Gut microbiota dysbiosis in sepsis and sepsis-associated organ injury: mechanisms, gut-organ axes, and therapeutic strategies.

Treatment-resistant neuropsychiatric patients and their families often endure extraordinary suffering, impaired functioning, and financial burden. One of the most important lessons emerging from modern neuropsychiatry is that psychiatric symptoms, particularly in children, can sometimes represent the downstream effects of hidden neurological, immunological, gastrointestinal, structural, or environmental pathology rather than primary psychiatric disease. A growing body of research suggests that diagnostic overshadowing, where psychiatric labels inadvertently narrow the clinical lens, may delay identification of treatable underlying conditions and, in some cases, compromise recovery. Psychiatrists Rosalie Greenberg, Robert Bransfield, Marion Leboyer and their colleagues have argued that psychiatry may be entering a new era in which immune dysfunction, inflammatory signaling, infectious burden, and blood-brain-barrier disruption should be considered alongside traditional psychiatric formulations (–, ). Their work provides an important conceptual framework for understanding why children with similar psychiatric symptoms may have profoundly different underlying pathophysiology. The connection between infection and psychiatric dysfunction is not new. More than a century ago, clinicians recognized that syphilis could cause psychosis. In the early twentieth century, Sydenham's chorea revealed that streptococcal infections could trigger not only movement disorders, but obsessions, compulsions, mood lability, and psychosis (, ). By the late twentieth century, viral theories of psychiatric illness gained traction. Prenatal viral exposure was associated with increased schizophrenia risk in offspring (), while herpes simplex virus and Epstein–Barr virus antibodies were linked to obsessive-compulsive and other psychiatric symptoms (, ).