Prevalence of antiphospholipid antibodies in psychiatric patients users and non‐users of antipsychotics

Abstract

SummaryPast reports have suggested that antiphospholipid (aPL) antibodies may emerge as a response to antipsychotics treatment, as a high prevalence of aPL antibodies in antipsychotics users has been observed. However, no control group of non-medicated psychiatric patients was included in these reports. In a cross sectional study we determined the prevalence of aPL antibodies in 333 psychiatric inpatients. We compared the proportions of positive aPL antibodytests between users and non-users of antipsychotics with adjustments for potential confounders. The proportion of antipsychotics users carrying at least one aPL antibody ranged from 10Á8% to 27Á0% compared with 6Á8% to 27Á2% in non-users (P = 0Á24, P = 0Á24) depending on the method of detection of lupus anticoagulant (LA). The prevalence of LA detected by dilute Russell viper venom time or partial thromboplastin time-LA was not different between antipsychotics users and non-users (8Á1% vs. 5Á4%, P = 0Á53 and 18Á4% vs. 18Á2%, P = 0Á22), as well as the prevalence of IgM and IgG anti-b2-glycoprotein-I antibodies, IgM and IgG anti-cardiolipin antibodies(3Á8% vs. 2Á0%, P = 0Á75, 0Á0% vs. 0Á0%, P = not applicable, 1Á1 vs. 1Á4%, P = 0Á91, 2Á7% vs. 3Á4%, P = 0Á71). In conclusion, aPL antibodies were frequently found in patients with psychiatric diseases and no significant increase in the prevalence of aPL antibodies was observed in antipsychotics users.

Dysfunction in the coagulation system and schizophrenia

“… 61 Conditions characterized by low protein S activity, such as systemic lupus erythematosus, Behçet's disease and Sjögren's syndrome may present with cognitive impairment, delusions and hallucinations. 9 , 62 In addition, puerperal psychosis occurs when protein S levels are low, regardless of systemic inflammation. 63 …”

“…Antiphospholipid antibodies such as anticardiolipin antibodies and lupus anticoagulant are highly prevalent in drug-naive schizophrenia. 9 , 10 , 11 The diagnosis of antiphospholipid antibody syndrome requires the persistence of antibodies, plus either a thrombotic event or an obstetric complication due to abnormal placentation. 67 Patients with antiphospholipid antibodies may present with cognitive dysfunction or full-blown psychosis, independent of brain ischemia.…”

“…Conditions affecting the activity of tPA, such as hyperhomocysteinemia and antiphospholipid antibodies, have been consistently described in drug-naive schizophrenia. 7 , 8 , 9 , 10 We recently screened 70 drug-treated schizophrenia patients and 98 controls for these and other conditions affecting tPA activity. 11 Persistent antiphospholipid antibodies were seen in 30% of the patients and none of the controls.…”

Improvement of Psychotic Symptoms and the Role of Tissue Plasminogen Activator

“…Markers of low tPA activity consistently described in schizophrenia include hyperhomocysteinemia and antiphospholipid antibodies, such as lupus anticoagulant and IgM isotype anticardiolipin antibody [ 16 , 17 , 18 ]. Importantly, both hyperhomocysteinemia and antiphospholipid antibodies may affect tPA activity without affecting tPA levels [ 19 ].…”

Coagulation and Mental Disorders

“…Some reports have also suggested that APLA may emerge as a response to antipsychotic treatment, since a high prevalence of the antibodies in antipsychotic users has been observed. A recent cross-sectional study determined the presence and a subtype of APLA in 333 psychiatric inpatients: APLA were frequently found positive, and prevalence of the antibodies was not significantly different in patients who were receiving, or not receiving, antipsychotics 39. Long-term prospective epidemiological cohort studies are still needed to analyze possible pathogenic implications of persistent APLA in psychiatric patients, such as worsening of the clinical symptomatology.…”