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Psychosis: an autoimmune disease?

Adam A J Al-Diwani1,2, Thomas A Pollak3, Sarosh R Irani2

  • 1Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.

Immunology
|July 14, 2017
PubMed
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Autoimmune mechanisms may underlie some psychotic disorders, suggesting new treatments. Research is exploring neuronal surface antibodies and their role in psychosis, with potential for immunotherapy.

Keywords:
autoimmunityneuronal surface antibodypsychosisschizophrenia

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Area of Science:

  • Neuroimmunology
  • Psychiatry
  • Immunology

Background:

  • Psychotic disorders are common and disabling, with potential autoimmune links.
  • Genetic and epidemiological data suggest immune system involvement in schizophrenia.
  • Neuronal surface antibodies (NSAb) offer a model for autoimmunity in psychosis.

Purpose of the Study:

  • To explore the role of autoimmune mechanisms in psychotic disorders.
  • To investigate the link between NSAb and psychopathology.
  • To assess the potential for immunotherapy in autoimmune-related psychosis.

Main Methods:

  • Review of genetic associations (MHC, CD19, CD20) in schizophrenia.
  • Analysis of peripheral lymphocyte counts (CD19+, CD3+) and CD4:CD8 ratios in psychosis.
  • Examination of post-mortem brain tissue for lymphocyte infiltration (CD3+, CD20+).
  • Focus on NSAb targeting psychosis-associated receptors (NMDA, GABA).

Main Results:

  • Evidence suggests immune loci and B-cell markers are significant in schizophrenia.
  • Altered lymphocyte counts and ratios observed in acute psychosis.
  • Lymphocyte infiltration found in relevant brain regions.
  • NSAb targeting NMDA and GABA receptors can cause psychosis in autoimmune encephalitis.

Conclusions:

  • Autoimmune mechanisms, particularly NSAb, are a potential factor in some psychoses.
  • Autoimmune encephalitis with psychosis is treatable with immunotherapy.
  • Further research with larger cohorts and clinical trials is needed to confirm the role of autoimmunity in isolated psychotic disorders.