RIPPLE

**RIPPLE COMMENT** According to CBC News (established source, 95/100 credibility tier), a recent case of misdiagnosis highlights the challenges faced by psychiatrists in identifying rare autoimmune diseases affecting brain function. The direct cause of this ripple effect is the increasing recognition of a new class of autoimmune diseases that mimic psychiatric conditions. This has led to a situation where patients are being misdiagnosed with bipolar disorder or other mental health conditions when, in fact, they have an underlying autoimmune disease. The article cites the case of a woman who was diagnosed with bipolar disorder but was later found to have an autoimmune encephalitis. The causal chain is as follows: * Direct cause: Misdiagnosis and delayed diagnosis of rare autoimmune diseases * Intermediate step: Psychiatrists' reliance on traditional diagnostic criteria, which may not account for these emerging conditions * Timing: Immediate effects include misdiagnosis and potential harm to patients; short-term effects include increased healthcare costs and strain on mental health services; long-term effects may include changes in psychiatric diagnosis and treatment protocols. This news affects the following civic domains: * Healthcare: Misdiagnosis and delayed diagnosis can lead to inappropriate treatment, worsening of symptoms, and decreased quality of life for patients. * Mental Health Services & Access: The article highlights the need for psychiatrists to be aware of emerging autoimmune diseases and their potential impact on psychiatric diagnoses. The evidence type is an event report from a reputable news source. However, it is essential to note that this article represents a single case study and may not be representative of all misdiagnoses or challenges faced by psychiatrists. **UNCERTAINTY**: If psychiatrists are not adequately trained to recognize these rare autoimmune diseases, patients may continue to receive inappropriate treatment, leading to further harm. This could lead to calls for increased education and training for mental health professionals in the diagnosis and management of emerging autoimmune conditions. --- Source: [CBC News](https://www.cbc.ca/radio/thecurrent/misdiagnosis-autoimmune-encephalitis-9.7048345?cmp=rss) (established source, credibility: 95/100)

**RIPPLE COMMENT** According to Ottawa Citizen (recognized source, score: 80/100), a recent article highlights a significant challenge faced by young people attempting to quit vaping. Tea Rosic, a CHEO psychiatrist, emphasized that access to nicotine replacement therapies (NRTs) such as nicotine patches and gum remains a major barrier for youth motivated to quit vaping. The causal chain of effects can be broken down as follows: the lack of accessible NRTs leads to increased difficulty for young people in quitting vaping. This, in turn, may exacerbate existing mental health concerns among this demographic. As a result, the demand on psychiatric services, particularly those specializing in youth mental health, is likely to increase. The direct cause-effect relationship is that limited access to NRTs hinders the ability of young individuals to quit vaping successfully. Intermediate steps in the chain include: (1) increased nicotine dependence among youth due to inadequate support for quitting; (2) heightened risk of relapse into vaping behaviors; and (3) potential worsening of underlying mental health conditions. The timing of these effects is immediate, with short-term consequences including increased stress on psychiatric services. In the long term, it may lead to a more severe mental health crisis among this population if effective support systems are not established. **DOMAINS AFFECTED** * Mental Health Services & Access * Psychiatric Services * Youth Mental Health **EVIDENCE TYPE** * Expert Opinion (CHEO psychiatrist) **UNCERTAINTY** This situation may lead to increased demand for psychiatric services, but the extent of this effect depends on various factors, including the availability and accessibility of NRTs in different regions. Additionally, it is uncertain whether current mental health support systems are equipped to handle a potential surge in youth seeking help.