Skip to main content
×
×
Home

The prevalence and treatment outcomes of antineuronal antibody-positive patients admitted with first episode of psychosis

  • James G. Scott (a1), David Gillis (a2), Alex E. Ryan (a3), Hethal Hargovan (a4), Nagaraj Gundarpi (a4), Gemma McKeon (a5), Sean Hatherill (a6), Martin P. Newman (a7), Peter Parry (a8), Kerri Prain (a2), Sue Patterson (a9), Richard C. W. Wong (a10), Robert J. Wilson (a10) and Stefan Blum (a11)...
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.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      The prevalence and treatment outcomes of antineuronal antibody-positive patients admitted with first episode of psychosis
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      The prevalence and treatment outcomes of antineuronal antibody-positive patients admitted with first episode of psychosis
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      The prevalence and treatment outcomes of antineuronal antibody-positive patients admitted with first episode of psychosis
      Available formats
      ×
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.
Corresponding author
Correspondence: James G. Scott, MBBS, FRANZCP, PhD, The University of Queensland Centre for Clinical Research, UQ Centre for Clinical Research. Building 71/918 Royal Brisbane and Women's Hospital Campus Herston, Queensland, Australia, 4029. Email: james.scott@health.qld.gov.au
References
Hide All
1 Farber, NB. The NMDA receptor hypofunction model of psychosis. Ann N Y Acad Sci 2003; 1003: 119–30.
2 Dalmau, J, Tuzun, E, Wu, H-y, Masjuan, J, Rossi, JE, Voloschin, A, et al. Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol 2007; 61(1): 2536.
3 Moura, M, Silva-Dos-Santos, A, Afonso, J, Talina, M. First-episode psychosis in a 15 year-old female with clinical presentation of anti-NMDA receptor encephalitis: a case report and review of the literature. BMC Res Notes 2016; 9: 374.
4 Kramina, S, Kevere, L, Bezborodovs, N, Purvina, S, Rozentals, G, Strautmanis, J, et al. Acute psychosis due to non-paraneoplastic anti-NMDA-receptor encephalitis in a teenage girl: Case report. Psych J 2015; 4(4): 226–30.
5 Heekin, RD, Catalano, MC, Frontera, AT, Catalano, G. Anti-NMDA receptor encephalitis in a patient with previous psychosis and neurological Abnormalities: a diagnostic challenge. Case Rep Psychiatry 2015; 2015: 253891.
6 Lu, J, Samson, S, Kass, J, Ram, N. Acute psychosis in a pregnant patient with Graves’ hyperthyroidism and anti-NMDA receptor encephalitis. BMJ Case Rep 2015; 2015: bcr2014208052.
7 Tidswell, J, Kleinig, T, Ash, D, Thompson, P, Galletly, C. Early recognition of anti-N-methyl D-aspartate (NMDA) receptor encephalitis presenting as acute psychosis. Australas Psychiatry 2013; 21(6): 596–9.
8 Shaaban, HS, Choo, HF, Sensakovic, JW. Anti-NMDA-receptor encephalitis presenting as postpartum psychosis in a young woman, treated with rituximab. Ann Saudi Med 2012; 32(4): 421–3.
9 Mesquita, J, Siva, L. Anti-NMDA receptor encephalitis suspected as cause of drug-induced psychosis. J Neuropsychiatry Clin Neurosci 2011; 23(4): E2.
10 Bergink, V, Armangue, T, Titulaer, MJ, Markx, S, Dalmau, J, Kushner, SA. Autoimmune encephalitis in postpartum psychosis. Am J Psychiatry 2015; 172(9): 901–8.
11 Irani, SR, Vincent, A. NMDA receptor antibody encephalitis. Curr Neurol Neurosci Rep 2011; 11(3): 298304.
12 Wandinger, K-P, Saschenbrecker, S, Stoecker, W, Dalmau, J. Anti-NMDA-receptor encephalitis: a severe, multistage, treatable disorder presenting with psychosis. J Neuroimmunol 2011; 231(1–2): 8691.
13 Masdeu, JC, Gonzalez-Pinto, A, Matute, C, Ruiz De Azua, S, Palomino, A, De Leon, J, et al. Serum IgG antibodies against the NR1 subunit of the NMDA receptor not detected in schizophrenia. Am J Psychiatry 2012; 169(10): 1120–1.
14 Rhoads, J, Guirgis, H, McKnight, C, Duchemin, AM. Lack of anti-NMDA receptor autoantibodies in the serum of subjects with schizophrenia. Schizophr Res 2011; 129(2–3): 213–4.
15 Dalmau, J, Lancaster, E, Martinez-Hernandez, E, Rosenfeld, MR, Balice-Gordon, R. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol 2011; 10(1): 6374.
