101
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Jézéquel J, Johansson EM, Leboyer M, Groc L. Pathogenicity of Antibodies against NMDA Receptor: Molecular Insights into Autoimmune Psychosis. Trends Neurosci 2018; 41:502-511. [PMID: 29807730 DOI: 10.1016/j.tins.2018.05.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/05/2018] [Accepted: 05/01/2018] [Indexed: 11/16/2022]
Abstract
Recent years have seen a flourishing literature on detection of circulating autoantibodies against neurotransmitter receptors in patients with neuropsychiatric disorders. These studies have generated hope for a better understanding of the underlying molecular dysfunctions and for appropriate therapeutic strategies. However, the detection of these autoantibodies in healthy subjects, and the lack of mechanistic insights have fostered debate about the pathogenic role of such autoantibodies. Here, we specifically discuss the biological evidence linking autoantibodies directed against the glutamatergic N-methyl-d-aspartate (NMDA) receptor (NMDAR-Abs) and psychosis, emphasising recent single-molecule imaging investigations that unveiled the impaired surface trafficking of NMDAR in the presence of NMDAR-Abs from psychotic patients. Although still in its infancy, the hypothesis that NMDAR-Abs from patients with psychosis play a pathogenic role is thus gaining support, opening avenues of fundamental and translational investigations.
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Affiliation(s)
- J Jézéquel
- Université de Bordeaux, Interdisciplinary Institute for Neuroscience, UMR 5297, Bordeaux, France; CNRS, IINS UMR 5297, Bordeaux, France
| | - E M Johansson
- Université de Bordeaux, Interdisciplinary Institute for Neuroscience, UMR 5297, Bordeaux, France; CNRS, IINS UMR 5297, Bordeaux, France
| | - M Leboyer
- University Paris Est Créteil, Psychiatry Department, Hopitaux Universitaires Henri Mondor, AP-HP, DHU PePSY, INSERM, U955, Créteil, France
| | - L Groc
- Université de Bordeaux, Interdisciplinary Institute for Neuroscience, UMR 5297, Bordeaux, France; CNRS, IINS UMR 5297, Bordeaux, France.
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102
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Oviedo-Salcedo T, de Witte L, Kümpfel T, Kahn RS, Falkai P, Eichhorn P, Luykx J, Hasan A. Absence of cerebrospinal fluid antineuronal antibodies in schizophrenia spectrum disorders. Br J Psychiatry 2018; 212:318-320. [PMID: 29587895 DOI: 10.1192/bjp.2018.24] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Antibody-mediated encephalitis has been discussed as one possible cause for isolated psychotic syndromes. Mostly based on serum samples, findings have been controversial. We present the results of a retrospective study of 124 clinically diagnosed psychotic patients without documented relevant neurological symptoms. All were tested for different antineuronal antibodies in cerebrospinal fluid (CSF) while 81 received serum testing. Antineuronal antibodies in CSF were negative across the sample. 3.7% showed low positive serum antibodies. Our findings highlight the importance of a deeper discussion about the relevance of low positive serum antibodies without concurrent findings in CSF or clinical signs for autoimmune encephalitis.Declaration of interestNone.
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Affiliation(s)
- Tatiana Oviedo-Salcedo
- Department of Psychiatry and Psychotherapy,Klinikum der Universität München, Ludwig Maximilians-UniversityMunich,Germany
| | - Lot de Witte
- Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, Klinikum der Universität München, Ludwig Maximilians-University Munich,Germany
| | - René S Kahn
- Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy,Klinikum der Universität München, Ludwig Maximilians-University Munich,Germany
| | - Peter Eichhorn
- Institute of Laboratory Medicine,Klinikum der Universität München, Ludwig Maximilians-University Munich,Germany
| | - Jurjen Luykx
- Brain Center Rudolf Magnus,Department of Translational Neuroscience,University Medical Center Utrecht,The Netherlands
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy,Klinikum der Universität München, Ludwig Maximilians-University Munich,Germany
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103
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Phillips OR, Joshi SH, Narr KL, Shattuck DW, Singh M, Di Paola M, Ploner CJ, Prüss H, Paul F, Finke C. Superficial white matter damage in anti-NMDA receptor encephalitis. J Neurol Neurosurg Psychiatry 2018; 89:518-525. [PMID: 29101253 PMCID: PMC5899027 DOI: 10.1136/jnnp-2017-316822] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/09/2017] [Accepted: 10/19/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Clinical brain MRI is normal in the majority of patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. However, extensive deep white matter damage wasrecently identifiedin these patients using diffusion weighted imaging. Here, our aim was to study a particularly vulnerable brain compartment, the late myelinating superficial white matter. METHODS Forty-six patients with anti-NMDAR encephalitis were included. Ten out of these were considered neurologically recovered (modified Rankin scale of zero), while 36 patients were non-recovered. In addition, 30 healthy controls were studied. MRI data were collected from all subjects and superficial white matter mean diffusivity derived from diffusion tensor imaging was compared between groups in whole brain, lobar and vertex-based analyses. Patients underwent comprehensive cognitive testing, and correlation analyses were performed between cognitive performance and superficial white matter integrity. RESULTS Non-recovered patients showed widespread superficial white matter damage in comparison to recovered patients and healthy controls. Vertex-based analyses revealed that damage predominated in frontal and temporal lobes. In contrast, the superficial white matter was intact in recovered patients. Importantly, persistent cognitive impairments in working memory, verbal memory, visuospatial memory and attention significantly correlated with damage of the superficial white matter in patients. CONCLUSIONS Anti-NMDAR encephalitis is associated with extensive superficial white matter damage in patients with incomplete recovery. The strong association with impairment in several cognitive domains highlights the clinical relevance of white matter damage in this disorder and warrants investigations of the underlying pathophysiological mechanisms.
