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Prevalence of serum anti-neuronal autoantibodies in patients admitted to acute psychiatric care

Published online by Cambridge University Press:  09 September 2016

M. Schou ,
S. G. Sæther ,
K. Borowski ,
B. Teegen ,
D. Kondziella ,
W. Stoecker ,
A. Vaaler  and
S. K. Reitan
M. Schou*
Affiliation:
Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway Department of Psychiatry, St Olavs University Hospital, Trondheim, Norway
S. G. Sæther
Affiliation:
Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway Department of Psychiatry, St Olavs University Hospital, Trondheim, Norway
K. Borowski
Affiliation:
Institute for Experimental Immunology, Euroimmun AG, Lübeck, Germany
B. Teegen
Affiliation:
Institute for Experimental Immunology, Euroimmun AG, Lübeck, Germany
D. Kondziella
Affiliation:
Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway Neurology Department, Rigshospitalet, Copenhagen, Denmark
W. Stoecker
Affiliation:
Institute for Experimental Immunology, Euroimmun AG, Lübeck, Germany
A. Vaaler
Affiliation:
Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway Department of Psychiatry, St Olavs University Hospital, Trondheim, Norway
S. K. Reitan
Affiliation:
Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway Department of Psychiatry, St Olavs University Hospital, Trondheim, Norway
*
*Address for correspondence: M. B. Schou, M.D., Department of Psychiatry, St Olavs Hospital HF avd Østmarka, Postboks 3250 Sluppen, 7006 Trondheim, Norway. (Email: [email protected])
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Abstract

Background

Autoimmune encephalitis associated with anti-neuronal antibodies may be challenging to distinguish from primary psychiatric disorders. The significance of anti-neuronal antibodies in psychiatric patients without clear evidence of autoimmune encephalitis is unknown. We investigated the serum prevalence of six anti-neuronal autoantibodies in a cohort of unselected patients admitted to acute psychiatric care.

Method

Serum was drawn from 925 patients admitted to acute psychiatric in-patient care. Psychiatric diagnoses were set according to International Classification of Diseases (ICD)-10 criteria. Antibody analysis was performed with an indirect immunofluorescence test for N-methyl d-aspartate receptor (NMDAR) antibodies and five other anti-neuronal autoantibodies of the immunoglobulin (Ig) classes IgA, IgG and IgM isotype.

Results

Anti-neuronal autoantibodies were found in 11.6% of patients: NMDAR antibodies in 7.6%, contactin-associated protein-like 2 (CASPR2) antibodies in 2.5%, glutamic acid decarboxylase-65 (GAD65) antibodies in 1.9%, and α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor antibodies in 0.1%. Leucine-rich glioma-inactivated protein-1 (LGI1) and γ-aminobutyric acid B (GABAB) receptor antibodies were not detected. NMDAR antibodies of class IgG were present in five patients only (0.5%). NMDAR antibodies of all Ig classes were equally prevalent in patients with and without psychosis. There were no significant differences in antibody prevalence in the different diagnostic categories, except for a higher odds ratio of being NMDAR antibody positive for patients without a specific psychiatric diagnosis.

Conclusions

NMDAR IgG autoantibodies, which are known to be strongly associated with anti-NMDAR encephalitis, were rarely found. CASPR2 and GAD65 antibodies were more frequently encountered in the present study than previously reported. Further research on the clinical significance of anti-neuronal autoantibodies in patients with acute psychiatric symptoms is needed.

Keywords

AntibodiesautoimmunityN-methyl D-aspartate (NMDA) receptorpsychiatry
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 16 , December 2016 , pp. 3303 - 3313
Copyright
Copyright © Cambridge University Press 2016 

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