Though causal relations cannot be determined from this cross-sectional study, this admission survey found early forms of autoimmune thyroid disease, sometimes characterized only by TPO-Abs, highly significantly associated with rapid cycles of a bipolar disorder. It also found a weak association between subclinical hyperthyroidism (low serum TSH without TPO-Ab positivity) and affective disorder.

Psychiatric symptoms are rarely reported as an initial feature of systemic lupus erythematosus (SLE). Nevertheless, many patients have the feeling that psychiatric symptoms occurred before they were diagnosed as having SLE. This feeling was confirmed by an enquiry among members of the Dutch Lupus Patients Society: half of them had experienced psychiatric complaints before SLE was diagnosed. Two-thirds of these patients searched for professional help for these complaints. This motivated us to study whether SLE patients were admitted into psychiatric hospitals without being diagnosed as having SLE. Sera from 2121 patients admitted to a psychiatric hospital and from 500 controls matched for sex and age were tested for the presence of antinuclear antibodies (ANA) and antibodies to DNA. ANA were found in 3% of patients, as well as controls. Anti-DNA antibodies were found in 1% of both patients and controls. Two out of 114 patients psychiatric patients with ANA and/or anti-DNA antibodies had SLE and/or Sjögren's syndrome. We concluded that SLE is not an important cause of admission to psychiatric hospitals. Routine tests for the determination of antinuclear and anti-DNA antibodies on admissions in these hospitals thus would not seem useful. To study whether patients with another chronic disease also had psychiatric complaints before being diagnosed, we performed the same enquiry among members of the Dutch Sarcoidosis Patients Society. The results were almost equal to those of the enquiry of the members of the Dutch Lupus Patients Society. Why members of both societies so often report psychiatric symptoms before their disease is diagnosed should be a subject of further studies.

To investigate whether unrecognized systemic lupus erythematosus (SLE) might occur more frequently among psychiatric patients than expected on clinical examination, sera of 100 patients from a psychiatric hospital were tested for the presence of antibodies against nuclear antigens (ANA) and antibodies against DNA. The occurrence of sera positive for ANA was compared with the test results of serum samples of 859 individuals randomly selected from the general population. Positive tests for ANA were found in 7% of the psychiatric patients and 4% of the individuals selected from the population. Antibodies against dsDNA were not found in sera of the psychiatric patients. After categorizing both groups for age and sex, no difference was found as for the frequency of ANA positive sera between both groups, indicating that on the basis of serology, no evidence exists that SLE might be underestimated among psychiatric patients.

Preliminary results were presented (Hekkens, 1978) about the level of antibodies to gliadin in sera of patients with schizophrenia. The idea behind the measuring of gliadin antibodies was that if gliadin or its breakdown products can affect the brain in schizophrenia (Dohan et al. , 1969), then those peptides have to pass more or less intact through the intestinal wall. We knew already that mucosal damage such as occurs in coeliac disease, gives rise to an increased level of antibodies against gliadin in the serum of these patients. If schizophrenia and coeliac disease are associated, and both are a consequence of the passage of gliadin or its breakdown products through the intestinal wall, one could expect that in schizophrenie patients on a diet including wheat the gliadin antibody level would be increased also. Our preliminary results indieated that this was true for only a few of the schizophrenie patients studied. This could me an that there are two groups of patients, one with an increased perme ability for gliadin and with a high antigliadin titre, the other with a low permeability and having a low titre. This phenomenon is similar to that described in Chapter 13 by Ashkenazi et al., in the re action of lymphocytes from psychotie patients. They measured a lymphokine-inducing effect of a gliadin fraction toxie to coeliac patients in only some of the schizophrenie and psychotie individuals. We therefore wanted to investigate a larger group of patients and to compare them with non-schizophrenie patients from the same psychiatrie hospitalliving under the same conditions. 125G. Hemmings (ed.), Biochemistry of Schizophrenia and Addiction

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