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Affiliation(s)
- Owen Robert Phillips
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Stanford University School of Medicine, Stanford, California, USA
| | - Shantanu H Joshi
- Department of Neurology, Ahmanson Lovelace Brain Mapping Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Katherine L Narr
- Department of Neurology, Ahmanson Lovelace Brain Mapping Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - David W Shattuck
- Department of Neurology, Ahmanson Lovelace Brain Mapping Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Manpreet Singh
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Stanford University School of Medicine, Stanford, California, USA
| | - Margherita Di Paola
- Department of Mental Health, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.,Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Christoph J Ploner
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Harald Prüss
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
| | - Friedemann Paul
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Berlin, Germany.,Experimental and Clinical Research Center, Charité Universitätsmedizin, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Carsten Finke
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany.,Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
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104
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Autoimmune encephalitis and psychiatric disorders. Rev Neurol (Paris) 2018; 174:228-236. [DOI: 10.1016/j.neurol.2017.11.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/15/2017] [Accepted: 11/29/2017] [Indexed: 12/20/2022]
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105
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Scott JG, Gillis D, Ryan AE, Hargovan H, Gundarpi N, McKeon G, Hatherill S, Newman MP, Parry P, Prain K, Patterson S, Wong RCW, Wilson RJ, Blum S. The prevalence and treatment outcomes of antineuronal antibody-positive patients admitted with first episode of psychosis. BJPsych Open 2018; 4:69-74. [PMID: 29971149 PMCID: PMC6020277 DOI: 10.1192/bjo.2018.8] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 12/05/2017] [Accepted: 01/21/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Antineuronal antibodies are associated with psychosis, although their clinical significance in first episode of psychosis (FEP) is undetermined. AIMS To examine all patients admitted for treatment of FEP for antineuronal antibodies and describe clinical presentations and treatment outcomes in those who were antibody positive. METHOD Individuals admitted for FEP to six mental health units in Queensland, Australia, were prospectively tested for serum antineuronal antibodies. Antibody-positive patients were referred for neurological and immunological assessment and therapy. RESULTS Of 113 consenting participants, six had antineuronal antibodies (anti-N-methyl-D-aspartate receptor antibodies [n = 4], voltage-gated potassium channel antibodies [n = 1] and antibodies against uncharacterised antigen [n = 1]). Five received immunotherapy, which prompted resolution of psychosis in four. CONCLUSIONS A small subgroup of patients admitted to hospital with FEP have antineuronal antibodies detectable in serum and are responsive to immunotherapy. Early diagnosis and treatment is critical to optimise recovery. DECLARATION OF INTEREST None.
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Affiliation(s)
- James G. Scott
- Centre for Clinical Research, The University of Queensland
(UQCCR), Metro North Mental Health, Royal Brisbane and Women's
Hospital (RBWH), and the Queensland Centre for Mental Health Research (QCMHR),
Australia
| | - David Gillis
- Division of Immunology, Pathology Queensland
Central Laboratory, RBWH, Australia
| | | | | | | | | | - Sean Hatherill
- Metro South Addiction and Mental Health Service,
Child and Youth Academic Clinical Unit,
Queensland, Australia
| | - Martin P. Newman
- Division of Immunology, Pathology Queensland
Central Laboratory, RBWH, and Faculty of Medicine,
University of Queensland, Australia
| | - Peter Parry
- Child and Youth Mental Health Service,
Children's Health Queensland, Australia
| | - Kerri Prain
- Division of Immunology, Pathology Queensland
Central Laboratory, RBWH, Australia
| | - Sue Patterson
- Metro North Mental Health, RBWH,
and Department of Applied Psychology, Griffith
University, Queensland, Australia
| | - Richard C. W. Wong
- Division of Immunology, Pathology Queensland
Central Laboratory, RBWH, and Department of Immunology,
Princess Alexandra Hospital, Queensland,
Australia
| | - Robert J. Wilson
- Division of Immunology, Pathology Queensland
Central Laboratory, RBWH, and Department of Immunology,
Princess Alexandra Hospital, Queensland,
Australia
| | - Stefan Blum
- Faculty of Medicine, University of
Queensland and Department of Neurology,
Princess Alexandra Hospital, Queensland,
Australia
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106
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Najjar S, Steiner J, Najjar A, Bechter K. A clinical approach to new-onset psychosis associated with immune dysregulation: the concept of autoimmune psychosis. J Neuroinflammation 2018; 15:40. [PMID: 29433523 PMCID: PMC5809809 DOI: 10.1186/s12974-018-1067-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/15/2018] [Indexed: 12/19/2022] Open
Abstract
