Psychosis in Teenager Improves with Gluten-Free Diet

Celiac.com 07/25/2023 - Non-celiac gluten sensitivity is a gluten-related disorder that results from immune-mediated reactions in predisposed people. Non-celiac gluten sensitivity usually manifests with gastrointestinal symptoms. However, in rare cases, it might present with psychiatric symptoms that could be severe enough to impair functioning. 

We've done a number of articles on the psychological and psychiatric manifestations of celiac disease, which can include, anxiety, depression, and eating disorders. There are also studies linked celiac disease to neurological manifestations, along with schizophrenia. 

Every so often, we cover a case study that may be relevant to celiac disease, in general. Our latest case involves a 15-year-old Sudanese girl, with no prior psychiatric history, who visited the emergency department due to anxiety, behavioral changes, and hallucinations of her deceased father. 

Girl Treated for Psychosis and Delusions

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After witnessing her father's burial, she started experiencing flashbacks and intrusive images of him, along with anxiety about death and paranoia towards others. The patient was agitated and psychotic, requiring rapid tranquilization. She was later diagnosed with hyperthyroidism due to Grave's disease.

A team of clinicians, including Olfa Selmi, Banan Khalid, and Saleem Al-Nuaimi, present the girl's case report. They are variously affiliated with the Department of Psychiatry and the Mental Health Service at Hamad Medical Corporation and Hospital in Doha, Qatar.

Despite receiving appropriate thyroid medication, her psychiatric symptoms did not improve, leading to further investigations. Blood tests revealed positive anti-transglutaminase IgA antibodies, suggesting possible celiac disease. 

Psychosis Improves on a Gluten-Free Diet

A gastroscopy showed mild duodenal changes, and she began a gluten-free diet. Within weeks of starting the gluten-free diet, the patient's psychotic symptoms improved significantly. Whenever she consumed gluten in large quantities, her delusions resurged, and they subsided again with a return to the gluten-free diet.

The case suggests a potential link between gluten and psychosis, although the exact mechanism remains uncertain. Prior case reports also show improvements in psychotic symptoms after adopting a gluten-free diet in patients with gluten allergies or sensitivities. As a gluten-free diet is safe and low-cost, it may be considered as part of the treatment plan for reducing psychotic symptoms in patients with gluten-related disorders or autoimmune diseases. 

This case adds to the growing literature exploring the role of gluten in atypical psychotic presentations and the potential benefits of a gluten-free diet in such cases. It also highlights the importance of considering nonconventional treatments when standard therapeutic interventions do not yield satisfactory results, as aggressive treatments may carry higher risks. 

The significant improvement of the girl's psychosis upon starting on a strict gluten-free diet suggests a potential connection between gluten ingestion and psychiatric disorders. However, further research is needed to better understand the relationship between gluten and psychiatric symptoms, and to guide the use of a gluten-free diet in appropriate cases.

Read more at Cureus 15(7): e41807.