
Karl BechterUlm University | UULM · Clinic of Psychiatry and Psychotherapy II (Günzburg)
Karl Bechter
Prof. Dr.
About
185
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Introduction
Mild Encephalitis hypothesis proposed (Bechter 2001, NPBR) and updated (Bechter 2013 ,Progr NP&BP) of severe mental disorders: Autoimmune psychosis. Psychoimmunology . Organisation of meetings in psychoimmunology.
Additional affiliations
October 1979 - March 2014
part of Clinic Psychiatry and Psychotherapy II,Universität Ulm,
Position
- Head of Department
Publications
Publications (185)
Virus-associated chronic inflammation may contribute to autoimmunity in a number of diseases. In the brain, autoimmune encephalitis appears related to fluctuating reactivation states of neurotropic viruses. In addition, viral miRNAs and proteins can be transmitted via exosomes, which constitute novel but highly relevant mediators of cellular commun...
The etiology of severe mental illnesses (SMIs) of the schizophrenic and affective spectra still appears to be rather obscure. However, a small, emerging subgroup can now be diagnosed as autoimmune psychoses (AP), often presenting as schizophrenia-like psychosis, and can be successfully treated with various immune-modulatory treatments. These recent...
The Pula Psychopathology Summer School (PPSS) at the yearly Pula Neuropsychiatric Congresses (INPC), now named Mind&Brain Congress (M&BC), overviews the years from 2012 to 2022, one congress missed due to COVID pandemic in 2020. The themes treated cover a broad range of psychological and biological factors and especially their interaction, by consi...
Obsessive-compulsive disorder (OCD) is a highly disabling mental illness that can be divided into frequent primary and rarer organic secondary forms. Its association with secondary autoimmune triggers was introduced through the discovery of Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infection (PANDAS) and Pediatric...
Zusammenfassung
Gerd Huber (1921–2012) war ein bedeutender westdeutscher Psychiater und Neurologe der Nachkriegszeit. Vor allem seine Studien mit bildgebenden Verfahren zur Frage der Hirnatrophie, zum Langzeitverlauf und zu den Basissymptomen der schizophrenen Erkrankungen leisteten einen wesentlichen Beitrag zur Erforschung der Schizophrenie und w...
Introduction
The mild encephalitis (ME) hypothesis of severe mental disorders, ME to be caused by infections, autoimmunity , toxicity and trauma ( Bechter 2001, updated Bechter 2013), is now emergingly supported from neuroimaging and CSF and postmorten findings.
Objectives
Review about the present status of ME hypothesis and autoimmune psychosis a...
Introduction
The mild encephalitis hypothesis(ME) ( Bechter 2001, NPBR; updated Bechter 2013,Progr NP&BP) proposed that mild neuroinflammation triggered by infections, autoimmunity, trauma or toxicity (including from stress) might causally underly a spectrum of severe mental disorders (SMDs), especially disorders of the schizophrenic and affective...
Affective (AF) and Schizophrenic (SZ) Spectrum disorders manifest with risk factors, involving inflammatory processes linked to infections and autoimmunity. This study searched for novel biomarkers in cerebrospinal fluid (CSF) and peripheral blood. A total of 29 AF and 39 SZ patients with treatment-resistant disease were included. In CSF, the chemo...
Encephalitis has an estimated prevalence of ≤0.01%. Even with extensive diagnostic work-up, an infectious etiology is identified or suspected in <50% of cases, suggesting a role for etiologically unclear, noninfectious processes. Mild encephalitis runs frequently unnoticed, despite slight neuroinflammation detectable postmortem in many neuropsychia...
A dysfunction of the glutamatergic transmission, especially of the NMDA receptor (NMDAR), constitutes one of the main biological substrate of psychotic disorders, such as schizophrenia. The NMDAR signaling hypofunction, through genetic and/or environmental insults, would cause a neurodevelopmental myriad of molecular, cellular, and network alterati...
Immune-pathological and autoimmune mechanisms are involved in the pathophysiology of severe mental disorders (SMDs). Many risk factors contribute to the development of disease. Clinical nomenclature is still emerging, which should focus on the observed clinical syndromes and the most relevant pathomechanisms for onset and/or progress of disease. Au...
Immunological explanatory approaches are becoming increasingly important in schizophrenia research. In this context, the function of the blood-brain barrier (BBB) and the blood-cerebrospinal fluid (CSF) barrier (BCSFB) plays an essential role. Different adhesion molecules, such as intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesio...
The encephalitis lethargica (EL) epidemic swept the world between 1916 and 1926 and is estimated to have afflicted between 80,000 to one million people worldwide. EL is an unusual neurological illness that causes profound sleep disorders, devastating neurological sequalae and, in many cases, death. Though uncommon, EL is still occasionally diagnose...