Growing data point to the overlap between psychosis and pathological processes associated with immunological dysregulation as well as inflammation. Notably, the recent discovery of antibodies against synaptic and neuronal cell membrane proteins such as anti-N-methyl-d-aspartate receptor provides more direct evidence of the etiological connection between autoimmunity and subsequent hazard of psychosis. Here, we advocate the use of term “autoimmune psychosis,” as this term suggests that autoimmune disorders can masquerade as drug-resistant primary psychosis, and this subtype of psychosis has anatomical and immunological footprints in the brain, despite the frequent absence of structural abnormalities on conventional brain MRI. Furthermore, this term might serve as a reminder not to overlook appropriate neurological workup such as neuroimaging and EEG testing, as well as CSF analysis, for cases with acute or subacute atypical onset of neuropsychiatric presentations including those dominated by acute psychotic symptoms. We propose etiologically and serologically oriented subclassification as well as multi-modal diagnostic approach to address some of the challenges inherent to early diagnosis of patients presenting with atypical and refractory new-onset psychotic symptoms of autoimmune origin. This is particularly relevant to the diagnosis of seronegative but probable autoimmune psychosis (SPAP) that might masquerade as antipsychotic drug-resistant primary psychotic disorder. This distinction is therapeutically important as autoimmune-related psychotic symptomatology can frequently respond well to timely treatment with proper immune modulatory therapies.
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Affiliation(s)
- Souhel Najjar
- Department of Neurology, Zucker School of Medicine at Hofstra/Northwell, 8 Black Hall, 130 E 77th Street, New York, NY, 10075, USA.
| | - Johann Steiner
- Department of Psychiatry, University of Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany
| | - Amanda Najjar
- Department of Neurology, Lenox Hill Hospital, 8 Black Hall, 130 E 77th Street, New York, NY, 10075, USA
| | - Karl Bechter
- Ulm University, Ludwig-Heilmeyer-Str. 4, D-89312, Günzburg, Germany
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107
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Mantere O, Saarela M, Kieseppä T, Raij T, Mäntylä T, Lindgren M, Rikandi E, Stoecker W, Teegen B, Suvisaari J. Anti-neuronal anti-bodies in patients with early psychosis. Schizophr Res 2018; 192:404-407. [PMID: 28461116 DOI: 10.1016/j.schres.2017.04.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/11/2017] [Accepted: 04/14/2017] [Indexed: 12/25/2022]
Abstract
It may be challenging to distinguish autoimmune encephalitis associated with anti-neuronal autoantibodies from primary psychiatric disorders. Here, serum was drawn from patients with a first-episode psychosis (n=70) or a clinical high-risk for psychosis (n=6) and controls (n=34). We investigated the serum prevalence of 24 anti-neuronal autoantibodies: IgG antibodies for anti-N-methyl-d-aspartate-type glutamate receptor (anti-NMDAR), glutamate and γ-aminobutyric acid alpha and beta receptors (GABA-a, GABA-b), alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPA), glycine receptor (GlyR), metabotropic glutamate receptor 1 and 5 (mGluR1, mGluR5), anti-Tr/Delta/notch-like epidermal growth factor-related receptor (DNER), contactin-associated protein-like 2 (CASPR2), myelin oligodendrocyte glycoprotein (MOG), glutamic acid decarboxylase-65 (GAD65), collapsin response mediator protein 5/crossveinless-2 (CV2), aquaporin-4 (AQP4), anti-dipeptidyl-peptidase-like protein-6 (DPPX), type 1 anti-neuronal nuclear antibody (ANNA-1, Hu), Ri, Yo, IgLON5, Ma2, zinc finger protein 4 (ZIC4), Rho GTPase-activating protein 26, amphiphysin, and recoverin, as well as IgA and IgM for dopamine-2-receptor (DRD2). Anti-NMDA IgG antibodies were positive with serum titer 1:320 in one patient with a clinical high risk for psychosis. He did not receive a diagnosis of encephalitis after comprehensive neurological evaluation. All other antineuronal autoantibodies were negative and there were no additional findings with immunohistochemistry of brain issues.
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Affiliation(s)
- O Mantere
- Department of Psychiatry, McGill University, Montréal, QC, Canada; Bipolar Disorders Clinic, Douglas Mental Health University Institute, Montréal, QC, Canada.
| | - M Saarela
- Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - T Kieseppä
- Department of Psychiatry, Helsinki University and Helsinki University Hospital, Helsinki, Finland.
| | - T Raij
- Department of Psychiatry, Helsinki University and Helsinki University Hospital, Helsinki, Finland; Department of Neuroscience and Biomedical Engineering, and Advanced Magnetic Imaging Center, Aalto NeuroImaging, Aalto University School of Science, Espoo, Finland.
| | - T Mäntylä
- Department of Neuroscience and Biomedical Engineering, and Advanced Magnetic Imaging Center, Aalto NeuroImaging, Aalto University School of Science, Espoo, Finland; VTT Technical Research Centre of Finland Ltd., Espoo, Finland; Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.
| | - M Lindgren
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.
| | - E Rikandi
- Department of Neuroscience and Biomedical Engineering, and Advanced Magnetic Imaging Center, Aalto NeuroImaging, Aalto University School of Science, Espoo, Finland; Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland; Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - W Stoecker
- Institute for Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany.
| | - B Teegen
- Institute for Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany.
| | - J Suvisaari
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.
