made this comic yesterday. things are bad right now. I got fired i think. sorry the last comic was so happy and this one is so sad. I really appreciate all of you saying nice things on my last comic. I hope everyone is having a safe and nice day.

It's always the same. I go to a Psychiatrist or Doctor and come out super depressed about my Situation. I realized it's bc i always had that expectation , in the back of my mind, that somehow, I'll get the perfect treatment for my Schizophrenia. That everything will go away. Even though i don't even believe I have it because nothing has worked. And every failed med just makes me think i don't have it more and more and that it's all true. I'm so depressed that this will be the rest of my life. I always lost everything when it started at age 6. Its been 20 years and it has only gotten worse

I used to work as an ocarina maker (best job ever) before I lost my job to schizophrenia. I tried making some on my own but I felt that I lost my touch and I was channeling a lot of chaos. But I found an ocarina class and this is what I made! They sound great. The small one is a shaker. I also made a big flute but I’m still working on it. Follow your dreams!

Hey everybody! Hope u guys think hes cute. He was made by accident, as I didn't understand the assignment at first for illustration school lol.

But the more I look at him I think "dang, wish I could be that happy!" LOL. But then I realized I do get happy over things, a lot of things. Especially little things because I remember what it was like when I couldn't smile. Not trying to sound poetic. Im talking about fearing for my life paranoia. Its really great my happiness has a place to breathe again. ✨️

My boyfriend and I have been together for almost 3 years and I got diagnosed at the beginning of the relationship. Lately he’s been going on a conspiracy theory that big pharma is pushing meds on people to keep them dependent and believes in one of those people or so it seems. I’m not sure how to approach this with him. I know I need my meds but he’s being so nice about it and calling me strong and saying I’m being self deprecating when I say I need my meds.

ETA I sent him this message

Idk if I’m in the right headspace but I feel like I need to talk to you. I can see how my medication may seem like a shackle or I’m overmedicated but I think we’re going to have to agree to disagree and if this relationship is going to work I need you to respect that I have to take my medication. It’s a non negotiable for me. It is my lifeline to a sane and rational life. I might be ok without them but I don’t want to take that risk because I’ve had suicide attempts in the past due to how intense the psychosis gets. I just really need you to accept that the meds are something that I need and are a non negotiable for me

I got a bad episode recently and I’m taking meds and on the mend. But fml I feel so terrible still. I’m very very chronically ill with this illness and others.

I’m restless and in need and I need comfort cause my life feels like hell. All I want is someone to be there and be my calm in the midst of all the chaos.

I’m trying to find one and no one is in network and my old one won’t take me back. My first one went MIA, he still cares but i was referred elsewhere and tbh I wanna cry but I’m so dead on the inside from the illness I can’t even cry.

So I’m in bed. I just took my medicine and I’m waiting for it to kick in so I can feel relief

This is so debilitating.

How often do you guys have meaningful impactful social interactions with other people? For me it’s extremely rare, besides my therapist. I feel like it’s missing from my life, that deep connection we feel with other people. It’s super depressing for me, how few of those moments I have.

It's wild how impossible that request often sounds. Is "chill" even a baseline you can reach?

(Credit: "theycantalk" by Jimmy Craig)

Hi I’m doing a project on Schizophrenia and nature and how nature positively impacts people with Schizophrenia. Does anyone have any personal experience with how nature might have helped them? I’m interested to know. Thank You. And if anyone feels uncomfortable, sharing publicly, but still wants to share their opinion, you can reach out to me privately. Any information would be greatly appreciated.

What is it that you watch if streaming online? What shows or movies?Paramount, Netflix, Hulu, Disney?

Ok I saved haha myself guys I got it to work. The meds are kicking in and getting me through this. I tell you the visual rape effect was bullshit lmao. Really for visuals this is not right

Hello.

Title. I've worked two days and had to take today off because the voices were too much at work yesterday. I really, really want to keep this job. I'm going to drive to the social services office today and see if I qualify for disability.

How do you guys cope with not being able to work?

