#round up 21

[stuckybingo]

Stucky Bingo Round-Up #21 (March 31st - April 6th)

If you would like a shiny Bingo Card of your own, you can fill out this form! Don’t forget to fill out the submission form to be a part of the round-ups and to get your bingo badges!

hoping these roses dull the pain, cover the scars and turn the page by aspen | blackwood4stucky Square filled: I4 - kink: breeding Ao3 rating: Explicit Warnings: Rape/non-con, Graphic depictions of violence, alpha x alpha, non con drug use, triggered mating Major tags: body horror, forced sex, non traditional omegaverse, triggered mating, secondary gender modification Summary: “A peculiar scent fills Steve’s nose as he wakes slowly. He knows that scent, it is one that still haunts him, that whispers his failures in his ears like prayers.” There were turncoats on the Lemurian Star. Format: Medium oneshot (1000 - 5000 words)

A Daddy's Himbo by Metalbvcky Square filled: N3 - Free Space Ao3 rating: Explicit Warnings: No archive warnings apply Major tags: Modern AU, Dom/sub, Bathroom Sex, Rimming Summary: Bucky wakes up beside his ex the morning after their reunion. Format: Medium oneshot (1000 - 5000 words)

Good Luck List by sparkagrace Square filled: B5 - steve's list Ao3 rating: Teen Warnings: No archive warnings apply Major tags: established relationship, shrinkyclinks, superstitions, alternate povs, non-linear timeline Summary: Steve has a list of items and traditions that have always brought him luck. These have led him to multiple wins at the pub quiz nights, appearances on three quiz shows, and at last to a finalist position on Mastermind. However, the greatest thing his lucky charms have brought him is his husband… who is still on his way back from a mission. - Bucky may not have the same superstitions as Steve, but that won’t stop him racing to get to that studio on time to deliver the last and most important one. Format: Long oneshot (over 5000 words)

Til the end of the line by Buckys-Wintersoldier Square filled: G4 - AU: Winter Soldier Steve Ao3 rating: Teen Warnings: No archive warnings apply, Slight violence, punches Major tags: Winter Soldier Steve, best friends to lovers, nightmares, fluff Summary: After another sleepless night and some stories about Steve and Bucky, they find him and Bucky can confess the feelings he has for Steve. Format: Medium oneshot (1000 - 5000 words)

Dig My Grave, Both Wide and Deep by hail-americas-ass (Tumblr username) Square filled: O5 - 1930's Ao3 rating: Teen Warnings: No archive warnings apply, Grief/Mourning, watermelon Major tags: Grief/Mourning, Steve Rogers Character Study, Steve Rogers feels, Jewish Bucky Barnes Summary: Steve takes his first step towards living in the 21st Century without Bucky by his side now that he hasn't got an alien invasion to distract him from grief. In which, Steve visits Bucky's grave and realises Bucky would want him to live the life he couldn't have. Format: Medium oneshot (1000 - 5000 words)

sometimes i hold you closer (just to know you're real) by moodymelanist Square filled: N3 - Free Space Ao3 rating: Teen Warnings: No archive warnings apply Major tags: Post-Movie: Captain America: The Winter Soldier (2014), Reunited and It Feels So Good, Bucky Barnes Needs a Hug, Bucky Barnes Feels, POV Steve Rogers Summary: Bucky shows up on Steve’s doorstep after the helicarriers, and Steve allows himself to think, we’re going to be alright. Format: Medium oneshot (1000 - 5000 words)

The Man On The Bridge by endlesstwanted Square filled: G5 - Looking after each other Ao3 rating: Teen Warnings: No archive warnings apply Major tags: Reflection, Amnesia, Bucky Barnes-centric Summary: He thinks about the man who spared his life. Format: Drabble (exactly 100 words)

Heaven Only Knows by endlesstwanted Square filled: G2 - Mutual Pinning Ao3 rating: Teen Warnings: Underage Major tags: Memories, Childhood Friends, Love Confessions Summary: Dreams he has of a blonde boy, and a later realisation. Format: Short oneshot (300 - 1000 words)