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108
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Mei YY, Wu DC, Zhou N. Astrocytic Regulation of Glutamate Transmission in Schizophrenia. Front Psychiatry 2018; 9:544. [PMID: 30459650 PMCID: PMC6232167 DOI: 10.3389/fpsyt.2018.00544] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 10/12/2018] [Indexed: 01/19/2023] Open
Abstract
According to the glutamate hypothesis of schizophrenia, the abnormality of glutamate transmission induced by hypofunction of NMDA receptors (NMDARs) is causally associated with the positive and negative symptoms of schizophrenia. However, the underlying mechanisms responsible for the changes in glutamate transmission in schizophrenia are not fully understood. Astrocytes, the major regulatory glia in the brain, modulate not only glutamate metabolism but also glutamate transmission. Here we review the recent progress in understanding the role of astrocytes in schizophrenia. We focus on the astrocytic mechanisms of (i) glutamate synthesis via the glutamate-glutamine cycle, (ii) glutamate clearance by excitatory amino acid transporters (EAATs), (iii) D-serine release to activate NMDARs, and (iv) glutamatergic target engagement biomarkers. Abnormality in these processes is highly correlated with schizophrenia phenotypes. These findings will shed light upon further investigation of pathogenesis as well as improvement of biomarkers and therapies for schizophrenia.
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Affiliation(s)
- Yu-Ying Mei
- Translational Medicine Research Center, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Dong Chuan Wu
- Translational Medicine Research Center, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Ning Zhou
- Translational Medicine Research Center, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
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109
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Jonuskaite D, Kalibatas P, Praninskiene R, Zalubiene A, Jucaite A, Cerkauskiene R. Adolescent with acute psychosis due to anti-N-methyl-D-aspartate receptor encephalitis: successful recovery. Scand J Child Adolesc Psychiatr Psychol 2017. [DOI: 10.21307/sjcapp-2017-012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a relatively new autoimmune disorder of the central nervous system. We report the first case of anti-NMDAR autoimmune encephalitis combined with anti-voltage-gated potassium channel (anti-VGKC) antibodies in Lithuania in a 16-year-old girl. The patient was admitted to psychiatry unit because of an acute psychotic episode. She was unsuccessfully treated with antipsychotics, and electroconvulsive therapy was initiated because of her rapidly deteriorating condition. Electroconvulsive therapy improved the patient’s condition even before the initiation of immunomodulatory therapy. The abrupt onset, atypical and severe course of psychosis, poor response to antipsychotic treatment, and signs of flu-like prodromal period led to the search of non-psychiatric causes. Although with considerable delay, she was screened for an autoimmune encephalitis. Positive anti-NMDA receptor antibodies were found in the cerebrospinal fluid, but not in serum. In addition, serum was found positive for antinuclear antibodies and anti-VGKC antibodies but negative for CASPR2 and LGI1 antibodies. The girl was treated with intravenous immunoglobulin and methylprednisolone with satisfactory response, although infrequent orofacial movements, emotional lability, and learning deficits remained upon discharge. The reported case suggests that multiple antibodies could be present, and that electroconvulsive therapy may have a role in symptomatic treatment of autoimmune encephalitis.
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Affiliation(s)
- Dovile Jonuskaite
- Children’s Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos , Vilnius , Lithuania
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University , Vilnius , Lithuania
| | - Paulius Kalibatas
- Children’s Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos , Vilnius , Lithuania
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University , Vilnius , Lithuania
| | - Ruta Praninskiene
- Children’s Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos , Vilnius , Lithuania
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University , Vilnius , Lithuania
| | - Asta Zalubiene
- University Dep. of Child and Adolescent Psychiatry, Republican Vilnius Psychiatry Hospital , Vilnius , Lithuania
| | - Aurelija Jucaite
- Dep. of Clinical Neuroscience, Karolinska Institutet , Stockholm , Sweden
| | - Rimante Cerkauskiene
- Children’s Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos , Vilnius , Lithuania
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University , Vilnius , Lithuania
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110
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Cell- and Single Molecule-Based Methods to Detect Anti-N-Methyl-D-Aspartate Receptor Autoantibodies in Patients With First-Episode Psychosis From the OPTiMiSE Project. Biol Psychiatry 2017; 82:766-772. [PMID: 28780967 DOI: 10.1016/j.biopsych.2017.06.015] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/14/2017] [Accepted: 06/14/2017] [Indexed: 12/13/2022]
Abstract
Circulating autoantibodies against glutamatergic N-methyl-D-aspartate receptor (NMDAR) have been reported in a proportion of patients with psychotic disorders, raising hopes for more appropriate treatment for these antibody-positive patients. However, the prevalence of circulating autoantibodies against glutamatergic NMDAR in psychotic disorders remains controversial, with detection prevalence rates and immunoglobulin classes varying considerably between studies, perhaps because of different detection methods. Here, we compared the results of serum assays for a large cohort of patients with first-episode psychosis using classical cell-based assays in three labs and a single molecule-based imaging method. Most assays and single molecule imaging in live hippocampal neurons revealed the presence of circulating autoantibodies against glutamatergic NMDAR in approximately 5% of patients with first-episode psychosis. However, some heterogeneity between cell-based assays was clearly observed, highlighting the urgent need for new sensitive methods to detect the presence of low-titer autoantibodies against glutamatergic NMDAR in seropositive patients who cannot be clinically identified from seronegative ones.