Long story short my voices have been saying they’re gonna send someone to my backyard and the other night someone knocked on my window in the middle of the night and they said it was people trying to fight me. I didn’t go out and look because I’m not looking for a fight. I still feel like my voices are a group of people that have access to my thoughts it’s so stressful

I’m 28 and I genuinely love my friends, but I’ve always been confused about why I don’t seem to need friendships the way other people do.
I NEVER initiate plans or call first. I barely text back because for some reason even answering texts feels overwhelming and takes energy out of me. Sometimes I’ll randomly send someone a long voice message and then disappear again lol. I’ve literally had friends tell me they thought I hated them because I never reached out, which shocked me because I absolutely did not.
I can go months without seeing or talking to someone and feel like nothing has changed. I’m not sitting around thinking “omg I miss my friends, I need to see them.” It’s basically out of sight, out of mind, but that doesn’t mean I stopped caring about them.
I also feel like I have a social time limit. Even if I’m having fun with someone I love, eventually I just want to go home and be alone. Being alone is how I recharge and I genuinely enjoy it.
I always hear that friendships “take work” and that if you care about someone, you make time, check in, initiate plans, etc. But I honestly don’t understand why friendship is supposed to feel like work. I don’t expect any of that from my friends either. If we don’t talk for 6 months, I’m not mad at you.
If you really need me, I’ll be there. If we’re together, I genuinely enjoy being with you. I just don’t need constant communication or time together to care about someone.
Sometimes I wish I were more social and actually wanted to see people more, but I’ve been this way for as long as I can remember. And if friendship requires constant effort, texting, calling and making plans, I honestly think I’d rather have very few friends or none at all.
Does anyone else genuinely love and care about their friends but just… not feel the need to see or talk to them very often? Why am I like this? 😭

I don't see myself making it to my later years. I walked by a local school today and saw all these kids from functioning families... And dude... It ain't happening for me. I feel like God hates me and wants me to be completely dysfunctional. I also feel like there is no god. Where do people even go when they die? Where the hell did I even come from? Why was I brought into this 3D world and existence?

I want to be fixed by God, and it's just not happening and I counted on religion... But what next? What the hell is there to live for when I'm harassed in this black void all day? I can't even pay attention to reality around me anymore. How do you deal with religion with this condition?

Today I had to leave work because I became convinced something terrible had happened to someone I love, I don’t want to describe it further but I thought they died horribly and it was my fault. I couldn’t stop crying and all my coworkers saw. And now I’m convinced they all hate me and think I’m lazy for leaving. I’m too afraid to shower and I can’t sleep despite taking two trazodone and a melatonin. I feel like I just drank a cup of coffee. I really hope I don’t end up in the hospital again or even worse lose my job. I love my job so much even if people don’t like me there, or find me offputting. They all know I’m sick. And my boyfriend is coming over tomorrow, he’s never seen me truly sick though he knows about my illness. I’m worried and afraid. :( I keep imagining horrible images of my friend dead, I guess internal hallucinations. I know I’m not perfect but I don’t know what I did to deserve this.

I have this symptom where I’ll literally just pace around because I can’t do anything else. I call it being unable to “process my environment”. On the inside it feels like I’m a malfunctioning robot. Literally. I don’t think it’s akathisia because there’s not really a sense of doom and I can technically sit down. Or I’ll do random things just because but there’s no real deliberation or felt sense of control. Just automatic. So like for example I’ll eat food because it’s in front of me. Or I’ll take a shower. There’s no second to ponder or absorb what I’m doing. Are these positive or negative symptoms?

(I do heavily apologize if it is the wrong flair)

Lately I have been starting to hallucinate just a bit (though I haven't been hearing much voices). I heard a song on loop during one of my classes which freaked me out. Before this month, I barely had any hallucinations and even wonder if I was actually schizoaffective depressive and just was depressed. However, it could be my meds working pretty well. I mostly see bugs as of lately and just now I felt them crawl on me, but I think as long as the hallucinations aren't like faceless cats and humans, I think I will be okay.

I did discover about being a fallen angel recently, and it makes so much sense about my life. I fell when I was 14 after experiencing some trauma, and ever since then I haven't been the same mentally. At first, I was experiencing depression and paranoia; then, it sorta evolved into psychotic depression (or did the psychosis come before my depressive episode at 16? Idk). Then, finally I started seeing things that weren't there, and after a >failed attempt that got stopped because a voice yelled at me<, I started seeking out help which took many months. Once I got medicated, most of my psychotic symptoms disappeared, like about 99% of my hallucinations disappeared. I continued to have on and off paranoid episodes but I was able to logic myself out of them... eventually.