Introduction
Immunological explanatory approaches are becoming increasingly important in schizophrenia research. In this context, the function of the blood–brain barrier (BBB) and the blood–cerebrospinal fluid (CSF) barrier (BCSFB) play an essential role. Different adhesion molecules, such as intercellular adhesion molecule-1 (ICAM-1) and vascular...
Background
The importance of cerebrospinal fluid (CSF) diagnostics for psychiatry is growing. The CSF/blood albumin quotient (QAlb) is considered to be a measure of the blood–CSF barrier function. Recently, systematically higher QAlb in males than in females was described in neurological patients. The aim of this study was to investigate whether a...
Primary schizophreniform psychoses are thought to be caused by complex gene–environment interactions. Secondary forms are based on a clearly identifiable organic cause, in terms of either an etiological or a relevant pathogenetic factor. The secondary or “symptomatic” forms of psychosis have reentered the focus stimulated by the discovery of autoan...
Introduction: Secondary schizophrenia spectrum disorders (SSDs) have clearly identifiable causes. The Department for Psychiatry and Psychotherapy at the University Hospital Freiburg has continued to expand its screening practices to clarify the organic causes of SSDs. This retrospective analysis was carried out to analyze whether a comprehensive or...
Background:
Autoimmune encephalitis (AE) is an important consideration during the diagnostic work-up of secondary mental disorders. Indeed, isolated psychiatric syndromes have been described in case reports of patients with underlying AE. Therefore, the authors performed a systematic literature review of published cases with AE that have predomina...
Recent psychoneuroimmunology research has provided new insight into the etiology and pathogenesis of severe mental disorders (SMDs). The mild encephalitis (ME) hypothesis was developed with the example of human Borna disease virus infection years ago and proposed, that a subgroup SMD patients, mainly from the broad schizophrenic and affective spect...
A historical and personal perspective is presented from research on the involvement of Bornavirus infection into the etiology of neurological and psychiatric disorders and the road to propose the Mild Encephalitis (ME) hypothesis of severe mental disorders, including a supportive role of Pula congresses herein. ME hypothesis was initially criticize...
There is increasing recognition in the neurological and psychiatric literature of patients with so-called isolated psychotic presentations (ie, with no, or minimal, neurological features) who have tested positive for neuronal autoantibodies (principally N-methyl-D-aspartate receptor antibodies) and who have responded to immunotherapies. Although th...
Im Kontext der sekundären, organisch bedingten schizophreniformen Psychosen spielen Autoantikörper (AK)-assoziierte Autoimmunenzephalitiden (AEs) eine zunehmend wichtige Rolle. Bei entsprechendem Verdacht wird eine organische Diagnostik inklusive Labor, MRT, EEG und Liquordiagnostik empfohlen. Die AK-Testung sollte zunächst ein Screening für die hä...
Primär psychotische Störungen aus dem schizophrenen Formenkreis sind nach heutigem Verständnis Erkrankungen, die durch eine komplexe Interaktion zwischen Genen und Umwelt bedingt sind. Sekundären psychotischen Störungen liegt eine zumindest mit Wahrscheinlichkeit benennbare organische Ursache im Sinne einer Erstverursachung (Ätiologie) oder einer b...
Background: Psychoneuroimmunology research has presented emerging evidence of the involvement of inflammatory and immune mechanisms in the pathogenesis of severe mental disorders. In this context, new terms with increasing clinical relevance have been proposed, challenging the existing terms, and requiring consensus definitions of the new ones.
Met...
This chapter aims to provide an overview of the burgeoning field of psychoneuroimmunology as it relates to psychiatric and neuropsychiatric disorders. It is a relatively young field, having come of age only recently, but the progress that has been made just in the past three decades has exceeded all expectations. It is fair to say that the field ha...
Since somatic or somatosensory tinnitus (ST) was first described as a subtype of subjective tinnitus, where altered somatosensory afference from the cervical spine or temporomandibular area causes or changes a patient’s tinnitus perception, several studies in humans and animals have provided a neurophysiological explanation for this type of tinnitu...
Growing data point to the overlap between psychosis and pathological processes associated with immunological dysregulation as well as inflammation. Notably, the recent discovery of antibodies against synaptic and neuronal cell membrane proteins such as anti-N-methyl-D-aspartate receptor provides more direct evidence of the etiological connection be...
We observed a case over 25 years of relapsing–remitting schizophrenic spectrum disorder, varying regarding the main symptomatology between more depressive or more schizoaffective or rather typical schizophrenic syndrome. Diseased phases were repeatedly accompanied by minor skin lesions, which were initially classified as mixed tissue disorder. Psyc...
The mild neuroinflammation hypothesis of schizophrenia was introduced by Bechter in 2001. It has been hypothesized that a hypofunction of glutamatergic signaling via N-methyl-D-aspartate receptors (NMDARs) and hyperactivation of dopamine D2 receptors play a role in schizophrenia. The triplet puzzle theory states that sets of triplet amino acid homo...
There is wide variability in how psychiatry guidelines and textbooks address the question of cerebrospinal fluid (CSF) diagnostics in the screening of psychiatric disorders. A United States-based textbook confirms that there is no consensus about which laboratory investigation should be routinely performed in psychiatric patients, but with respect...
Introduction: In today's psychiatry only a minority of psychiatry inpatients with severe mental illness (SMI) undergo CSF diagnostics. Autoimmune encephalitis and mild encephalitis: There is increasing evidence that refined differential diagnosis is advantageous for a subgroup of patients before beginning psychopharmacological treatment. In any cli...
The Bezirkskrankenhaus (BKH) Günzburg was founded in 1915 as a state hospital for psychiatry in Bavaria/Germany. The psychiatric state hospitals were typically situated in rural areas outside big cities. In the 1970s a movement of country wide psychiatry reform was going on involving the state hospitals with their large numbers of severely ill psyc...
Introduction
Cervicogenic tinnitus is not a generally accepted pathogenetic subtype, which might be subsumed under the concept of somatosensory tinnitus. After the personal experience of therapy-resistant tinnitus in context with a cervical pain syndrome (CPS) and successful add-on treatment with cervical collar (CC), the idea was pursued in severa...
Two major types of intercellular communication are found in the central nervous system (CNS), namely wiring transmission (point-to-point communication, the prototype being synaptic transmission with axons and terminals) and volume transmission (VT; communication in the extracellular fluid and in the cerebrospinal fluid (CSF)) involving large number...
The psychopharmacological treatment of therapy-resistant symptoms of schizophrenia is a great challenge for psychiatrists, because this problem is usually approached with a pragmatic and polypharmaceutical medical treatment, for which evidence is lacking. There is some evidence that the combination of olanzapine and aripiprazole has advantages rega...
Despite a not insignificant number of anatomical and experimental studies describing the distribution and movement of the cerebrospinal fluid several questions were answered controversially, leaving room for objections and doubts. Some of these controversies I have tried to address by new experiments. Before going on to describe these studies, some...
Objective
Infections and autoimmune disorders additively increase the risk of severe mental illness, even in time relationship to respective insults. The pathogenicity of infections varies by age, which fits for various infections with preferred age of onset of psychosis. The mild encephalitis (ME) hypothesis proposed a prevailing low level neuroin...
Introduction: The mild encephalitis (ME) hypothesis addresses a separate category of clinically meaningful CNS inflammation of a lower degree compared to classical encephalitis (CE), patients presenting with predominant psychiatric symptoms. Inflammation is a dimensional entity over time and space within various bodily compartments or tissues, trig...
CSF outflow through the cribriform plate near the olfactory nerves and the outflow along brain and spinal nerves are together known as peripheral CSF outflow pathway (PCOP). It is still not clear whether the PCOP has pathogenetic relevance. Our previous clinical observations have indicated that CSF may interact with nerves along the PCOP and in thi...
Fragestellung: Haben Patienten mit Schizophrenie ein erhöhtes Risiko an Autoimmunerkrankungen zu erkranken und welchen Effekt haben Infektionen?Hintergrund: Vorhergehende Studien zeigten ein erhöhtes Schizophrenierisiko bei Personen mit Autoimmunerkrankungen. In dieser Studie wurde die umgekehrte Reihenfolge untersucht.Patienten und Methodik: Im Dä...
Quincke in 1872 demonstrated that CSF is flowing out from the subarachnoid spaces along spinal nerves into peripheral tissues. CSF outflow through the cribriform plate near olfactory nerves was extensively demonstrated whereas poorly investigated along brain nerves and rarely along spinal nerves. From clinical observations it was hypothesized, that...
Fragestellung: Erhöht ein Schädel-Hirn-Trauma das Risiko einer psychiatrischen Erkrankung?Hintergrund: Bisherige Studien zu dieser Fragestellung waren methodisch nicht ausgereift und zeigten widersprüchliche Ergebnisse.Patienten und Methodik: Die Autoren untersuchten die Inzidenz schwerer psychiatrischer Erkrankungen im Nationalen Dänischen populat...
In April 2013, Gisela Gross, honorary editor and long-standing board member of NPBR (the previous Zentralblatt Neurologie/ Psychiatrie), passed away, exactly one year after the death of her close scientific and personal companion and husband Gerd Huber. Their both lives became connected when cand-med Gisela Gross in 1960 began her scientific work,...