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111
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Al‐Diwani AAJ, Pollak TA, Irani SR, Lennox BR. Psychosis: an autoimmune disease? Immunology 2017; 152:388-401. [PMID: 28704576 PMCID: PMC5629440 DOI: 10.1111/imm.12795] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/03/2017] [Accepted: 07/05/2017] [Indexed: 12/22/2022] Open
Abstract
Psychotic disorders are common and disabling. Overlaps in clinical course in addition to epidemiological and genetic associations raise the possibility that autoimmune mechanisms may underlie some psychoses, potentially offering novel therapeutic approaches. Several immune loci including the major histocompatibility complex and B-cell markers CD19 and CD20 achieve genome-wide significance in schizophrenia. Emerging evidence suggests a potential role via neurodevelopment in addition to classical immune pathways. Additionally, lymphocyte biology is increasingly investigated. Some reports note raised peripheral CD19+ and reduced CD3+ lymphocyte counts, with altered CD4 : CD8 ratios in acute psychosis. Also, post-mortem studies have found CD3+ and CD20+ lymphocyte infiltration in brain regions that are of functional relevance to psychosis. More specifically, the recent paradigm of neuronal surface antibody-mediated (NSAb) central nervous system disease provides an antigen-specific model linking adaptive autoimmunity to psychopathology. NSAbs bind extracellular epitopes of signalling molecules that are classically implicated in psychosis such as NMDA and GABA receptors. This interaction may cause circuit dysfunction leading to psychosis among other neurological features in patients with autoimmune encephalitis. The detection of these cases is crucial as autoimmune encephalitis is ameliorated by commonly available immunotherapies. Meanwhile, the prevalence and relevance of these antibodies in people with isolated psychotic disorders is an area of emerging scientific and clinical interest. Collaborative efforts to achieve larger sample sizes, comparison of assay platforms, and placebo-controlled randomized clinical trials are now needed to establish an autoimmune contribution to psychosis.
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Affiliation(s)
- Adam A. J. Al‐Diwani
- Department of PsychiatryWarneford HospitalUniversity of OxfordOxfordUK
- Autoimmune Neurology GroupNuffield Department of Clinical NeurosciencesJohn Radcliffe HospitalUniversity of OxfordOxfordUK
| | - Thomas A. Pollak
- Department of Psychosis StudiesInstitute of Psychiatry, Psychology and NeuroscienceKing's Health PartnersLondonUK
| | - Sarosh R. Irani
- Autoimmune Neurology GroupNuffield Department of Clinical NeurosciencesJohn Radcliffe HospitalUniversity of OxfordOxfordUK
| | - Belinda R. Lennox
- Department of PsychiatryWarneford HospitalUniversity of OxfordOxfordUK
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112
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Radtke FA, Chapman G, Hall J, Syed YA. Modulating Neuroinflammation to Treat Neuropsychiatric Disorders. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5071786. [PMID: 29181395 PMCID: PMC5664241 DOI: 10.1155/2017/5071786] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/13/2017] [Indexed: 12/14/2022]
Abstract
Neuroinflammation is recognised as one of the potential mechanisms mediating the onset of a broad range of psychiatric disorders and may contribute to nonresponsiveness to current therapies. Both preclinical and clinical studies have indicated that aberrant inflammatory responses can result in altered behavioral responses and cognitive deficits. In this review, we discuss the role of inflammation in the pathogenesis of neuropsychiatric disorders and ask the question if certain genetic copy-number variants (CNVs) associated with psychiatric disorders might play a role in modulating inflammation. Furthermore, we detail some of the potential treatment strategies for psychiatric disorders that may operate by altering inflammatory responses.