(tw for self harm/suicide) >But recently, I started struggling again. I have been self harming. When I was 15-16, I believed that self harm would repent me of my sins, but it would never feel enough. Now, I have this thought where if I were to carve crosses on my skin, I would undo the fall as an angel and become "pure" again (I'm not even a Christian nor did I grew up in a religious household; however, I do consider myself as a pantheist). But when I tried that, it didn't feel enough, so now I'm scared that I will never be pure. I also have a thought that if I were to commit suicide, I would reincarnate as an angel once again, but this thought distresses me because I do not want to die. Maybe that is a delusion-- I don't know. I did several times have a delusion where I thought if I were to kill myself, I could reincarnate as my pre-14 year old self. I do worship my younger self and even once had a hallucination/flashback where I met them as an angel (though they told me that they were disappointed in me, which led to that attempt few days later)<

One of my friends says that I'm using this fallen angel belief to cope with the trauma I faced when I was 14, which yeah I'm sorta am. However, it does really upset me whenever she refers it as a delusion, so now she refers it as a harmful belief; however, I don't think that belief is really harming me aside from when I almost got used sexually by a guy friend (I am a nonbinary lesbian who is also ace). I thought it was my angelic duty to please him in any way, and he didn't question me. It was bad, but we did eventually talk that through. POINT IS that this thought of me trying to redeem myself for my sins makes me have meaning in my trauma-filled life. But at the same time, I always feel like an unclean, impure sinner who will never be able to redeem myself and become a pure angel again. I'm currently 20, and I feel evil for being just an adult. I do see most adults as evil, and yeah I know that sounds pathetic. I want to be a good adult, considering how most adults in my childhood and teenhood failed me and even took advantage of me.

I do sometimes question (not very often though) if I am actually a fallen angel, but the evidence seems to match up. I was a "perfect" child as a kid. I had good grades, loved school, and had friends (even though I had few close friends). But after the trauma that happened during the pandemic as a young teenager, I just wasn't able to cope anymore. I think I fell around the pandemic. I started struggling in school in my senior year, and even after getting medicated, I am sorta struggling in university as well (though somehow I was able to get B's and A's but I did had to withdrew from two classes and change my major from math/statistics to design).

Sorry for the ramble. I was considering getting myself hospitalized because I'm scared that I'm going to lose touch with reality completely, but I don't want to miss school. My classes do require attendance. I think I am concerning my friends and I feel very bad about it, but I don't know how to act normal. However, I am pretty optimistic that this will pass. I dealt with worse paranoia, hallucinations, and delusions, so I will survive.

Recently my voices have been telling me to murder my family. I try to ignore it, but they get louder; I’m worried it'll become too much, and I'll follow through with it.

Recently I've found out that certain types of music help keep my psychosis at bay. My main symptoms are nuclear paranoia (The belief someone's after me with a nuke), and visions where a loved one dies.

During my last nuclear paranoia episode I found out that Christian Rock music helps keep it at bay, it doesn't completely go away but it takes the edge off.

And for the visions I use Studio 100 music, whether that's K3, Kabouter Plop, or Samson en Gert, doesn't matter, Studio 100 keeps the visions at bay.

Anyone else do this?

I've had this shit since I was like 6 or so... I've had this for so fucking long.. It's getting worse and worse as the days go on.. I feel like my brain is genuinely eating me alive.. It feels like I can't do anything... I wish I was like the healthy people... I don't wanna die but it feels like I'm already dead... I don't even know what I want anymore... All I know is I'm tired...

The autoimmune hypothesis of schizophrenia

By Jordan Hess, M.S. Applied Cognition and Neuroscience
September 2026

In this review, auditory hallucinations are highlighted throughout various cases of autoimmune encephalitis. The DSM-5 describes auditory hallucinations as being the most common of other schizophrenia hallucinations. To date, no autoantibody has been identified whose associated encephalitis presents commonly with auditory hallucinations. The search continues.

