Autoimmune Concept of Schizophrenia: Historical Roots and Current Facets

Mayorova, Margarita; Бутома, Б. Г.; Чурилов, Леонид Павлович; Gilburd, Boris; Petrova, Н.; Shoenfeld, Yehuda

doi:10.24869/psyd.2021.3

Cited by 9 publications

(8 citation statements)

References 49 publications

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“…More large-scale studies are therefore necessary to investigate any systematic age effect that might affect our findings. Surprisingly, we have also detected a higher proportion of patients with a paranoid hallucinatory syndrome in the group of psychiatric patients without neural autoantibodies as a tendency, a finding that contradicts previous reports on autoantibody-mediated psychosis in patients (18)(19)(20)(21) and animal models (10) and that might depend on cohort size; this result should be replicated in larger cohorts. Another limitation is that we did not systematically screen for any head injuries, none of the patients' clinical data suggested any trauma.…”

Section: Limitationscontrasting

confidence: 99%

City Environment and Occurrence of Neural Autoantibodies in Psychiatric Patients

et al. 2022

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BackgroundCity living might lead to a higher risk of psychiatric disease, but to date there is no evidence of any correlation between an urban environment and the occurrence of neural autoantibodies in psychiatric disease. Our aim is to identify whether the number of patients with and without neural autoantibodies living in diverse rural and urban environments differ.MethodsWe enrolled retrospectively a cohort of 167 psychiatric patients via a cross-sectional design from the Department of Psychiatry and Psychotherapy University Medical Center Göttingen and determined serum and/or CSF neural autoantibodies in them. The patients live in the German states of Lower Saxony, Thuringia, and Hessen. Their data were investigated in conjunction with the location of their primary residence. We categorized them into five different categories depending upon their primary residence: one rural and four different urban environments depending on their population numbers.ResultsWe identified 36 psychiatric patients with neural autoantibodies, and 131 psychiatric patients with none. In total, 24 psychiatric patients with neural autoantibodies were classified as sharing a possible, probable, or definitive autoimmune origin according to our recently set criteria. We observed as a non-significant trend that more psychiatric patients with neural autoantibodies and a probable or definitive autoimmune origin (45.8%) live in a major city with over 100,000 inhabitants than do psychiatric patients presenting no evidence of autoantibodies (26.4%). However, we identified no relevant differences between (1) psychiatric patients with and without neural autoantibodies or between (2) psychiatric patients with a possible, probable, or definitive autoimmune origin and those without such autoantibodies in relation to the diverse rural and urban environmental settings.ConclusionThe inherently different aspects of rural and urban environments do not appear to be relevant in determining the frequency of neural autoantibodies in psychiatric patients in Lower Saxony, Thuringia, and Hessen in Germany. Furthermore, large-scale studies involving other states across Germany should be conducted to exclude any regional differences and to examine the tendency of a higher frequency in large cities of autoimmune-mediated psychiatric syndromes.

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Section: Limitationscontrasting

confidence: 99%

City Environment and Occurrence of Neural Autoantibodies in Psychiatric Patients

et al. 2022

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“…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).…”

Section: Discussionmentioning

confidence: 99%

“…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 ).…”