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Affiliation(s)
- Franziska A. Radtke
- Neuroscience and Mental Health Research Institute and School of Biosciences, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
| | - Gareth Chapman
- Neuroscience and Mental Health Research Institute and School of Biosciences, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
| | - Jeremy Hall
- Neuroscience and Mental Health Research Institute and School of Biosciences, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
| | - Yasir A. Syed
- Neuroscience and Mental Health Research Institute and School of Biosciences, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
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113
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Zong S, Hoffmann C, Mané-Damas M, Molenaar P, Losen M, Martinez-Martinez P. Neuronal Surface Autoantibodies in Neuropsychiatric Disorders: Are There Implications for Depression? Front Immunol 2017; 8:752. [PMID: 28725222 PMCID: PMC5497139 DOI: 10.3389/fimmu.2017.00752] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 06/13/2017] [Indexed: 12/16/2022] Open
Abstract
Autoimmune diseases are affecting around 7.6-9.4% of the general population. A number of central nervous system disorders, including encephalitis and severe psychiatric disorders, have been demonstrated to associate with specific neuronal surface autoantibodies (NSAbs). It has become clear that specific autoantibodies targeting neuronal surface antigens and ion channels could cause severe mental disturbances. A number of studies have focused or are currently investigating the presence of autoantibodies in specific mental conditions such as schizophrenia and bipolar disorders. However, less is known about other conditions such as depression. Depression is a psychiatric disorder with complex etiology and pathogenesis. The diagnosis criteria of depression are largely based on symptoms but not on the origin of the disease. The question which arises is whether in a subgroup of patients with depression, the symptoms might be caused by autoantibodies targeting membrane-associated antigens. Here, we describe how autoantibodies targeting membrane proteins and ion channels cause pathological effects. We discuss the physiology of these antigens and their role in relation to depression. Finally, we summarize a number of studies detecting NSAbs with a special focus on cohorts that include depression diagnosis and/or show depressive symptoms.
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Affiliation(s)
- Shenghua Zong
- Division Neuroscience, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Carolin Hoffmann
- Division Neuroscience, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Marina Mané-Damas
- Division Neuroscience, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Peter Molenaar
- Division Neuroscience, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Mario Losen
- Division Neuroscience, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Pilar Martinez-Martinez
- Division Neuroscience, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
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114
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Corsi-Zuelli FMDG, Brognara F, Quirino GFDS, Hiroki CH, Fais RS, Del-Ben CM, Ulloa L, Salgado HC, Kanashiro A, Loureiro CM. Neuroimmune Interactions in Schizophrenia: Focus on Vagus Nerve Stimulation and Activation of the Alpha-7 Nicotinic Acetylcholine Receptor. Front Immunol 2017; 8:618. [PMID: 28620379 PMCID: PMC5449450 DOI: 10.3389/fimmu.2017.00618] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 05/10/2017] [Indexed: 12/28/2022] Open
Abstract
Schizophrenia is one of the most debilitating mental disorders and is aggravated by the lack of efficacious treatment. Although its etiology is unclear, epidemiological studies indicate that infection and inflammation during development induces behavioral, morphological, neurochemical, and cognitive impairments, increasing the risk of developing schizophrenia. The inflammatory hypothesis of schizophrenia is also supported by clinical studies demonstrating systemic inflammation and microglia activation in schizophrenic patients. Although elucidating the mechanism that induces this inflammatory profile remains a challenge, mounting evidence suggests that neuroimmune interactions may provide therapeutic advantages to control inflammation and hence schizophrenia. Recent studies have indicated that vagus nerve stimulation controls both peripheral and central inflammation via alpha-7 nicotinic acetylcholine receptor (α7nAChR). Other findings have indicated that vagal stimulation and α7nAChR-agonists can provide therapeutic advantages for neuropsychiatric disorders, such as depression and epilepsy. This review analyzes the latest results regarding: (I) the immune-to-brain pathogenesis of schizophrenia; (II) the regulation of inflammation by the autonomic nervous system in psychiatric disorders; and (III) the role of the vagus nerve and α7nAChR in schizophrenia.
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Affiliation(s)
| | - Fernanda Brognara
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Carlos Hiroji Hiroki
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Rafael Sobrano Fais
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Cristina Marta Del-Ben
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Luis Ulloa
- Department of Surgery, Center of Immunology and Inflammation, Rutgers University-New Jersey Medical School, Newark, NJ, United States
| | - Helio Cesar Salgado
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Alexandre Kanashiro
- Department of Physiological Sciences, Federal University of São Carlos, São Carlos, Brazil
| | - Camila Marcelino Loureiro
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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115
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Lee MM, Oke J, Palmer-Cooper EC, Lennox BR. NMDAR antibodies in first episode psychosis: conclusions too inflammatory given results? - Authors' reply. Lancet Psychiatry 2017; 4:356-357. [PMID: 28456292 DOI: 10.1016/s2215-0366(17)30139-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 03/20/2017] [Indexed: 12/30/2022]
Affiliation(s)
- Mei-Man Lee
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX3 7JX, UK
| | - Jason Oke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX3 7JX, UK
| | - Emma C Palmer-Cooper
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford OX3 7JX, UK
| | - Belinda R Lennox
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford OX3 7JX, UK.