Tried to drift but don’t know how by dharmashark Square filled: N3 - Free space Ao3 rating: Explicit Warnings: No archive warnings apply, Body image issues, insomnia, explicit sex Major tags: Post-CATWS, Brooklyn, Nostalgia, Starting Over Summary: “If you’re gonna stand there admiring your handiwork,” Steve says to the construction paper he’s laying over the hardwood floor, “the least you could do is pitch in.” Format: Long oneshot (over 5000 words)

Steve is trying his best by Rufferto Square filled: B1 - Long Distance Ao3 rating: Teen Warnings: No archive warnings apply Major tags: Steve shirtless, Facetiming, awkward poses, blushing, Notalone Summary: Bucky had to go to California for six months and Steve is stuck in New York. They make time to talk as much as possible but it's hard. Steve just wants to prove to Bucky that he's capable of being sexy on the phone just like any other boyfriend. Tony might have dared him. Bucky appreciates it, Steve just needs to learn to pick his timing better. Format: Art

#stucky bingo #stucky bingo round 5 #round up 21 #weekly round up #don't forget to fill out the submission form

[mamawasatesttube]

sometimes im tempted to just open to action comics #1 and read through from the very beginning. i haven't done it yet but the temptation does exist

#i read all of robin 1993 in 4 days. which is 180 issues. so if i read at a rate of 45 issues a day... #... round that up to 50/day for ease of math and i could THEORETICALLY get thru ~1100 issues in 21 days. #of course that would require me to be an insane person who does nothing but read comics for 3 weeks straight #so realistically it would take longer than that #but the idea that i COULD do this. it's rattling around in my head #rimi talks

[gallacrafts]

📣Theme 21 Round Up! 📣

Last month's theme was Throwback Theme 2 and a special project for Gallacrafts' second anniversary in a couple months. We had so many amazing crafts and several great collaborations too!

Thanks to @vintagelacerosette @lingy910y @depressedstressedlemonzest @ian-galagher @suzy-queued @tsuga-of-mars @doodlevich @michellemisfit @deedala @grumble-fish @juliakayyy @energievie and @look-i-love-u!

We were once again bowled over by your talent and creativity ✨

#Mod Post #gallacrafts #theme 21 #gallacrafts round up post #throwback theme 2 #gallavich #shameless #ian x mickey #ian gallagher #mickey milkovich

[introspectivememories]

My fear is that DC makes Bernard such a beautiful well written character that mixs his old asshole personality with his newer tamed personality and people start actively liking him because he is own person with his own hopes and dreams and then fans want more of this Bernard only to be met with a shitty shell of a character and starting back at square one by forcing him just to be Tim’s love interest

this too actually

#a well written bernard... but at what cost? #sometimes the more popular a character is.... the worse they get treated by both the fandom and the editors #bernard getting popular and then the fandom flattens him into one personality trait? im literally quaking #a good writer other than fitzmartin gets their hands on bernard and we finally get a well rounded character? #and then more people start coming for bernard #and then they see this and they fuckin idk reboot the universe again #and now we have to start over from scratch #if real life had fear toxin i think that's what i would see #he's already only 'tim's bf' to them #every bit of character info on him is like inferred #or from like throwaway lines #like when he's patching up tim in tdr3 and tim goes 'but you're okay now right?' and bear says 'some days' #or the holy grail of bear info tdr7 #and then a little bit of urban legends 4 #all of the rr run from way back then is like a good starting point for bear but like he was 16 and the worst thing that ever happened to hi #at that point was his parents being shitty and when we meet him again he's like 20/21 #so i don't really enjoy it when people say he's lost his flavor or whatever because he's clearly been through some shit in the last 5 years #but like tdr7 when bear tell tim to 'have a great piss!' that was fitzmartin briefly being possesed by the real bernard dowd for a sec #these tags are getting too long #dc #bernard dowd #tim drake #timbern #asks

[jtl-fics]

2/21/24 WIP Wednesday Round-Up

Everything requested for 2/21/24's WIP Wednesday!

