol and substance abuse are all strongly correlated with a range of mental illnesses, the paper also identifies antipsychotic and other medications as having causal roles, as also are high rates of hepatitis B & C infection.

"Conclusions

In this study, marked deviations from normative reference ranges for brain and body health were evident across multiple organ systems in people with neuropsychiatric disorders in this study. The metabolic, hepatic, and immune systems showed the poorest health and function for the disorders studied. Despite the unequivocal neural basis of common neuropsychiatric disorders, the findings of this study suggest that poor body health and function may be important illness manifestations that require ongoing treatment in patients. Routinely monitoring body health and integrated physical and mental health care in psychiatric practice may provide cost-effective targets for reducing the adverse effect of physical comorbidity in people with mental illness."