Brain on Fire: Mental Illness & Mold

Mold Toxicity Summit Outline of Presentation by Mary Ackerley MD, ABIHM

1. Anxiety is the most common comorbidity
   1. Severe anxiety
   1. Night sweats
   1. Adolescents
      1. Not doing well at school
      1. Not wanting to go to school
      1. Poor test performance   
   1. Depression usually not recognized until it’s more severe
   1. OCD/PANS in childhood
      1. Strept
      1. Lyme
      1. Possibly others
   1. More severe psychiatric illnesses also present
      1. Manias
      1. Severe depression
      1. Catatonic depression
         1. Especially when new onset
         1. No family history
   1. Every psychiatric illness can be caused by mold
      1. May exacerbate genetic predispositions
      1. Especially when initial presentation of psychiatric illness in 50’s, 60’s
   1. Mild cognitive impairment is considered “normal” in this day and age
   1. Can present as
      1. severe psychosis
      1. Physical presentations/disabilities
      1. Life-threatening/undiagnosed illness
         1. May be in nursing home, hospice etc.
         1. Can be initial presentation of mold illness
         1. Not recognized by many partialist/specialists for given issues
   1. Preferred diagnostic testing;
      1. Over time, has gotten away from the complete Shoemaker List, now…
         1. TGFB1 “Fire” (when elevated, take it as “real”) Cytokine
            1. Lyme
            1. Autoimmunity
            1. EDS
         1. MMP9,
            1. Cytokine,
            1. increases BBB permeability,
            1. “more and more pain”
         1. ADH/Osm
            1. Not always covered by insurance
            1. Need to check with Osm
            1. ADH is another cytokine
         1. VEGF commonly low, <31
            1. Poor blood flow
            1. May present as Raynaud’s
            1. Poor brain oxygenation
            1. Cytokine most associated with suicides when low
            1. Marker for chronic fatigue
         1. C4a good but hard to get, but not the most sensitive marker
            1. May be related to FedEx, other non-lab factors
            1. Hard to get truly valid results
         1. Mycotoxin testing/urine GPL
            1. Very helpful when positive
            1. Good for follow-up
            1. Needs to be used with history & symptoms
      1. PFT’s to assess level of disability
         1. Help patient advocacy with insurers, disability boards
         1. Cardiopulmonary Exercise testing is the most useful of testing
            1. Post-exertional malaise
            1. Lactic acidemia
            1. Flu-like symptoms
            1. May take 2-3 days to recover
            1. Exercise bike over 2 days
      1. NeuroQuant/Neuroinflammation
         1. HPA Axis is clearly intertwined with the brain
         1. Age/Sex match diet can be problematic, but
         1. CoreTechs labs does a good job with the Age/Sex matched data
         1. Traumatic Brain Injury (TBI) may have an impact many years later with asymmetry and atrophy
         1. TBI can open the Blood Brain Barrier allowing toxins greater access to do more injury/damage
         1. Triage Brain Atrophy (TBar) report
            1. Amygdala 2 or more standard deviations larger than it should be for age sex
            1. Amygdala re-training (vagus exercises, DSMR) can help people recover
      1. How many folks in psych facilities have underlying inflammatory disorders?
         1. Mold
         1. Lyme
         1. Other infections
      1. How many addicts/alcoholics have similar outcomes
         1. “Mold rage” in dysregulated inflamed brains
         1. Combined with alcohol
         1. Mix in the cost of remediating and the stress that adds
         1. “Self-treatment for the brain can make things worse”.
         1. There is an addiction facility in FL that tests all patients for mycotoxins
      1. ISEAI & 3 Tiers/Groups
         1. Chronic illness
            1. Lyme
            1. Tick-borne other illnesses
            1. Heavy Metals
            1. Parasites
            1. Food acquired illnesses
               1. GMO
               1. Pesticides and other toxins in food
         1. Chronic complex illness
         1. Environmentally Acquired
         1. Encourage professional collaboration
         1. Group 1 get well the easiest
            1. Basically, well before mold exposure, were basically healthy before, had an exposure and rapidly went downhill
            1. Easiest to get better, often respond to ending exposure and CSM again
         1. Group II
            1. Not as healthy
            1. More complex
            1. Take more time to get better
            1. They will improve but may not fully recover and it may take a longer time
            1. May or may not benefit from remediation
         1. Group III
            1. Most chronically ill, complicated, complex patients
            1. Important to try to recognize their complexity earlier
            1. Group 3A; hypermobility, Ehler’s Danlos Syndrome (EDS) very common presentation
               1. Medical complications are same whether or not the full EDS Criteria are met.
               1. Dysautonomia
                  1. POTS (often called anxiety, OCD in young people)
                  1. Sweating
                  1. Breathing
                  1. Mast cell syndromes common in this population
                     1. Stabilize the Mast cells and work backwards from there
                  1. Remediation vs. abandoning the problematic bldg.
            1. Group 3B
               1. Major mental illnesses for whatever reason
                  1. Suicidal
                  1. Manic
                  1. Psychosis
               1. Severely neurocognitively impaired
                  1. Dementias
                     1. Require a good caretaker
         1. IEP’s are an important/essential asset
            1. Air testing is almost never fine if done properly
            1. Learn to communicate well between self and IEP
   1. Histamine issues
      1. Niacin/Psychosis link
      1. Mold sets off the innate immune system
         1. Destabilizes Mast Cells
            1. Histamines
            1. Leukotrienes
      1. Stabilizing the Mast cells can help dysautonomia’s
      1. Common with hypermobility (EDS)
      1. Quercetin
      1. Low-dose Naltrexone
      1. Hydroxyzine is a good antihistamine for these folks
      1. Atopy/ ”Cheap Irish Skin”

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Dr. Raymond Oenbrink

Dr. Raymond Oenbrink DO is board certified by the American Osteopathic Board of Family Physicians (AOBFP) and the American Board of Addiction Medicine (ABAM). He specializes in complex and chronic illnesses such as Chronic Inflammatory Response Syndrome (CIRS).

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