Nach lege artis durchgeführter Antibiotikabehandlung bei Lyme Borreliose (LB) berichtet ein Teil der Patienten über persistierende Symptome, die als Post-Treatment Lyme Disease Syndrome (PTLDS) bezeichnet werden.
Fragestellung: Nach lege artis durchgeführter Antibiotikabehandlung bei Lyme Borreliose (LB) berichtet ein Teil der Patienten persistierende Symptome, die als Post-Treatment Lyme Disease Syndrome (PTLDS) bezeichnet werden. Wie häufig ist dies?Patienten und Methodik: In einer prospektiven Kohortenstudie wurden 63 Teilnehmer mit neu aufgetretenem Ery...
The Mild Encephalitis (ME) hypothesis describes a subgroup of low level neuroinflammation (LLNI) associated psychiatric disorders, LLNI representing the core of the underlying pathophysiology (Bechter, 2001). A model for ME was infections with the highly neurotropic Borna Disease Virus (BDV). In general, various infections have the potential to ind...
Many psychiatric patients have a minor blood-CSF barrier dysfunction and increased Cerebrospinal fluid (CSF) neopterin concentrations. The source of normal CSF neopterin, a biomarker in inflammatory and non-inflammatory neurological diseases, has never been shown explicitly, a precondition for sensitive detection of pathologically increased CSF neo...
Mild encephalitis (ME) hypothesis suggested a usually smouldering in any case low level inflammatory process in the CNS resulting in a variety of psychopathological symptoms: indeed increased proinflammatory markers like cytokines have been described in blood and CSF in patients suffering from affective or schizophrenic disorders. Animal models sho...
Fragestellung: Übersichtsarbeit zu Fehlannahmen in der Diagnostik und Behandlung von Borreliose-Erkrankungen.Methodik: Mit Bezug auf die Bedenken des Institute of Medicine über stark unterschiedliche Ansichten zum oben genannten Thema [1] werden in diesem Artikel eine kritische Übersicht über die hauptsächlichen Fehlannahmen gegeben, die Ursachen d...
The mild encephalitis (ME) hypothesis describes a subgroup of severe psychiatric disorders, with a focus on a subgroup of schizophrenias, in which low-level neuroinflammation (LLNI) represents the core in pathogenesis. LLNI is increasingly recognised in experimental neuroimmunology and is in principle able to explain various types of psychopatholog...
Fragestellung: Übersichtsarbeit über klinische und epidemiologische Studien mit abschließender Wertung und Empfehlungen für weitere Schizophrenieforschung.Hintergrund: Die Ätiologie der Schizophrenie erscheint komplex und multifaktoriell. Genetische Faktoren sind wesentlich, aber nicht ausreichend. Berichte über immunologische Veränderungen bei Pat...
Emerging evidence indicates that low level neuroinflammation (LLNI) may not occur infrequently. Many infectious agents with low overall pathogenicity are risk factors for psychoses including schizophrenia and for autoimmune disorders. According to the mild encephalitis (ME) hypothesis, LLNI represents the core pathogenetic mechanism in a schizophre...
Many neurotropic viruses exist and may cause classical inflammation but also low-level neuroinflammation. However, viruses may be dormant within the CNS and become active later. The role of neurotropic virus infections in the causation of psychiatric disorders may be underestimated, because the diagnostic approach to the CNS is difficult and to dor...
Before an outline of the process of diagnosis and differential diagnosis in infectious and/or inflammatory psy-chosyndromes is given, a more general overview onto the approach to organic psychosyndromes seems useful, because in both entities similar principles of causality conclusion are applied. Correlation does not demonstrate causality. Therefor...
Schizophrenia seems to be a heterogeneous disorder. Emerging evidence indicates that low level neuroinflammation (LLNI) may not occur infrequently. Many infectious agents with low overall pathogenicity are risk factors for psychoses including schizophrenia and for autoimmune disorders. According to the mild encephalitis (ME) hypothesis, LLNI repres...
An anatomical connection from subarachnoid spaces along nerves into peripheral tissues represents an important route for CNS antigens release, termed here peripheral cerebrospinal fluid outflow pathway (PCOP), is assumed analogous to mammals in humans: CSF leaves the subarachnoid spaces along nerves and joins respective interstitial tissue fluids,...
Acute myeloid leukemia (AML) can affect not only bone marrow (BM) and peripheral blood (PB), but also the compartment of cerebrospinal fluid (CSF). Besides standard chemotherapy, specific and non-specific immunotherapy has been employed synergistically to treat AML patients. Here we report on a patient who received standard chemotherapy, unspecific...