Math Nerd AU - 13 Requests

Fall: 16 - 17 - 18 - 19 - 20 - 21 - 22 - 23 - 24 - 25 - 26 - 27 Moriyamas: 31

Smalls AU - 1

HTPXFI: 16

Pretty Boy - 6 Requests

Chapter 3: 28 - 29 - 30 - 31 - 32 - 33

Surely - 4 Requests

Cherry 7UP: 26 - 27 - 28 - 29

#2-21-24 WIP Wednesday #WIP Wednesday Round-Up #AFTG #AFTG FIC #AFTG AU

[skunkes]

rest of chwibis from this months batch ^_^

#arts tho #comms #furry #i actually have 1 more to finish that i cldnt last night bc i had to wake up early today #but. 21 comms in 6 days is quite epic of me hee hee ^_^ #<- (only did them so quick bc i had so many single chibis this round)

[shopcat]

also whenever i joke about going to america and getting cheeseburger that is obviously in a loving way i never had a cheeseburger when i was there and it ruins me. and the joke is funny but like that post that's like americans live to say brother this one's on the house. which kills me. but it's not hateful ☝️ OR in that way those wet eyed losers who call all americans dumb and stupid and are like insane and classist and racist abojt it. also apparently when i was there we also went to a diner where the waitresses were on rollerblades and i didn't even fucking notice because i had a cold and was zonked out of my mind which also is just crazy. Land of dreams

#🐾 #and then they went off menu to make me a chicken soup which was really sweet and makes me cry a little thinking about it #anywya i love america any hate i have is for individual idiots who americans would also hate #ans anyone not from there can probably relate it's all just minor annoyances that stack up over a life time but that they don't even think #abt. like the centralisation of american media and news #RMR WHEN j posted about drinking alcohol when i was 18 and someone was like but that's not the drinking age #and i was like no it is where i live and thy were like well you should still abide by the 21 age bc that's there for a reason and ur #setting a bad example. BRAH #or when the election comes round and people forget there are ? 😭 other countries #honestly politics is such a big one the audacity to be mad that we don't CARE at all about american politics like that #i don't care who the president of a country 15000 miles away is 😭 name one australian state #but i dunno like yeah it's all petty shit but i think we're allowed to be annoyed 🤨 #also when americans in particular but europeans as well try and have opinions on things happening HERE #still mad that one time i saw a callout for someone for race faking bc they were whitepassing and said they were indigenous australian #like you have to be actually fucking stupid to ignorantly comment like literally do one google search #or when they make fun of city and town names here sounding silly or made up 😭 wild #anyway. way too much to even go over but this is still all individualised annoying cunts #i think america is a cool place 👍 with as many flaws as every other country and as much history of covering them up as them as well 👍

[fearandhatred]

ok my goal is to follow idk. 21 more people

#fearandhatred #FIRST. and if i can take it i'll follow more #i need to stop being so PICKY and OVERWHELMED by POSTS #i was just going to say 20 but i think i only follow 99 now so rounding it up to 120 total #very fitting in honour of me turning 21

[poohwhin]

“breezy” bitch it is an arctic tundra outside. there is snow SLAMMING against my windows wtf do you mean “breezy”

#; poo talk #i can’t sleep ‘cause there’s banging outside #and im so upset �� #i’m shleepy 😞 #also for my celsius peeps this is -20° ~ -21° #( google specifically says 20.5 so i’m rounding up )

[noco7]

people might be wondering about the state of ch.12 and uhh it’s going. I got a late start on it because my internet was being wonky this past week. But now I’m working on it, so here’s the update

#NCi7 #i write way too much #like i have an outline #but then i add random shit #the chapter was packed BEFORE i started adding extra stuff #but like im too attached to the random things #to want to delete them #so we'll see #i'm going to guess that im a third of a way through the chapter #so in two more days the first draft will be done #and then maybe i'll take another two days to revise it #and rounding up #might come out in a week #sorry i know it's taking a while #but uhh #my last few chapters were really good so i hope that makes up for it #nervous laughter #also in case u were wondering #most of those 21 pages is NOT them cooking

[stuckybingo]

Stucky Bingo Round-Up #21 (February 27th - March 4th)

Don’t forget to fill out the submission form to be a part of the round-ups and to get your bingo badges!