16 Steiner, J, Walter, M, Glanz, W, Sarnyai, Z, Bernstein, HG, Vielhaber, S, et al. 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. JAMA Psychiatry 2013; 70(3): 271–8.
17 Pruss, H, Lennox, BR. Emerging psychiatric syndromes associated with antivoltage-gated potassium channel complex antibodies. J Neurol Neurosurg Psychiatry 2016; 87(11): 1242–7.
18 Lennox, BR, Palmer-Cooper, EC, Pollak, T, Hainsworth, J, Marks, J, Jacobson, L, et al. Prevalence and clinical characteristics of serum neuronal cell surface antibodies in first-episode psychosis: a case-control study. Lancet Psychiatry 2017; 4(1): 42–8.
19 Newman, MP, Blum, S, Wong, RC, Scott, JG, Prain, K, Wilson, RJ, et al. Autoimmune encephalitis. Intern Med J 2016; 46(2): 148–57.
20 van Sonderen, A, Schreurs, MW, de Bruijn, MA, Boukhrissi, S, Nagtzaam, MM, Hulsenboom, ES, et al. The relevance of VGKC positivity in the absence of LGI1 and Caspr2 antibodies. Neurology 2016; 86(18): 1692–9.
21 van Sonderen, A, Petit-Pedrol, M, Dalmau, J, Titulaer, MJ. The value of LGI1, Caspr2 and voltage-gated potassium channel antibodies in encephalitis. Nat Rev Neurol 2017; 13(5): 290301.
22 Zandi, MS, Deakin, JB, Morris, K, Buckley, C, Jacobson, L, Scoriels, L, et al. Immunotherapy for patients with acute psychosis and serum N-Methyl D-Aspartate receptor (NMDAR) antibodies: a description of a treated case series. Schizophr Res 2014; 160(1–3): 193–5.
23 Tsutsui, K, Kanbayashi, T, Tanaka, K, Boku, S. Anti-NMDA-receptor antibody detected in encephalitis, schizophrenia, and narcolepsy with psychotic features. BMC Psychiatry 2012; 12: 37.
24 Zandi, MS, Irani, SR, Lang, B, Waters, P, Jones, PB, McKenna, P, et al. Disease-relevant autoantibodies in first episode schizophrenia. J Neurol 2011; 258(4): 686–8.
25 McKeon, GL, Scott, JG, Spooner, DM, Ryan, AE, Blum, S, Gillis, D, et al. Cognitive and social functioning deficits after anti-N-methyl-D-aspartate receptor encephalitis: an exploratory case series. J Int Neuropsychol Soc 2016; 22(8): 828–38.
26 Finke, C, Kopp, UA, Pruss, H, Dalmau, J, Wandinger, K, Ploner, CJ. Cognitive deficits following anti-NMDA receptor encephalitis. J Neurol Neurosurg Psychiatry 2012; 83: 195–8.
27 Irani, SR, Bera, K, Waters, P, Zuliani, L, Maxwell, S, Zandi, MS, et al. N-methyl-D-aspartate antibody encephalitis: temporal progression of clinical and paraclinical observations in a predominantly non-paraneoplastic disorder of both sexes. Brain 2010; 133(Pt 6): 1655–67.
28 Lang, K, Pruss, H. Frequencies of neuronal autoantibodies in healthy controls: estimation of disease specificity. Neurol Neuroimmunol Neuroinflammation 2017; 4(5): e386.
29 Masdeu, JC, Dalmau, J, Berman, KF. NMDA receptor internalization by autoantibodies: a reversible mechanism underlying psychosis? Trends Neurosci 2016; 39(5): 300–10.
30 Galletly, C, Castle, D, Dark, F, Humberstone, V, Jablensky, A, Killackey, E, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Aust N Z J Psychiatry 2016; 50(5): 410–72.
31 World Health Organisation. International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). Geneva: WHO 1992.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Open
  • ISSN: -
  • EISSN: 2056-4724
  • URL: /core/journals/bjpsych-open
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 101
Total number of PDF views: 68 *
Loading metrics...

Abstract views

Total abstract views: 404 *
Loading metrics...

* Views captured on Cambridge Core between 16th March 2018 - 20th April 2018. This data will be updated every 24 hours.

The prevalence and treatment outcomes of antineuronal antibody-positive patients admitted with first episode of psychosis

  • James G. Scott (a1), David Gillis (a2), Alex E. Ryan (a3), Hethal Hargovan (a4), Nagaraj Gundarpi (a4), Gemma McKeon (a5), Sean Hatherill (a6), Martin P. Newman (a7), Peter Parry (a8), Kerri Prain (a2), Sue Patterson (a9), Richard C. W. Wong (a10), Robert J. Wilson (a10) and Stefan Blum (a11)...
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *