Increased prevalence of diverse N-methyl-D-aspartate glutamate receptor antibodies in patients with an initial diagnosis of schizophrenia: specific relevance of IgG NR1a antibodies for distinction from N-methyl-D-aspartate glutamate receptor encephalitis.
Johann Steiner,Martin Walter,Wenzel Glanz,Zoltán Sarnyai,Hans-Gert Bernstein,Stefan Vielhaber,A. Kästner,Martin Skalej,Wolfgang Jordan,Kolja Schiltz,Christine Klingbeil,Klaus-Peter Wandinger,Bernhard Bogerts,Winfried Stoecker +13 more
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TLDR
Acutely ill patients with an initial schizophrenia diagnosis show an increased prevalence of NMDA-R antibodies and the repertoire of antibody subtypes in schizophrenia and MD is different from that with NMda-R encephalitis.Abstract:
Context: Evidence for symptomatic convergence of schizophrenia and N-methyl-D-aspartate glutamate receptor (NMDA-R) encephalitis highlights the need for an assessment of antibody prevalence and specificity for distinct disease mechanisms in patients with a diagnosis of schizophrenia among glutamatergic pathophysiologic abnormalities in psychiatric disorders. Objectives: To compare the specificity and prevalence of NMDA-R antibodies in schizophrenia (DSM-IV criteria) with those of other psychiatric diagnoses and to determine whether antibody subtypes characterize overlap withanddistinctionfromthoseinNMDA-Rencephalitis. Design: Serum from 459 patients admitted with acute schizophrenia, major depression (MD), and borderline personality disorder (BLPD) or individuals serving as matched controls was obtained from our scientific blood bank. To explore epitope specificity and antibody subtype, IgA/IgG/IgM NMDA-R (NR1a or NR1a/NR2b) and -amino-3-hydroxyl-5-methyl-4-isoxazole-propionatereceptors(AMPA-R)(GluR1/GluR2)serumantibodieswere determined. Participants:Twohundredthirtymatchedhealthycontrols were compared with patients (unmedicated for at least6weeks)withschizophrenia(n=121),MD(n=70), or BLPD (n=38). Main Outcome Measures: The primary outcome was theoverallnumberofseropositivecasesforNMDA-Rand AMPA-R antibodies; the secondary outcome was disease specificity of IgA/IgG/IgM antibodies and epitope specificity for clinical subgroups. Results: Diverse NMDA-R antibodies were identified in 15 subjects, primarily those with an initial schizophrenia diagnosis (9.9%), opposed to MD (2.8%), BLPD (0), and controls (0.4%). Retrospectively, 2 patients initially classifiedashavingcatatonicordisorganizedschizophreniawere reclassified as having misdiagnosed NMDA-R encephalitis(presenceofspecificserumandcerebrospinalfluidIgG NR1a antibodies). In all other seropositive cases, the antibodies consisted of classes IgA and/or IgM or were directedagainstNR1a/NR2b(notagainstNR1aalone).None ofthepatientsorcontrolshadantibodiesagainstAMPA-R. Conclusions: Acutely ill patients with an initial schizophrenia diagnosis show an increased prevalence of NMDA-R antibodies. The repertoire of antibody subtypesinschizophreniaandMDisdifferentfromthatwith NMDA-Rencephalitis.Thelatterdisordershouldbeconsidered as a differential diagnosis, particularly in young females with acute disorganized behavior or catatonia.read more
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Autoimmunity in psychotic disorders. Where we stand, challenges and opportunities.
Marina Mané-Damas,Carolin Hoffmann,Shenghua Zong,Amanda Tan,Peter C. M. Molenaar,Mario Losen,Pilar Martinez-Martinez +6 more
TL;DR: The current knowledge, on antibody mediated autoimmunity in psychotic disorders, the different diagnostic methods and their limitations, as well as varying therapeutic approaches targeting the immune system are reviewed.
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Brain-relevant antibodies in first-episode psychosis: a matched case-control study.
Fiona Gaughran,John Lally,Katherine Beck,Ruaidhri McCormack,Poonam Gardner-Sood,Ester Coutinho,Leslie Jacobson,Bethan Lang,Ricardo Sainz-Fuertes,Evangelos Papanastasiou,Marta Di Forti,Timothy R Nicholson,Angela Vincent,Robin M. Murray +13 more
TL;DR: This case–control study of the prevalence of antibodies in FEP does not provide evidence to support the hypothesis that FEP is associated with an immune-mediated process in a subgroup of patients, and the field requires more research to put these findings in context.
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Anti-N-methyl-d-aspartate receptor encephalitis in a patient with a 7-year history of being diagnosed as schizophrenia: complexities in diagnosis and treatment
Chaohua Huang,Yukun Kang,Bo Zhang,Li Bin,Changjian Qiu,Shanming Liu,Hongyan Ren,Yanchun Yang,Xiehe Liu,Tao Li,Wanjun Guo +10 more
TL;DR: It is illustrated that psychiatrists should consider anti-NMDAR encephalitis and order tests for specific immunoglobulin G NR1 autoantibodies in patients presenting with disorientation, disturbance of consciousness, cognitive deficit, dyskinesia, autonomic disturbance, or rapid deterioration, even with a seemingly clear history of a psychiatric disorder.
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Autoimmune encephalitis and psychiatric disorders.
TL;DR: The description of AE subgroups over the past decade has allowed the present overview of their incidence in psychiatric diseases and some general guidelines for the management of these patients.
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Autoimmune-induced glutamatergic receptor dysfunctions: conceptual and psychiatric practice implications.
TL;DR: The characterization of autoimmune-induced glutamatergic receptor dysfunctions (AGRD) is likely to have a substantial conceptual impact upon the understanding of neuropsychiatric disorders including schizophrenia, affective and movement Dysfunctions.
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Dementia praecox and paraphrenia
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