Stucky Bingo February 2023 Round Robin by Dogsled, Sivan325, Purpleicedteas, Girl_Back_There, buckybarnesdeservestobehappy Square filled: AU: Sports, Free Square, Accidental Kiss, Writing Format: Interview Ao3 rating: General audiences Warnings: No archive warnings apply Major tags: Winter Olympics, Olympics AU, Team Russia, Team USA, Ice Skating Summary: When Russian figure skater Bucky Barnes defects, he can only skate for the Team USA if he skates with a partner. What he and Steve Rogers find together on the ice is golden. Format: Round Robin

TIME by rookthorne Square filled: I5 - Time Ao3 rating: Teen Warnings: No archive warnings apply Major tags: gifset, light violence/blood, angst Summary: There is nothing straight about these two. Format: Gifs

Who Was He? by singthebeginningofmoana Square filled: I3 - Identity Porn Ao3 rating: Teen Warnings: No archive warnings apply, Kidnapping Major tags: Angst, Hurt/Comfort, Post-Captain America: The Winter Soldier, Not Canon Compliant, Winter Soldier Bucky Barnes Summary: Alternate universe where during the highway fight scene before Steve learns that the Winter Soldier is Bucky, Bucky snaps out of the programming and kidnaps Steve, running away and taking him to safety. Format: Short oneshot (300 - 1000 words)

i got the fire (but you're holding the fuse) by hanitrash Square filled: G2 - kink: underage Ao3 rating: Explicit Warnings: Underage, Daddy Kink, Large Age Gap, Power Imbalance, Public Sex Major tags: Sex Worker Bucky Barnes, Sugar Daddy Steve Rogers, Sex Club, Teenage Bucky Barnes, Angst with a happy ending, Summary: Steve has held his position as a board member of the club for several years now, and has seen hundreds of boys come and go. There's no reason why this night should be any different from previous events, why he can't just have one of the older, experienced boys and be done with it and go home. There's no reason why the new kid in the lineup should catch his eye the way he does. No reason why James should turn Steve's world upside down the way he does. All Steve knows is, from the moment James first calls him Daddy, he'll move heaven and earth to makes James his. Format: Medium oneshot (1000 - 5000 words)

Don’t want no other shade of blue but you by rya_204 Square filled: G5 - mirrors Ao3 rating: Teen Warnings: No archive warnings apply, sick steve rogers Major tags: AU, pre serum steve, h/c Summary: That was his greatest fear. To become a reflection of a lonely, grumpy man and inside himself, invisible to the others, the memory of Steve. Format: Short oneshot (300 - 1000 words)

My Heart Skips A Beat When I’m With You by Navya Square filled: I2 - Art Ao3 rating: Explicit Warnings: No archive warnings apply Major tags: Valentine's Day, Topping From The Bottom, Butt Plug, Enthusiastic Sex, Steve Is A Little Shit Summary: ""I had plans, Rogers. A romantic candle lit dinner, your favorite rom com on the TV while we snuggle and then I was going to let you enjoy your Valentine's Day present nice and slow. But you sent that monstrosity-"" Bucky pointed to the scattered bits of the card still on the floor, ""and derailed it all. So now there's gonna be a change in plans."" Bucky walked closer and Steve backed up until his knees hit the edge of the couch. With a surprised exhale of breath, Steve sat down and had to look up as Bucky hovered in a slightly menacing manner. Heart thumping wildly, Steve gulped before he could find his voice. ""So what did you have in mind, Buck?"" Wrapping his vibranium fingers carefully around Steve’s throat, Bucky gave a gentle squeeze. Steve felt all the blood in his head rush straight to his dick. Bucky leaned and whispered so low that Steve was instantly grateful for his super soldier hearing. ""You're going to fuck me right here, right now. I'm going to ride you so hard that you better start praying the serum can keep up."" (Or: Steve has terrible taste in gifts and has to suffer in delicious agony.) Format: Long oneshot (over 5000 words)

