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

Abstract

<b><i>Objective:</i></b> 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. <b><i>Methods:</i></b> A literature search was conducted using the PubMed/Medline, Web of Knowledge, and Scopus databases. <b><i>Results:</i></b> 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. <b><i>Conclusions:</i></b> 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.

NMDAR autoantibodies in psychiatric disease - An immunopsychiatric continuum and potential predisposition for disease pathogenesis

“…1 ) involving a mild encephalitis developing into a severe autoimmune encephalitis fulfilling the latest NMDARE criteria. A systematic review of NMDAR antibodies in psychiatric disorders pointed out that the seropositivity varies widely, ranging from 0.5 to 11.6% depending on the study population and testing methods (fixed or live cell-based assay) [ 38 ]. These authors suggested that the NMDAR autoantibodies play a role in a subgroup of psychotic patients [ 38 ].…”

“…A systematic review of NMDAR antibodies in psychiatric disorders pointed out that the seropositivity varies widely, ranging from 0.5 to 11.6% depending on the study population and testing methods (fixed or live cell-based assay) [ 38 ]. These authors suggested that the NMDAR autoantibodies play a role in a subgroup of psychotic patients [ 38 ]. A very recent investigation highlighted a specific psychopathology that may indicate an NMDARE, such as a polymorphic psychotic symptomatology, a fluctuating course with marked cognitive dysfunction and psychotic symptoms [ 39 ].…”

Autoimmune Encephalitis With Psychotic Manifestations and Cognitive Impairment Presenting as Schizophrenia: Case Report and Literature Review

“…Previous studies indicated that patients diagnosed with bipolar disorder, autistic traits, or psychotic disorder presented with autoimmune encephalitis a few years after the original diagnosis (20,22,28,30), demonstrating that autoimmune encephalitis with prevalent psychiatric manifestations may be misdiagnosed and mistreated. Anti-NMDA-receptor encephalitis frequently has a relapsing course (30)(31)(32).…”

“…Psychotic manifestations are often observed among patients with autoimmune disorders ( 20 , 21 ). Anti-NMDA-receptor encephalitis might be present in a subset of patients with psychosis, and immunotherapy can be considered a treatment option for patients who fail to respond to other therapies ( 22 ). Moreover, although pure psychotic manifestations of antibody-associated autoimmune encephalitis without any additional neuropsychiatric findings are rare ( 23 ), it is easy to overlook autoimmune encephalitis, particularly when the neurological symptoms are atypical.…”

Comprehensive Clinical and Social Research at the Moscow Research Institute of Psychiatry: Translation into Clinical Practice

“…This refers to the study of evoked potentials, 50,51 in particular, the study of facial expressions, [52][53][54][55] the study of oculomotor alterations in patients with schizophrenia spectrum disorders 56 and autoimmune disorders in newly emerging psychotic states. [56][57][58][59] In general, the task is to carry out a network analysis of the identified disorders. [60][61][62] Thus, the research carried out at the present time preserves the tradition of an integrated clinical and social approach, on the basis of which organizational models of psychiatric services are proposed.…”