Anti-NMDA receptor antibody positivity in acute psychotic states: An exploratory study

Bharadwaj, Balaji; Sathyanarayanan, Gopinath; Kaliaperumal, Venkatesh; Dhodapkar, Rahul

doi:10.1016/j.ajp.2019.05.023

Cited by 3 publications

(10 citation statements)

References 26 publications

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“…However, studies focusing on different populations have reported the prevalence of ATPD. [ 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 ] One of the studies from Chandigarh that focused on the first prescription of patients presenting to the outpatient setting of a tertiary care hospital suggests the prevalence of ATPD to be 2.26% in new adult patients presenting to the walk-in clinic. [ 37 ] The prevalence of ATPD in older people from the same dataset was reported to be 0.6%.…”

Section: Resultsmentioning

confidence: 99%

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Acute and transient psychotic disorders: A review of Indian research

Grover,

Kathiravan

2023

Indian Journal of Psychiatry

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Background: Acute and transient psychotic disorder (ATPD) was recognized as separate from other psychotic disorders and described in the International Classification of Diseases (ICD) tenth revision for the first time. A lot of research on ATPD has been conducted in India over the last six decades, but a review focusing exclusively on Indian research on ATPD is not available. Aim: This paper aims to review the literature on ATPD emerging from India. Methodology: A combination of search terms “Acute and Transient Psychosis,” “acute psychosis,” “non-affective psychosis,” “non-affective psychotic disorder,” “reactive psychosis,” “first-episode psychosis,” and “India” were searched on various search engines like PUBMED, Medknow, Hinari, and Google Scholar. We also did a hand search for additional relevant articles, including published abstracts of the Indian Journal of Psychiatry from 2007 to 2023. Relevant papers were selected. Results: The prevalence of ATPD varies across different study settings, and it tends to have an abrupt to acute onset, and is primarily associated with stress. Few studies have assessed the subtypes of ATPD, and symptom profile has been inconsistently reported. There is a lack of trials on the effectiveness or efficacy of antipsychotics in ATPD patients. In a large proportion of patients initially diagnosed with ATPD, the diagnosis remains stable, with recurrence varying from 10% to 46.6% based on the duration of follow-up. Conclusion: There is a need for more multicentric studies, studies with larger sample sizes, and consistency in data about risk factors. There is a need to evaluate symptom profile, course, outcome, and treatment outcomes in patients with ATPD using validated instruments to improve our understanding. Further, there is a need for comparative studies to evaluate the risk factors for ATPD.

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Section: Resultsmentioning

confidence: 99%

“…[ 53 ] In a mixed setting of both inpatient and outpatient populations of females with postpartum depression (PPD)/PPP, the prevalence of ATPD ranged from 7.7%[ 54 ] to 61%. [ 55 ] A study that evaluated patients with suspected autoimmune encephalitis reported the prevalence to be 53.4%[ 56 ] [ Table 1 ].…”

Section: Resultsmentioning

confidence: 99%

Acute and transient psychotic disorders: A review of Indian research

Grover,

Kathiravan

2023

Indian Journal of Psychiatry

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“…Overall, 26 of 41 studies found some percentage of positive cases in patient groups (that had ABs of any Ig class against any subunit of NMDAR). Five studies that did not find any positive cases had very small samples ( n < 30) [32-36], while all other studies had bigger samples. Only 3 studies that included small patient groups (5 patients with narcolepsy and severe psychosis, 15 patients with first episode psychosis [FEP] [less than a month of psychotic symptoms] with neurological symptoms, and 6 patients with a clinical high risk for psychosis) succeeded in finding 3 (60%), 4 (26.7%), and 1 (16.7%) positive cases, respectively [37-39].…”

Section: Resultsmentioning

confidence: 99%

“…Nineteen studies assessed IgG ABs directed against NMDA receptor NR1 subunit. These ABs were found in some participants of 8 studies [24, 41, 43, 45, 46, 49-51], while 11 studies failed to find them [32-34, 36, 40, 48, 52-56] (Table 1). Most studies used immunohistochemistry and/or immunocytochemistry and/or single-molecule high-resolution imaging as confirmation methods.…”

Section: Resultsmentioning

confidence: 99%

“…Eight studies clearly stated that blood was taken from patients in acute phase of the disease, 2 studies acquired samples at admission, 3 during hospitalization, and 2 – “as soon as possible” after admission or contact for psychosis. In general, 12 of the 15 aforementioned studies found small numbers of participants with IgG ABs [31, 41, 44-46, 50, 51, 55, 57, 59, 61, 66], one with IgA or IgM ABs only [48], and no AB-positive patients were found in 2 studies (one of them had very small sample) [32, 53]. However, the only study that stated that patients were stable at the moment of blood withdrawal also revealed positive cases [49].…”

Section: Resultsmentioning

confidence: 99%

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Antibodies against N-Methyl D-Aspartate Receptor in Psychotic Disorders: A Systematic Review

et al. 2021

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Objective: The objective of this study was to provide comprehensive evidence synthesis including all available up-to-date data about the prevalence of N-methyl D-aspartate receptor (NMDAR) antibodies (ABs) in psychotic patients in order to evaluate the clinical relevance of ABs as well as to specify potential explanations of the heterogeneity of the findings and determine areas for further research. Methods: A literature search was conducted using the PubMed/Medline, Web of Knowledge, and Scopus databases. Results: Forty-seven studies and 4 systematic reviews (including 2 meta-analyses) were included in the present review. Studies that used cell-based assays (CBAs) provided heterogeneous results on AB prevalence, obviously depending on the type of detection assay and sample characteristics. Improvement of AB detection methods is necessary to determine the real prevalence of ABs across different groups of patients and healthy people. Live CBAs seem to have better sensitivity but probably poorer specificity than fixed CBAs. Moreover, some links between AB-positive status and acute symptoms are possible. A small amount of data on immunotherapy in AB-positive patients raises the possibility of its effectiveness but obviously require further research. Conclusions: NMDAR ABs are definitely present in a subset of psychotic patients. NMDAR ABs might shape psychosis and underlie some symptoms, and immunotherapy might be regarded as a treatment option for patients failing to respond to other therapies.

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