Of Cats and Cat Naps by SomeSortofItalianRoast Square filled: B4 - AU: Animal Shelter Ao3 rating: General audiences Warnings: No archive warnings apply Major tags: Alternate Universe - Coffee Shops & Cafés, Alternate Universe - Soulmates, Alternate Universe - No Powers, Cat Cafés, Writer Bucky Barnes Summary: Bucky thinks it's time for a new cat, so he and Steve head to a cat café run by a friend of of Darcy's. Format: Medium oneshot (1000 - 5000 words)

just for tonight by Galks Square filled: G1 - AU: zombies Ao3 rating: Explicit Warnings: Graphic depictions of violence, blood and gore Major tags: Amputee Bucky Barnes, Post-Serum Steve Rogers, Barnes Siblings, Light Dom/Sub Summary: When Natasha and her group go radio silent on their way to Indianapolis, Sam and Steve decide to go looking for them. After searching for days, they stumble across a walled in community about thirty miles out of the city. The leaders of the community allow them in to spend the night, eat and recharge, before they head back out. But after spending the night with one of the leaders, Steve isn't so sure he wants to leave after all. Format: Long oneshot (over 5000 words)

Tell Me I Can Have It All by hanitrash Square filled: Adopted square - Scars Ao3 rating: Explicit Warnings: No archive warnings apply, Mentioned Past Suicide Attempts Major tags: Wakanda Stucky, Getting Back Together, Stubborn Steve Rogers, Recovering Bucky Barnes Summary: Steve is tired of Bucky trying to push him away after he comes out of cryo in Wakanda. Rehashing the same argument brings up some new information that Bucky can't ignore, and makes him second-guess his decision to keep Steve at arm's length. Format: Medium oneshot (1000 - 5000 words)

From Distance to Closeness by Andrea1717 Square filled: G5 - Long Distance Ao3 rating: Teen Warnings: No archive warnings apply, Implied/Referenced Child Abuse, Implied/Referenced Cheating Major tags: Alternative Universe - Modern Setting, Getting back together, Fluff and Angst Summary: Two years after their breakup Bucky and Steve meet again by surprise and want to figure out if there is room for a second chance. Format: Long oneshot (over 5000 words)

a league of our own by Galks Square filled: I3 - beard Ao3 rating: Explicit Warnings: No archive warnings apply, past sports injury Major tags: kid fic, modern au, baseball au, slow burn Summary: Steve's sixteen-year-old son's one and only dream is to play in the Major League. He thinks he has a shot when the team get a new coach, retired MLB legend and Steve's high school crush, Bucky Barnes. Steve hasn't thought of the man in many years, but seeing him brings back many memories that push Steve to reach out to an old friend and maybe make new ones on the way. What happens when Steve gets to know Bucky properly? What happens when they open up about their darkest secrets and deepest fears? There's really only one thing that can happen. Format: Part of a multichapter fic

#stucky bingo #stucky bingo round 4 #round up 21 #weekly round up #don't forget to fill out the submission form

[bbg100]

I DO NOT MIND being unable to follow someone because I fit their dnfi. It's chill, I genuinely think it's important for people to feel safe in their online space, and even tho 'assholes don't read dni' is true, the warning makes people feel more comfortable asserting their boundaries and that's pog.

HOWEVER some of y'all need to restructure your dnfi! I just read a dnfi- their opinion of lesbian discourse was listed BEFORE the no pedophiles! Their 'nobody over x age' was listed after all that, which is weird because hopefully that is what disqualifies the Most people! I'm just saying sorting by relevancy or urgency would be great because holy shit

#This is ABSOLUTELY a nitpick but this is far from the first time that like #I scroll and I'm like okay I don't like mcyt okay I'm not a proshipper cool cool #Only to be disqualified in the last round like damn I'm over 21! #It's like signing up for a toddler beauty pageant and a random ass elk has been entered #And the elk gets to the final three before it's like okay humans under 5 only #And it's like damn sorry annebellemily I guess you won't be miss toddler 2022 #Like I feel like she should have been voted off sooner is all!!