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116
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NMDAR antibodies in first episode psychosis: conclusions too inflammatory given results? Lancet Psychiatry 2017; 4:356. [PMID: 28456291 DOI: 10.1016/s2215-0366(17)30104-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 03/04/2017] [Accepted: 03/06/2017] [Indexed: 11/24/2022]
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117
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Dalmau J, Geis C, Graus F. Autoantibodies to Synaptic Receptors and Neuronal Cell Surface Proteins in Autoimmune Diseases of the Central Nervous System. Physiol Rev 2017; 97:839-887. [PMID: 28298428 PMCID: PMC5539405 DOI: 10.1152/physrev.00010.2016] [Citation(s) in RCA: 340] [Impact Index Per Article: 48.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Investigations in the last 10 years have revealed a new category of neurological diseases mediated by antibodies against cell surface and synaptic proteins. There are currently 16 such diseases all characterized by autoantibodies against neuronal proteins involved in synaptic signaling and plasticity. In clinical practice these findings have changed the diagnostic and treatment approach to potentially lethal, but now treatable, neurological and psychiatric syndromes previously considered idiopathic or not even suspected to be immune-mediated. Studies show that patients' antibodies can impair the surface dynamics of the target receptors eliminating them from synapses (e.g., NMDA receptor), block the function of the antigens without changing their synaptic density (e.g., GABAb receptor), interfere with synaptic protein-protein interactions (LGI1, Caspr2), alter synapse formation (e.g., neurexin-3α), or by unclear mechanisms associate to a new form of tauopathy (IgLON5). Here we first trace the process of discovery of these diseases, describing the triggers and symptoms related to each autoantigen, and then review in detail the structural and functional alterations caused by the autoantibodies with special emphasis in those (NMDA receptor, amphiphysin) that have been modeled in animals.
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Affiliation(s)
- Josep Dalmau
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania; Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain; Hans-Berger Department of Neurology, Jena University Hospital, Jena, Germany; Servei de Neurologia, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Christian Geis
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania; Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain; Hans-Berger Department of Neurology, Jena University Hospital, Jena, Germany; Servei de Neurologia, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Francesc Graus
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania; Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain; Hans-Berger Department of Neurology, Jena University Hospital, Jena, Germany; Servei de Neurologia, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
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118
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Pollak TA, Moran N. Emergence of new-onset psychotic disorder following recovery from LGI1 antibody-associated limbic encephalitis. BMJ Case Rep 2017; 2017:bcr-2016-218328. [PMID: 28363946 PMCID: PMC5388006 DOI: 10.1136/bcr-2016-218328] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Neuronal autoantibodies targeting cell surface antigens have been described in association with autoimmune encephalitides which frequently feature psychosis and other psychiatric disturbances alongside neurological signs and symptoms. Little has been written however about the long-term psychiatric status of individuals following recovery from the acute phase of autoimmune encephalitis, despite case series and anecdotal evidence suggesting this may be a cause of considerable disability. Here, we describe a man aged 58 years with no psychiatric history who developed a severe and acute psychotic disorder following resolution of a protracted course of limbic encephalitis associated with antibodies to leucine-rich glioma inactivated 1 protein. No indications of a gross ongoing inflammatory or encephalopathic process were present at presentation of his psychosis. Possible aetiologies of his acute psychosis are discussed. This case highlights the importance of ongoing psychiatric follow-up of patients following an episode of autoimmune encephalitis.
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Affiliation(s)
- Thomas A Pollak
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nick Moran
- King's College Hospital NHS Foundation Trust, London, UK
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119
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Riedmüller R, Müller S. Ethical Implications of the Mild Encephalitis Hypothesis of Schizophrenia. Front Psychiatry 2017; 8:38. [PMID: 28348532 PMCID: PMC5346578 DOI: 10.3389/fpsyt.2017.00038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 02/27/2017] [Indexed: 02/02/2023] Open
Abstract
Schizophrenia is a serious mental disease with a high mortality rate and severe social consequences. Due to insufficient knowledge about its etiopathogenesis, curative treatments are not available. One of the most promising new research concepts is the mild encephalitis hypothesis of schizophrenia, developed mainly by Karl Bechter and Norbert Müller. According to this hypothesis, a significant subgroup of schizophrenia patients suffer from a mild, but chronic, form of encephalitis with markedly different etiologies ranging from viral infections, traumas to autoimmune diseases. This inflammatory process is thought to occur in the beginning or during the course of the disease. In this article, we investigate the consequences of the mild encephalitis hypothesis of schizophrenia for the scientific community, and evaluate these consequences ethically. The mild encephalitis hypothesis implies that schizophrenia would no longer be considered an incurable psychiatric disorder. Instead, it would be considered a chronic, but treatable, neurological disease. This paradigm shift would doubtlessly have significant consequences: (1) major reforms would be necessary in the theoretical conceptualization of schizophrenia, which would challenge the psychiatric diagnostic systems, Diagnostic and Statistical Manual of Mental Disorders version 5 and ICD-10. (2) Psychotic patients should be treated in interdisciplinary teams, optimally in neuropsychiatric units; additionally, specialists for endocrinology, diabetology, and cardiology should be consulted for the frequently occuring somatic comorbidities. (3) Current diagnostic procedures and (4) therapies would have to be modified significantly. (5) There might be repercussions for the pharmaceutical industry as well: first, because old drugs with expired patent protection could partly replace expensive drugs and, second, because there would be a demand for the development of new anti-inflammatory drugs. (6) Legal evaluation of compulsory treatment orders might have to be reconsidered in light of causal therapies; leading to increased legal approval and reduced need for compulsory treatment orders due to better patient compliance. (7) The social inclusion of patients might improve, if treatment became more effective regarding cognitive and social functioning. (8) The stigmatization of patients and their relatives might decrease.