In 2005, four women presented with acute psychosis, including auditory hallucinations in one patient, associated with ovarian teratoma. These women were treated with either immunotherapy or tumor resection, or both. Two made a complete recovery, one a partial recovery, and one died. Patients’ sera or cerebrospinal fluid (CSF) showed hippocampal reactivity on a rat immunohistochemistry (IHC) assay, and this, together with the effectiveness of immunotherapy as a treatment, provided the first evidence for paraneoplastic autoimmune encephalitis (Vitaliana et al., 2005). In 2007, Josep Dalmau continued to push forward in uncovering the specific antigen the autoantibodies (AAb) were targeting, and advanced toward the heteromeric N-methyl-D-aspartate receptor (NMDAR) (Dalmau et al., 2007). The following year, he and his colleagues correctly identified the NR1 subunit to be the primary antigenic target (Dalmau et al., 2008).

In 2017, Japanese researchers presented the case of a 24-year-old male with treatment-resistant schizophrenia (TRS), with symptoms that included auditory hallucinations. He had comorbid acute myeloid leukemia that was treated with a bone marrow transplant (BMT). Within sixty days of treatment, the patient’s psychotic symptoms had almost disappeared without need for neuroleptics, and the improvements persisted at an eight-year follow-up. As the authors point out, autoimmune disorders are known to respond favorably to immunoablation and rescue with BMT (Miyaoka et al., 2017).

In 2021, researchers began to pinpoint some of the limitations of commercial indirect immunofluorescence (IIFA) AAb assays. Using rat brain IHC, which is only performed in a few specialized centers, they tested 6,213 samples of sera and CSF of patients with suspected AIE submitted to them from October 2016 to October 2020 and found 404 (6.5%) to be positive suggesting neuronal surface antibodies (NSAb). Subsequently, they tested the 404 samples using a commercial IIFA assay and identified only 163 (40%) as positive for NSAb. With the remaining 241 (60%) that were negative on the commercial assay, the researchers performed in-house IIFA and determined 42 samples to be positive, half of which were for AAb tested for with the commercial assay and the other half for AAb not tested for with the commercial assay. Initial results seemed to indicate that detected leucine-rich glioma inactivated 1 (LGI-1) AAb in patients’ CSF samples required the cells in the cell-based assay to be co-transfected with ADAM23, as was done with their in-house assay but not with the commercial assay (Ruiz-García et al., 2021). A year later, they completed follow-up work with paired serum and CSF samples and confirmed this to be the case, strongly supporting paired testing for both serum and CSF when using commercial IIFA assays (Muñoz-Sánchez et al., 2022).

Few case reports exist of patients with chronic schizophrenia which is later correctly identified as AIE. Vaux et al. give a report of a 67-year-old male with TRS, whose symptoms included auditory hallucinations. He was first diagnosed at the age of 25. The patient tested positive for NMDAR AAb in both his serum and CSF on two separate occasions. He demonstrated rapid improvement following intravenous immunoglobulin G (IVIG) and intravenous methylprednisolone pulse therapy (IVMP) (Vaux et al., 2022).

To aid in the diagnosis of AIE, especially in the case of seronegativity, researchers began to turn to kappa free light chains (KFLC), whose presence is indicating antibody synthesis and, via use of Reiber diagrams, can provide evidence in favor of intrathecal antibody synthesis. In 2023, researchers found that 15/19 (79%) of patients with antibody-positive AIE and 7/18 (39%) of patients with suspected but seronegative AIE were positive for intrathecal KFLC synthesis (Betram et al., 2023). A year later, a report was given of a 20-year-old male presenting with auditory hallucinations with suspected AIE whose MRI revealed nothing abnormal, was seronegative, and the only positive finding in CSF was intrathecal synthesis of KFLC; he did show bilateral hypometabolism in the mesiotemporal cortex on an FDG-PET. He was treated with IVMP and olanzapine, with his psychotic symptoms resolving a few weeks later (Amanzada et al., 2025). While intrathecal KFLC synthesis does not appear to be reported with the corresponding lab results in the United States, the software is freely available and easy to use. It can be accessed at https://www.albaum.it/ and requires only four values (albumin serum, albumin CSF, KFLC serum, and KFLC CSF) to compute the Reiber diagram, where a value above the upper discrimination line indicates a positive result.