[rosemariecawkwell]

My Favourite Sci Fi and Fantasy of 2023

View On WordPress

#21% Monster Ice Giant #42: The Wildly Improbable Ideas of Douglas Adams #Alex Woodroe #Amelie Wen Zhao #Anna Stephens #Annalee Newitz #Annual Round-up #book list 2023 #Bookshops &amp; Bonedust #C.M. Waggoner #Django Wexler #Don&039;t DIsturb The Dragon! #Emily Owen #Emperor of Ruin #Eric Brown #fantasy #Frontier #Grace Curtis #Keith Brooke #Lucha of the Night Forest #Mr Gearheart #My favourite sci fi and fantasy reads 2023 #N.E. Davenport #P.J. Canning #Rhiannon Findlay #Richard Swan #Sci-Fi #Sian ROberts #Song of silver Flame like night #Tehlor Kay Mejia

[reloaderror]

don’t underestimate my ability to go home

#txt #genuinely at like 21 something clicked i can just leave #i used to feel soooo guilty #when i didn’t suffer thru til the end that is but now lmao #i mean leaving simply because indont want to be somewhere is still not super easy ill go thru rounds of ‘just hang in there a little try a #bit longer’ unless the anxiety kicks in ofc and not just discomfort cause ill rather run out than stay and cry #but the improvement is massive #also not related but maybe i once had my dad almost yell at me to drive hole the fact that i was not obligated to eat food i did not like #home* #simply to seem respectful or whatever to the point of getting sick when visiting someone #im flat on the couch. feet up and reminiscing <- procrastinating

[hexiva]

Roleplay Is Not Dead Nor Doth It Sleep

There's a post going around about how text-based, freeform roleplay is dead, and I was typing up a huge response to this, with an accompanying guide on how to find roleplayer in 2024, when I realized it might have a bigger reach if I made it its own post. So here's that guide.

I hesitate to say that there isn't a problem with the new format of social media making roleplay more difficult to find, but in the desire to make that point, the OP of the original post has left people with the idea that there's no way for them to get into freeform text roleplay in 2024. Which just isn't true! Here, look at all the ways.

Forums

The link to RPG-Directory to find roleplaying forums is a good start. Once you've found a forum RPG, even if you don't join, there's usually an 'advertising' section on that forum where other forum RPGs post their ads - this may help you to find forums that don't advertise on RPG-D.

Another really good forum to find roleplay on is Barbermonger. Barbermonger is focused on connecting people for one-on-one roleplays.

This last one's going to be weird, but it turns out that there are still people seeking roleplay on the Gaia Online forums after all these years. I think this is delightfully retro and then crowd there seems a little older than average. No pre-existing knowledge of Gaia required.

Tumblr

You can also find forum roleplay groups (as well as tumblr and Discord groups) right here on Tumblr. Usually, the thing to do is to use the search function - search for "[genre] rp" or "[fandom] rp" and sort by "latest." (If you sort by Top, you are likely to find dead RPs.) For example, here's fantasy rp, historical rp, and marvel rp. You can also try jcink rp, as most roleplay forums are hosted on Jcink these days, or discord rp, depending on your favored platform.

There are also tumblr blogs specifically dedicated to advertising roleplays. I'm not super familiar with these nowadays, but just in the process of searching those tags above, I found these:

Jcink Tinder

RPG Adverts

RPings

There are more, I just don't know them off the top of my head.

Reddit

Listen, don't run away, I swear it's good now - I swear Reddit is good now -

Reddit is a good place to find Discord roleplays. It's a little heavier on smut-only roleplays than other platforms mentioned here, but it's not impossible to find sexless, plot-based roleplay here either. Most ads are for one on one RP, but you can find groups mixed in here too. The big subreddits for text-based freeform RP seem to be:

r/DiscordRP

r/RoleplayPartnerSearch

r/roleplaying

r/Roleplay

Some of these have weird rules about what you can put in your ad, and I don't remember which ones, so read carefully and don't get discouraged if your ad is initially removed.

Discord

In 2024, Discord is by far the biggest and most popular platform for roleplay, and it has its own native roleplay advertising hubs. Here are a bunch:

roleplay partner hub

Rockin Roleplay

The Roleplay Garden

roleplay help

the roleplay connection

RP Central

Roleplay Central

Roleplay Hub

Barbermonger also has a Discord server

Roleplay Meets: Reborn

RP Hub

The Scribes Guild

DM Rp Village

cherry blossom! roleplay hub

DM-RP

Roleplay Round Table (21+)

The Historical Syndicate (specifically for historical roleplay)

The Roleplayer's Directory

If you can't find the Discord roleplay you want on here, you can also try Discord hub websites, like Disboard. These work similar to tumblr tags - search for [genre] rp or [fandom] rp.

Other

The original post specifically mentions that 'all the old "omegle but for role play" type websites died out ages ago'. This is mostly true, but not quite! There's still Rolechat. It's a little janky, but what it needs more than anything is a bigger user base. Their Discord server is also a good place to find one on one discord roleplay. It is, of course, free, but if you want to support its development, they have a patreon.

Please reblog this post, and add your own tips on how to find roleplay!

#roleplay #rp #fandom rp #discord rp #jcink rp

[reasonsforhope]

Story from the Washington Post here, non-paywall version here.

Washington Post stop blocking linksharing and shit challenge.

"The young woman was catatonic, stuck at the nurses’ station — unmoving, unblinking and unknowing of where or who she was.

Her name was April Burrell.

Before she became a patient, April had been an outgoing, straight-A student majoring in accounting at the University of Maryland Eastern Shore. But 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 percent 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 Sander Markx, 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 [for lupus] — 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 health-care system have identified about 200 patients with autoimmune diseases, some institutionalized for years, who may be helped by the discovery.

And scientists around the world, including Germany and Britain, are conducting similar research, finding that underlying autoimmune and inflammatory processes may be more common in patients with a variety of psychiatric syndromes than previously believed.

Although the current research probably will help only a small subset of patients, the impact of the work is already beginning to reshape the practice of psychiatry and the way many cases of mental illness are diagnosed and treated.

“These are the forgotten souls,” said Markx. “We’re not just improving the lives of these people, but we’re bringing them back from a place that I didn’t think they could come back from.” ...

Waking up after two decades

The medical team set to work counteracting April’s rampaging immune system and started April on an intensive immunotherapy treatment for neuropsychiatric lupus...

The regimen is grueling, requiring a month-long break between each of the six rounds to allow the immune system to recover. But April started showing signs of improvement almost immediately...

A joyful reunion

“I’ve always wanted my sister to get back to who she was,” Guy Burrell said.

In 2020, April was deemed mentally competent to discharge herself from the psychiatric hospital where she had lived for nearly two decades, and she moved to a rehabilitation center...

Because of visiting restrictions related to covid, the family’s face-to-face reunion with April was delayed until last year. April’s brother, sister-in-law and their kids were finally able to visit her at a rehabilitation center, and the occasion was tearful and joyous.

“When she came in there, you would’ve thought she was a brand-new person,” Guy Burrell said. “She knew all of us, remembered different stuff from back when she was a child.” ...

The family felt as if they’d witnessed a miracle.

“She was hugging me, she was holding my hand,” Guy Burrell said. “You might as well have thrown a parade because we were so happy, because we hadn’t seen her like that in, like, forever.”

“It was like she came home,” Markx said. “We never thought that was possible.”

...After April’s unexpected recovery, the medical team put out an alert to the hospital system to identify any patients with antibody markers for autoimmune disease. A few months later, Anca Askanase, a rheumatologist and director of the Columbia Lupus Center,who had been on April’s treatment team, approached Markx. “I think we found our girl,” she said.

Bringing back Devine

When Devine Cruz was 9, she began to hear voices. At first, the voices fought with one another. But as she grew older, the voices would talk about her, [and over the years, things got worse].

For more than a decade, the young woman moved in and out of hospitals for treatment. Her symptoms included visual and auditory hallucinations, as well as delusions that prevented her from living a normal life.

Devine was eventually diagnosed with schizoaffective disorder, which can result in symptoms of both schizophrenia and bipolar disorder. She also was diagnosed with intellectual disability.

She was on a laundry list of drugs — two antipsychotic medications, lithium, clonazepam, Ativan and benztropine — that came with a litany of side effects but didn’t resolve all her symptoms...

She also had lupus, which she had been diagnosed with when she was about 14, although doctors had never made a connection between the disease and her mental health...

Last August, the medical team prescribed monthly immunosuppressive infusions of corticosteroids and chemotherapy drugs, a regime similar to what April had been given a few years prior. By October, there were already dramatic signs of improvement.

“She was like ‘Yeah, I gotta go,’” Markx said. “‘Like, I’ve been missing out.’”

After several treatments, Devine began developing awareness that the voices in her head were different from real voices, a sign that she was reconnecting with reality. She finished her sixth and final round of infusions in January.

In March, she was well enough to meet with a reporter. “I feel like I’m already better,” Devine said during a conversation in Markx’s office at the New York State Psychiatric Institute, where she was treated. “I feel myself being a person that I was supposed to be my whole entire life.” ...

Her recovery is remarkable for several reasons, her doctors said. The voices and visions have stopped. And she no longer meets the diagnostic criteria for either schizoaffective disorder or intellectual disability, Markx said...

Today, Devine lives with her mother and is leading a more active and engaged life. She helps her mother cook, goes to the grocery store and navigates public transportation to keep her appointments. She is even babysitting her siblings’ young children — listening to music, taking them to the park or watching “Frozen 2” — responsibilities her family never would have entrusted her with before her recovery.

Expanding the search for more patients

While it is likely that only a subset of people diagnosed with schizophrenia and psychotic disorders have an underlying autoimmune condition, Markx and other doctors believe there are probably many more patients whose psychiatric conditions are caused or exacerbated by autoimmune issues...

The cases of April and Devine also helped inspire the development of the SNF Center for Precision Psychiatry and Mental Health at Columbia, which was named for the Stavros Niarchos Foundation, which awarded it a $75 million grant in April. The goal of the center is to develop new treatments based on specific genetic and autoimmune causes of psychiatric illness, said Joseph Gogos, co-director of the SNF Center.

Markx said he has begun care and treatment on about 40 patients since the SNF Center opened. The SNF Center is working with the New York State Office of Mental Health, which oversees one of the largest public mental health systems in America, to conduct whole genome sequencing and autoimmunity screening on inpatients at long-term facilities.

For “the most disabled, the sickest of the sick, even if we can help just a small fraction of them, by doing these detailed analyses, that’s worth something,” said Thomas Smith, chief medical officer for the New York State Office of Mental Health. “You’re helping save someone’s life, get them out of the hospital, have them live in the community, go home.”

Discussions are underway to extend the search to the 20,000 outpatients in the New York state system as well. Serious psychiatric disorders, like schizophrenia, are more likely to be undertreated in underprivileged groups. And autoimmune disorders like lupus disproportionately affect women and people of color with more severity.

Changing psychiatric care

How many people ultimately will be helped by the research remains a subject of debate in the scientific community. But the research has spurred excitement about the potential to better understand what is going on in the brain during serious mental illness...

Emerging research has implicated inflammation and immunological dysfunction as potential players in a variety of neuropsychiatric conditions, including schizophrenia, depression and autism.

“It opens new treatment possibilities to patients that used to be treated very differently,” said Ludger Tebartz van Elst, a professor of psychiatry and psychotherapy at University Medical Clinic Freiburg in Germany.

In one study, published last year in Molecular Psychiatry, Tebartz van Elst and his colleagues identified 91 psychiatric patients with suspected autoimmune diseases, and reported that immunotherapies benefited the majority of them.

Belinda Lennox, head of the psychiatry department at the University of Oxford, is enrolling patients in clinical trials to test the effectiveness of immunotherapy for autoimmune psychosis patients.

As a result of the research, screenings for immunological markers in psychotic patients are already routine in Germany, where psychiatrists regularly collect samples from cerebrospinal fluid.

Markx is also doing similar screening with his patients. He believes highly sensitive and inexpensive blood tests to detect different antibodies should become part of the standard screening protocol for psychosis.

Also on the horizon: more targeted immunotherapy rather than current “sledgehammer approaches” that suppress the immune system on a broad level, said George Yancopoulos, the co-founder and president of the pharmaceutical company Regeneron.

“I think we’re at the dawn of a new era. This is just the beginning,” said Yancopoulos."

-via The Washington Post, June 1, 2023

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