Τhe right intervention at the right time - Focusing on the timing of autoimmunity and psychosis initiation

Abstract

Reviewing the clinical and pathophysiological similarities between dysmyelinating diseases and psychosis, we may suggest that the dysconnectivity syndrome of psychosis represents the outcome of a multifaceted dysmyelinating disorder, which is based on a lifelong immunogenetic dysregulation. Issues of ‘timing’ and ‘neuroplasticity’ suggest several considerations for therapeutic interventions. The most important principle that emerges from this developmental issue is: ‘the right intervention, at the right time’. This means that the intervention should ideally be done at the beginning of the autoimmune processes that affect the neurons. Finding appropriate immunological biomarkers would be the most appropriate effort to early intervention and illness modification of mental disorders. Any immunological or anti-inflammatory agent should therefore be administered at a time when psychopathology is not yet evident or has perhaps given minimal signs. Therapeutic trials can range from anti-inflammatory or antioxidant agents to long-term gene expression modification therapies. Also, early intervention in known autoimmune diseases that are closely related to the development of mental illnesses, such as thyroid diseases, is considered to yield the expected results. The ‘temporal dimension’, including items such as time, timing, perception of time and timing of perception, could be an important conceptual, research and therapeutic target for mental illnesses, in the future.