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Affiliation(s)
- Rita Riedmüller
- Mind and Brain Research, Department of Psychiatry and Psychotherapy, CCM, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Sabine Müller
- Mind and Brain Research, Department of Psychiatry and Psychotherapy, CCM, Charité – Universitätsmedizin Berlin, Berlin, Germany
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120
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Anti-NMDAR antibodies as a new piece in schizophrenia's puzzle. Future Sci OA 2017; 3:FSO178. [PMID: 28670470 PMCID: PMC5481851 DOI: 10.4155/fsoa-2017-0009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 01/26/2017] [Indexed: 12/27/2022] Open
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121
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Leypoldt F, de Witte L, Lancaster E, Titulaer MJ. Serum neuronal cell-surface antibodies in first-episode psychosis. Lancet Psychiatry 2017; 4:186-187. [PMID: 28236946 DOI: 10.1016/s2215-0366(17)30043-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 01/11/2017] [Accepted: 01/12/2017] [Indexed: 01/28/2023]
Affiliation(s)
- Frank Leypoldt
- Department of Neurology and Institute of Laboratory Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Lot de Witte
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Eric Lancaster
- The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Maarten J Titulaer
- Department of Neurology, Erasmus University Medical Center, Rotterdam 3015 CE, Netherlands.
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122
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Serum neuronal cell-surface antibodies in first-episode psychosis. Lancet Psychiatry 2017; 4:187. [PMID: 28236948 DOI: 10.1016/s2215-0366(17)30039-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 12/29/2016] [Accepted: 01/09/2017] [Indexed: 11/21/2022]
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123
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Lennox BR, Pollak T, Palmer-Cooper EC, Scoriels L, Harrison PJ, Jones PB, Lang B, Crowley H, Marks J, Vincent A. Serum neuronal cell-surface antibodies in first-episode psychosis-Authors' reply. Lancet Psychiatry 2017; 4:187-188. [PMID: 28236947 DOI: 10.1016/s2215-0366(17)30053-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 02/01/2017] [Indexed: 11/17/2022]
Affiliation(s)
| | - Thomas Pollak
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | | | - Linda Scoriels
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paul J Harrison
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Peter B Jones
- Department of Psychiatry, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Bethan Lang
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Hannah Crowley
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Jacqui Marks
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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124
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Al-Diwani A, Pollak TA, Langford AE, Lennox BR. Synaptic and Neuronal Autoantibody-Associated Psychiatric Syndromes: Controversies and Hypotheses. Front Psychiatry 2017; 8:13. [PMID: 28220082 PMCID: PMC5292436 DOI: 10.3389/fpsyt.2017.00013] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 01/17/2017] [Indexed: 12/26/2022] Open
Abstract
Autoimmune encephalitis (AE) mediated by antibodies against synaptic and neuronal surface targets frequently presents with a psychiatric syndrome. In these patients, removal of autoantibodies treats the disease and outcomes are closely linked to early intervention. The discovery of these autoantibodies in isolated psychiatric syndromes has raised the possibility that these patients may derive similar benefits from immunotherapy, a potentially transformational approach to the treatment of mental illness. Although open-label case series suggest impressive therapeutic outcomes, the pathological relevance of these autoantibodies outside of canonical presentations is debated. The advent of diagnostic criteria for AE attempts to facilitate its prompt identification but risks prematurely neglecting the potential scientific and clinical significance of isolated syndromes that do not satisfy these criteria. Here, we propose using a syndrome-level taxonomy that has occasional, but not necessary, overlap with AE: synaptic and neuronal autoantibody-associated psychiatric syndromes or "SNAps". This will prevent confusion with AE and act heuristically to promote active investigation into this rare example of psychopathology defined on a molecular level. We suggest that this concept would have application in other autoantibody-associated syndromes including seizure, cognitive, and movement disorders, in which similar issues arise. We review putative direct and indirect mechanisms and outline experimentally testable hypotheses that would help to determine prospectively in whom autoantibody detection is relevant, and as important, in whom it is not. We summarize a pragmatic approach to autoantibody testing and management in severe mental illness in order to promptly diagnose AE and advocate a research-orientated experimental medicine paradigm for SNAps, where there is greater equipoise. We conclude that SNAps remains a nascent area of clinical neuroscience with great potential and in ongoing need of psychiatry-led basic and clinical research.
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Affiliation(s)
- Adam Al-Diwani
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Thomas A Pollak
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's Health Partners , London , UK
| | - Alexander E Langford
- Oxford Health NHS Foundation Trust, Oxford, Oxfordshire, UK; Department of Psychological Medicine, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Belinda R Lennox
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, Oxfordshire, UK
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125
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Fyfe I. Neuroimmunology: Could antibodies cause psychosis? Nat Rev Neurol 2016; 13:66-67. [PMID: 28009015 DOI: 10.1038/nrneurol.2016.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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