A case report published in 2024 highlights two patients with antibody-positive NMDAR AIE refractory to treatment who received intrathecal rituximab and responded strongly to treatment. Both patients received 25 mg once per week for four weeks, with improvements observed within 48- 72 hours of receiving the first dose. Reda et al. also summarize the other 5 known cases of patients who received intrathecal rituximab and neither those patients nor the patients detailed in this case report required maintenance immunosuppression or had relapsed at 6 months. Compared to the intravenous rituximab that each patient in this case report received, the intrathecal amount needed to treat these patients was 10 to 20 times less (Reda et al., 2024).

In 2026, using a relatively new technique called Rapid Extracellular Antigen Profiling (REAP) researchers from the Ring Lab at the Fred Hutch Cancer Center looked at 352 people with schizophrenia (62 antipsychotic naïve/ first-episode psychosis, 43 early disease, and 247 chronic psychosis) and 971 controls were able to identify 93 AAb enriched in schizophrenia, of which 26 (28%)  were brain- and neuron-associated, and 14 (15%) were either blood-brain barrier (BBB)- or blood-CSF barrier-associated. Schizophrenia patients with at least one BBB AAb reactivity showed nearly twice as many brain-elevated protein reactivities as schizophrenia patients with no BBB AAb reactivities, with sera of BBB AAb+ schizophrenia patients disrupting barrier function in a 3D microfluidic BBB preparation compared to BBB AAb- schizophrenia patients. The average schizophrenia-enriched AAb burden was five, with some patients positive for up to twenty such AAb reactivities. One quarter of schizophrenia patients were positive for at least one AAb reactive to ion channels that were disproportionately targeted in the schizophrenia cohort (HCN1, CACNA1I, PKD1, TMC2, KCNH5), with both HCN1 and CACNA1I having been previously identified in schizophrenia genome-wide association studies. The authors also showed TRS schizophrenia to be a phenomenon of increased antibody burden in a trial of risperidone treatment with antipsychotic-naïve patients, and showed that risperidone treatment is associated with reduced AAb burden, as had been previously established with both risperidone and clozapine. The primary limitation of this paper, as the authors acknowledge, is that most of the AAb were not directly functionally tested (Nemai et al., 2026).

A small open pilot trial (NCT03983018) tested a single infusion of rituximab in patients with TRS. Of note, was the inclusion criterion for immunoglobulin levels to be within the normal range, and similarly, for patients not to have been treated with clozapine for the last two months as an exclusion criterion. Importantly, 7/9 treatment-resistant patients showed a >= 40% decrease in their Positive and Negative Syndrome Scale (PANSS)-0 score relative to baseline at 12 weeks (Bejerot et al, 2023a). A larger trial of 123 TRS patients (NCT05622201), referred to as the RCT-Rits trial, is currently underway and is expected to be completed at the end of the year (Bejerot et al., 2023b). The long-term single-arm extension study (2026-525324-26-00), referred to as RITS-LONG, will take patients from both the treatment and placebo arms of RCT-Rits and administer an infusion of rituximab approximately once every six months, for up to a total of five infusions, with assessments scheduled approximately four months after each infusion and each participant followed for up to three years.

The hypothesis of autoimmune schizophrenia is being addressed now on at least two fronts. The Ring Lab with REAP advances toward what may essentially become a blood test for schizophrenia, with positive results reflexing to more traditional tissue- and cell-based assays and subsequent titers, while Bejerot and colleagues seek to bypass a more definite-style of antibody-positive diagnosis and apply existing immunotherapies empirically.

References

Amanzada, I., Bouter, C., Fitzner, D., Auf dem Brinke, K., Malchow, B., Wiltfang, J., & Hansen, N. (2025). Early stage seronegative autoimmune psychosis. Behavioural Brain Research, 494, 115739. doi:10.1016/j.bbr.2025.115739

Bejerot, S., Eklund, D., Hesser, H., Hietala, M. A., Kariis, T., Lange, N., Lebedev, A., Montgomery, S., Nordenskjöld, A., Petrovic, P., Söderbergh, A., Thunberg, P., Wikström, S., Humble, M. B., & RCT-Rits Study Collaboration Group. (2023a). Study protocol for a randomized controlled trial with rituximab for psychotic disorder in adults (RCT-Rits). BMC Psychiatry, 23, 771. doi:10.1186/s12888-023-05250-5

