The young woman was catatonic, stuck at the nurses' station — unmoving, unblinking, not knowing where or who she was. Her name was April Burrell (pictured). Before she became a patient, April had been an outgoing, straight-A student majoring in accounting at the University of Maryland Eastern Shore. After a traumatic event when she was 21, April suddenly developed psychosis and became lost in a constant state of visual and auditory hallucinations. The former high school valedictorian could no longer communicate, bathe or take care of herself. April was diagnosed with a severe form of schizophrenia, an often devastating mental illness that affects approximately 1% of the global population and can drastically impair how patients behave and perceive reality. "She was the first person I ever saw as a patient," said Dr. Sander Markx (pictured), Director of Precision Psychiatry at Columbia University, who was still a medical student in 2000 when he first encountered April. "She is, to this day, the sickest patient I've ever seen.” It would be nearly two decades before their paths crossed again, but in 2018 another chance encounter led to several medical discoveries. Markx and his colleagues discovered that although April's illness was clinically indistinguishable from schizophrenia, she also had lupus, an underlying and treatable autoimmune condition that was attacking her brain. After months of targeted treatments and more than two decades trapped in her mind, April woke up. The awakening of April and the successful treatment of other people with similar conditions now stand to transform care for some of psychiatry's sickest patients, many of whom are languishing in mental institutions. Researchers working with the New York State mental healthcare system have identified about 200 patients with autoimmune diseases, some institutionalized for years, who may be helped by the discovery. Today, Dr. Markx has the same advice for all medical students: “Don’t give up on a patient who comes in with unexplained autoimmunity or unexplained psychiatric symptoms.”
