Psychosis: an autoimmune disease?
Psychotic disorders are common and disabling. Overlaps in clinical course in addition to epidemiological and genetic associations raise the possibility that autoimmune mechanisms may underlie some psychoses, potentially offering novel therapeutic approaches. Several immune loci including the major h...
| Main Authors: | , , , |
|---|---|
| Format: | Journal article |
| Language: | English |
| Published: |
Wiley
2017
|
| _version_ | 1826299364857872384 |
|---|---|
| author | Al-Diwani, AAJ Pollak, TA Irani, SR Lennox, BR |
| author_facet | Al-Diwani, AAJ Pollak, TA Irani, SR Lennox, BR |
| author_sort | Al-Diwani, AAJ |
| collection | OXFORD |
| description | Psychotic disorders are common and disabling. Overlaps in clinical course in addition to epidemiological and genetic associations raise the possibility that autoimmune mechanisms may underlie some psychoses, potentially offering novel therapeutic approaches. Several immune loci including the major histocompatibility complex and B-cell markers CD19 and CD20 achieve genome-wide significance in schizophrenia. Emerging evidence suggests a potential role via neurodevelopment in addition to classical immune pathways. Additionally, lymphocyte biology is increasingly investigated. Some reports note raised peripheral CD19+ and reduced CD3+ lymphocyte counts, with altered CD4 : CD8 ratios in acute psychosis. Also, post-mortem studies have found CD3+ and CD20+ lymphocyte infiltration in brain regions that are of functional relevance to psychosis. More specifically, the recent paradigm of neuronal surface antibody-mediated (NSAb) central nervous system disease provides an antigen-specific model linking adaptive autoimmunity to psychopathology. NSAbs bind extracellular epitopes of signalling molecules that are classically implicated in psychosis such as NMDA and GABA receptors. This interaction may cause circuit dysfunction leading to psychosis among other neurological features in patients with autoimmune encephalitis. The detection of these cases is crucial as autoimmune encephalitis is ameliorated by commonly available immunotherapies. Meanwhile, the prevalence and relevance of these antibodies in people with isolated psychotic disorders is an area of emerging scientific and clinical interest. Collaborative efforts to achieve larger sample sizes, comparison of assay platforms, and placebo-controlled randomized clinical trials are now needed to establish an autoimmune contribution to psychosis. |
| first_indexed | 2024-03-07T05:00:50Z |
| format | Journal article |
| id | oxford-uuid:d83b7d76-2247-41d3-88d7-07e9b4b11b55 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T05:00:50Z |
| publishDate | 2017 |
| publisher | Wiley |
| record_format | dspace |
| spelling | oxford-uuid:d83b7d76-2247-41d3-88d7-07e9b4b11b552022-03-27T08:46:49ZPsychosis: an autoimmune disease?Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:d83b7d76-2247-41d3-88d7-07e9b4b11b55EnglishSymplectic Elements at OxfordWiley2017Al-Diwani, AAJPollak, TAIrani, SRLennox, BRPsychotic disorders are common and disabling. Overlaps in clinical course in addition to epidemiological and genetic associations raise the possibility that autoimmune mechanisms may underlie some psychoses, potentially offering novel therapeutic approaches. Several immune loci including the major histocompatibility complex and B-cell markers CD19 and CD20 achieve genome-wide significance in schizophrenia. Emerging evidence suggests a potential role via neurodevelopment in addition to classical immune pathways. Additionally, lymphocyte biology is increasingly investigated. Some reports note raised peripheral CD19+ and reduced CD3+ lymphocyte counts, with altered CD4 : CD8 ratios in acute psychosis. Also, post-mortem studies have found CD3+ and CD20+ lymphocyte infiltration in brain regions that are of functional relevance to psychosis. More specifically, the recent paradigm of neuronal surface antibody-mediated (NSAb) central nervous system disease provides an antigen-specific model linking adaptive autoimmunity to psychopathology. NSAbs bind extracellular epitopes of signalling molecules that are classically implicated in psychosis such as NMDA and GABA receptors. This interaction may cause circuit dysfunction leading to psychosis among other neurological features in patients with autoimmune encephalitis. The detection of these cases is crucial as autoimmune encephalitis is ameliorated by commonly available immunotherapies. Meanwhile, the prevalence and relevance of these antibodies in people with isolated psychotic disorders is an area of emerging scientific and clinical interest. Collaborative efforts to achieve larger sample sizes, comparison of assay platforms, and placebo-controlled randomized clinical trials are now needed to establish an autoimmune contribution to psychosis. |
| spellingShingle | Al-Diwani, AAJ Pollak, TA Irani, SR Lennox, BR Psychosis: an autoimmune disease? |
| title | Psychosis: an autoimmune disease? |
| title_full | Psychosis: an autoimmune disease? |
| title_fullStr | Psychosis: an autoimmune disease? |
| title_full_unstemmed | Psychosis: an autoimmune disease? |
| title_short | Psychosis: an autoimmune disease? |
| title_sort | psychosis an autoimmune disease |
| work_keys_str_mv | AT aldiwaniaaj psychosisanautoimmunedisease AT pollakta psychosisanautoimmunedisease AT iranisr psychosisanautoimmunedisease AT lennoxbr psychosisanautoimmunedisease |