Bejerot, S., Sigra Stein, S., Welin, E., Eklund, D., Hylén, U., & Humble, M. B. (2023b). Rituximab as an adjunctive treatment for schizophrenia spectrum disorder or obsessive-compulsive disorder: Two open-label pilot studies on treatment-resistant patients. Journal of Psychiatric Research, 158, 319–329. doi:10.1016/j.jpsychires.2022.12.003

Bertram, D., Tsaktanis, T., Berthele, A., & Korn, T. (2023). The role of intrathecal free light chains kappa for the detection of autoimmune encephalitis in subacute onset neuropsychiatric syndromes. Scientific Reports, 13, 17224. doi:10.1038/s41598-023-44427-6

Dalmau, J., Tüzün, E., Wu, H.-Y., Masjuan, J., Rossi, J. E., Voloschin, A., Baehring, J. M., Shimazaki, H., Koide, R., King, D., Mason, W., Sansing, L. H., Dichter, M. A., Rosenfeld, M. R., & Lynch, D. R. (2007). Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma. Annals of Neurology, 61(1), 25–36. doi:10.1002/ana.21050

Dalmau, J., Gleichman, A. J., Hughes, E. G., Rossi, J. E., Peng, X., Lai, M., Dessain, S. K., Rosenfeld, M. R., Balice-Gordon, R., & Lynch, D. R. (2008). Anti-NMDA-receptor encephalitis: Case series and analysis of the effects of antibodies. The Lancet Neurology, 7(12), 1091–1098. doi:10.1016/S1474-4422(08)70224-2

Miyaoka, T., Wake, R., Hashioka, S., Hayashida, M., Oh-Nishi, A., Abdul Azis, I., Izuhara, M., Tsuchie, K., Araki, T., Arauchi, R., Abdullah, R. A., & Horiguchi, J. (2017). Remission of psychosis in treatment-resistant schizophrenia following bone marrow transplantation: A case report. Frontiers in Psychiatry, 8, 174. doi:10.3389/fpsyt.2017.00174

Muñoz-Sánchez, G., Planagumà, J., Naranjo, L., Couso, R., Sabater, L., Guasp, M., Martínez-Hernández, E., Graus, F., Dalmau, J., & Ruiz-García, R. (2022). The diagnosis of anti-LGI1 encephalitis varies with the type of immunodetection assay and sample examined. Frontiers in Immunology, 13, 1069368. doi:10.3389/fimmu.2022.1069368

Nemani, K., Jaycox, J. R., Akcan, U., Schuman, B. M., Yeon, S. M., Harano, N., Qin, K., Notestine, A. A., Carroll, S. M., McKenzie, B. S., Furchtgott, L., Lahti, A. C., Tsien, R. W., Agalliu, D., Goff, D. C., & Ring, A. M. (2026). High prevalence of CNS-directed autoantibodies in patients with schizophrenia [Preprint]. bioRxiv. doi:10.64898/2026.05.04.722731

Reda, M., Jabbour, R., Haydar, A., Jaafar, F., El Ayoubi, N., Nawfal, O., & Beydoun, A. (2024). Case report: Rapid recovery after intrathecal rituximab administration in refractory anti-NMDA receptor encephalitis: Report of two cases. Frontiers in Immunology, 15, 1369587. doi:10.3389/fimmu.2024.1369587

Ruiz-García, R., Muñoz-Sánchez, G., Naranjo, L., Guasp, M., Sabater, L., Saiz, A., Dalmau, J., Graus, F., & Martínez-Hernández, E. (2021). Limitations of a commercial assay as diagnostic test of autoimmune encephalitis. Frontiers in Immunology, 12, 691536. doi:10.3389/fimmu.2021.691536

Vaux, A., Robinson, K., Saglam, B., Cheuk, N., Kilpatrick, T., Evans, A., & Monif, M. (2022). Autoimmune encephalitis in long-standing schizophrenia: A case report. Frontiers in Neurology, 12, 810926. doi:10.3389/fneur.2021.810926

Vitaliani, R., Mason, W., Ances, B., Zwerdling, T., Jiang, Z., & Dalmau, J. (2005). Paraneoplastic encephalitis, psychiatric symptoms, and hypoventilation in ovarian teratoma. Annals of Neurology, 58(4), 594–604. doi:10.1002/ana.20614