Prevalence of N-Methyl-d-Aspartate Receptor antibody (NMDAR-Ab) encephalitis in patients with first episode psychosis and treatment resistant schizophrenia on clozapine, a population based study

Kelleher, Eric; McNamara, Patricia; Dunne, Jean; Fitzmaurice, Brian; Heron, Elizabeth A.; Whitty, Peter; Walsh, Richard A.; Mooney, Christina; Hogan, Denise K.; Conlon, Niall; Gill, Michael; Vincent, Angela; Doherty, Colin P.; Corvin, Aiden

doi:10.1016/j.schres.2019.11.023

Cited by 18 publications

(19 citation statements)

References 40 publications

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“…All studies that failed to find any positive results used fixed CBA [35, 62, 63]. However, only 6 studies applied confirmation methods [44, 45, 55, 57, 60, 63]. The percentage of positive cases in controls varied from 0.4 to 2.9 in 4 studies [42, 47, 55, 59].…”

Section: Resultsmentioning

confidence: 99%

“…A portion of the studies presented follow-up data on patients with ABs against NMDAR NR1/NR2. Only 2 studies reported that AB-positive patients developed anti-NMDAR encephalitis [38, 60]. Tang et al [38] found 4 (26.7%) positive patients, and all of them were diagnosed with anti-NMDAR encephalitis; however, the researchers recruited patients with FEP (<1 month of psychotic symptoms) and neurological symptoms that could raise suspicion for the encephalitis.…”

Section: Resultsmentioning

confidence: 99%

“…Tang et al [38] found 4 (26.7%) positive patients, and all of them were diagnosed with anti-NMDAR encephalitis; however, the researchers recruited patients with FEP (<1 month of psychotic symptoms) and neurological symptoms that could raise suspicion for the encephalitis. Kelleher et al [60] reported that 1 patient was tested positive for NMDAR ABs in serum and CSF and developed anti-NMDAR encephalitis. The other 3 patients were tested positive using live CBA but negative using fixed CBA or immunohistochemistry.…”

Section: Resultsmentioning

confidence: 99%

“…The other 3 patients were tested positive using live CBA but negative using fixed CBA or immunohistochemistry. None of them developed neurological features [60]. AB-positive patients from other 7 studies had not developed any neurological symptoms or other clinical signs of anti-NMDAR encephalitis [23, 44, 50, 55-58, 61].…”

Section: Resultsmentioning

confidence: 99%

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Antibodies against N-Methyl D-Aspartate Receptor in Psychotic Disorders: A Systematic Review

et al. 2021

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Objective: The objective of this study was to provide comprehensive evidence synthesis including all available up-to-date data about the prevalence of N-methyl D-aspartate receptor (NMDAR) antibodies (ABs) in psychotic patients in order to evaluate the clinical relevance of ABs as well as to specify potential explanations of the heterogeneity of the findings and determine areas for further research. Methods: A literature search was conducted using the PubMed/Medline, Web of Knowledge, and Scopus databases. Results: Forty-seven studies and 4 systematic reviews (including 2 meta-analyses) were included in the present review. Studies that used cell-based assays (CBAs) provided heterogeneous results on AB prevalence, obviously depending on the type of detection assay and sample characteristics. Improvement of AB detection methods is necessary to determine the real prevalence of ABs across different groups of patients and healthy people. Live CBAs seem to have better sensitivity but probably poorer specificity than fixed CBAs. Moreover, some links between AB-positive status and acute symptoms are possible. A small amount of data on immunotherapy in AB-positive patients raises the possibility of its effectiveness but obviously require further research. Conclusions: NMDAR ABs are definitely present in a subset of psychotic patients. NMDAR ABs might shape psychosis and underlie some symptoms, and immunotherapy might be regarded as a treatment option for patients failing to respond to other therapies.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Antibodies against N-Methyl D-Aspartate Receptor in Psychotic Disorders: A Systematic Review

et al. 2021

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“…The condition of encephalitis caused by anti-NMDA (N-methyl-D-aspartate) antibodies, which has become a current issue recently, should also be considered especially in young female patients who show symptoms of psychosis for the first time. A recent study found Anti-NMDA antibody positivity in 3.5% of 112 patients with first episode psychosis, but only one patient was diagnosed with encephalitis ( 3 ). It was also reported that this diagnosis needed to be supported by EEG and magnetic resonance imaging results and a patient who did not have antibodies in their cerebrospinal fluid (CSF) was, in fact, diagnosed with anti-NMDA encephalitis based on these results ( 4 ).…”

Section: What To Consider In Differential Diagnosis?mentioning

confidence: 99%

Treatment principles of first-episode psychosis

Üçok¹

2021

Archives of Neuropsychiatry

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Treatment of first-episode psychosis, which has unique advantages and challenges, has an impact on the course of the illness. On one hand, clinician has to understand triggering factors of psychosis and make differential diagnosis, and on other hand he has to choose a rationale psychopharmacological treatment. Although there is no difference between first generation antipsychotics and second generation antipsychotics in terms of effectiveness, the latter group has advantages in terms of side effects and tolerability. Tolerability issues and particularly metabolic side effects should be taken into account when choosing antipsychotic to treat first episode and beyond. Additionally, psychosocial approaches like family psychoeducation should be combined with pharmacological approaches in early phase of psychosis. Clinicians should monitor the medication adherence in every outpatient visit, and minimum duration of treatment is recommended as three years after remission.

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Methylprednisolone

2021

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Prevalence of N-Methyl-d-Aspartate Receptor antibody (NMDAR-Ab) encephalitis in patients with first episode psychosis and treatment resistant schizophrenia on clozapine, a population based study

Cited by 18 publications

References 40 publications

Antibodies against N-Methyl D-Aspartate Receptor in Psychotic Disorders: A Systematic Review

Antibodies against N-Methyl D-Aspartate Receptor in Psychotic Disorders: A Systematic Review

Treatment principles of first-episode psychosis

Methylprednisolone

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