Section: Introductionmentioning

confidence: 99%

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

Luo

Jiang

et al. 2022

Front. Psychiatry

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Autoimmune encephalitis is characterized by mental and behavioral symptoms, seizures, and cognitive impairment. The presence of schizophrenia needs to be distinguished from that of autoimmune encephalitis. Herein, we describe the case of a woman who exhibited abnormal mental behavior and cognitive impairment. The patient had experienced similar symptoms more than 20 years previously and had been diagnosed with schizophrenia. The patient's psychotic symptoms improved after treatment with antipsychotic drugs; however, cognitive impairment persisted. She was diagnosed with anti-N-methyl-D-aspartate (NMDA)-receptor concurrent with anti-α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA)-receptor encephalitis. She showed improvement after treatment with steroids and intravenous immunoglobulins (IVIgs). Furthermore, we reviewed the literature and found that, including the present case, 10 patients have been diagnosed with anti-NMDA concurrent with anti-AMPA-receptor encephalitis. Three of these patients were men and seven were women, and their ages ranged from 21 to 71 years. Moreover, seven (70%) patients had a history of tumors. Symptoms of these patients included psychotic symptoms, varying degrees of consciousness disturbance, seizures, dyskinesia, dystonia, autonomic dysfunction, agitation, and verbal reduction. Brain magnetic resonance imaging findings showed scattered fluid-attenuated inversion recovery hyperintensity in subcortical white matter and/or medial temporal lobe in seven (70%) patients. After combination treatment, including tumor removal and administration of steroids, IVIg, plasma exchange, or immunity inhibitors, the symptoms improved in part of the patients. It is necessary to exclude autoimmune encephalitis for patients with psychiatric manifestations and cognitive impairment. Timely combination therapy is important in anti-NMDA-receptor concurrent with anti-AMPA-receptor encephalitis.

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Section: Introductionmentioning

confidence: 99%

“…Autoimmune encephalitis is associated with a range of disorders and has been observed in patients diagnosed with schizophrenia, bipolar disorder and depression [8]. There have been reports that previous research has indicated that patients initially diagnosed with bipolar disorder, autistic traits, or psychotic disorder may develop autoimmune encephalitis several years later highlighting the possibility of misdiagnosis and mistreatment of autoimmune encephalitis with predominant psychiatric manifestations [9][10][11][12] Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is commonly characterized by a relapsing pattern, with patients often experiencing persistent behavioral, memory, cognitive, and executive function alterations even during the recovery phase [13]. In contrast, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (anti-AMPA-receptor) encephalitis typically leads to a rapid deterioration of neurological function [14].…”

Section: Introductionmentioning

confidence: 99%

Pediatric anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis: Exploring psychosis, related risk factors, and hospital outcomes in a nationwide inpatient sample: A cross-sectional study

Jaka,

Singh,

Vashist

et al. 2024

PLoS ONE

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Objective Our study aims to examine the risk factors for comorbid psychosis in pediatric patients hospitalized for anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis and its impact on hospital outcomes. Methods We conducted a cross-sectional study using the nationwide inpatient sample (NIS 2018–2019). We included 3,405 pediatric inpatients (age 6–17 years) with a primary discharge diagnosis of anti-NMDAR encephalitis. We used binomial logistic regression model to evaluate the odds ratio (OR) of variables (demographic and comorbidities) associated with comorbid psychosis. Results The prevalence of comorbid psychosis in anti-NMDAR encephalitis inpatients was 5.3%, and majorly constituted of adolescents (72.2%) and females (58.3%). In terms of race, Blacks (OR 2.41), and Hispanics (OR 1.80) had a higher risk of comorbid psychosis compared to Whites. Among comorbidities, encephalitis inpatients with depressive disorders (OR 4.60), sleep-wake disorders (OR 3.16), anxiety disorders (OR 2.11), neurodevelopmental disorders (OR 1.95), and disruptive behavior disorders (OR 2.15) had a higher risk of comorbid psychosis. Anti-NMDAR encephalitis inpatients with comorbid psychosis had a longer median length of stay at 24.6 days (vs. 9.8 days) and higher median charges at $262,796 (vs. $135,323) compared to those without psychotic presentation. Conclusion Adolescents, females, and Blacks with encephalitis have a higher risk of psychotic presentation leading to hospitalization for anti-NMDAR encephalitis. Identification of demographic predictors and comorbidities can aid in early recognition and intervention to optimize care and potentially reduce the healthcare burden.

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Autoimmune Concept of Schizophrenia: Historical Roots and Current Facets

Cited by 9 publications

References 49 publications

City Environment and Occurrence of Neural Autoantibodies in Psychiatric Patients

City Environment and Occurrence of Neural Autoantibodies in Psychiatric Patients

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

Pediatric anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis: Exploring psychosis, related risk factors, and hospital outcomes in a nationwide inpatient sample: A cross-sectional study

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