Tags

Type your tag names separated by a space and hit enter

Psychiatric Autoimmunity: N-Methyl-D-Aspartate Receptor IgG and Beyond.
Psychosomatics. 2015 May-Jun; 56(3):227-41.P

Abstract

BACKGROUND

Descriptions of psychiatric autoimmunity beyond N-methyl-D-aspartate (NMDA) receptor encephalitis are sparse.

OBJECTIVE

To report the autoimmune psychiatric spectrum currently recognized in Mayo Clinic practice.

METHODS

Medical record review, testing of stored serum and cerebrospinal fluid for IgGs reactive with synaptic receptors and ion channels, neuronal nuclear and cytoplasmic antigens (including glutamic acid decarboxylase 65-kDa isoform) and case-control comparison were conducted. Patients were categorized into group 1, all adult psychiatric inpatients tested for neural autoantibodies (2002-2011; n = 213), and group 2, all Mayo NMDA receptor IgG-positive patients (2009-2013; n = 13); healthy control subjects were also included (n = 173).

RESULTS

In group 1, at least 1 serum autoantibody (but not NMDA receptor IgG) was detected in 36 of 213 psychiatric inpatients. In total, 12 patients were determined retrospectively to have high-likelihood autoimmune encephalitic diagnoses. The most commonly detected autoantibody specificities were voltage-gated potassium channel ([Kv1] VGKC) complex (6) and calcium channel (P/Q type or N type; 5). Symptoms seen were as follows: depressive (8), anxious (7), psychotic (7), disorganized (5), suicidal (3), manic (1) and catatonic (1). In group 2, among 13 NMDA receptor IgG-positive patients, 12 had encephalitis; their psychiatric symptoms were as follows: depressive (9), catatonic (9), disorganized (8), anxious (8), psychotic (7), manic (6), and suicidal (3). Catatonic symptoms were more common in the 12 NMDA receptor IgG-positive patients than in the 12 group 1 patients with high likelihood of encephalitis (p = 0.002). Antibody positivities were usually low positive in value among healthy controls (12 of 16 vs 3 of 12 group 1 encephalitis cases, p = 0.025). NMDA receptor IgG was not detected in any healthy control subject.

CONCLUSIONS

A spectrum of psychiatric autoimmunity beyond NMDA-R IgG may be under-recognized. Diagnosis is facilitated by combining results of comprehensive psychiatric, laboratory, radiologic, and electrophysiologic evaluations.

Authors+Show Affiliations

Department of Psychiatry and Psychology, College of Medicine, Mayo Clinic, Rochester, MN.Department of Psychiatry and Psychology, College of Medicine, Mayo Clinic, Rochester, MN.Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic, Rochester, MN; Department of Neurology, College of Medicine, Mayo Clinic, Rochester, MN; Department of Immunology, College of Medicine, Mayo Clinic, Rochester, MN.Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic, Rochester, MN; Department of Neurology, College of Medicine, Mayo Clinic, Rochester, MN.Department of Neurology, College of Medicine, Mayo Clinic, Rochester, MN.Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic, Rochester, MN; Department of Neurology, College of Medicine, Mayo Clinic, Rochester, MN.Department of Neurology, College of Medicine, Mayo Clinic, Rochester, MN.Department of Psychiatry and Psychology, College of Medicine, Mayo Clinic, Rochester, MN.Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic, Rochester, MN; Department of Neurology, College of Medicine, Mayo Clinic, Rochester, MN. Electronic address: mckeon.andrew@mayo.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25975857

Citation

Kruse, Jennifer L., et al. "Psychiatric Autoimmunity: N-Methyl-D-Aspartate Receptor IgG and Beyond." Psychosomatics, vol. 56, no. 3, 2015, pp. 227-41.
Kruse JL, Lapid MI, Lennon VA, et al. Psychiatric Autoimmunity: N-Methyl-D-Aspartate Receptor IgG and Beyond. Psychosomatics. 2015;56(3):227-41.
Kruse, J. L., Lapid, M. I., Lennon, V. A., Klein, C. J., Toole, O. O., Pittock, S. J., Strand, E. A., Frye, M. A., & McKeon, A. (2015). Psychiatric Autoimmunity: N-Methyl-D-Aspartate Receptor IgG and Beyond. Psychosomatics, 56(3), 227-41. https://doi.org/10.1016/j.psym.2015.01.003
Kruse JL, et al. Psychiatric Autoimmunity: N-Methyl-D-Aspartate Receptor IgG and Beyond. Psychosomatics. 2015 May-Jun;56(3):227-41. PubMed PMID: 25975857.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Psychiatric Autoimmunity: N-Methyl-D-Aspartate Receptor IgG and Beyond. AU - Kruse,Jennifer L, AU - Lapid,Maria I, AU - Lennon,Vanda A, AU - Klein,Christopher J, AU - Toole,Orna O', AU - Pittock,Sean J, AU - Strand,Edythe A, AU - Frye,Mark A, AU - McKeon,Andrew, Y1 - 2015/02/04/ PY - 2014/12/23/received PY - 2015/01/27/revised PY - 2015/01/28/accepted PY - 2015/5/16/entrez PY - 2015/5/16/pubmed PY - 2016/12/15/medline SP - 227 EP - 41 JF - Psychosomatics JO - Psychosomatics VL - 56 IS - 3 N2 - BACKGROUND: Descriptions of psychiatric autoimmunity beyond N-methyl-D-aspartate (NMDA) receptor encephalitis are sparse. OBJECTIVE: To report the autoimmune psychiatric spectrum currently recognized in Mayo Clinic practice. METHODS: Medical record review, testing of stored serum and cerebrospinal fluid for IgGs reactive with synaptic receptors and ion channels, neuronal nuclear and cytoplasmic antigens (including glutamic acid decarboxylase 65-kDa isoform) and case-control comparison were conducted. Patients were categorized into group 1, all adult psychiatric inpatients tested for neural autoantibodies (2002-2011; n = 213), and group 2, all Mayo NMDA receptor IgG-positive patients (2009-2013; n = 13); healthy control subjects were also included (n = 173). RESULTS: In group 1, at least 1 serum autoantibody (but not NMDA receptor IgG) was detected in 36 of 213 psychiatric inpatients. In total, 12 patients were determined retrospectively to have high-likelihood autoimmune encephalitic diagnoses. The most commonly detected autoantibody specificities were voltage-gated potassium channel ([Kv1] VGKC) complex (6) and calcium channel (P/Q type or N type; 5). Symptoms seen were as follows: depressive (8), anxious (7), psychotic (7), disorganized (5), suicidal (3), manic (1) and catatonic (1). In group 2, among 13 NMDA receptor IgG-positive patients, 12 had encephalitis; their psychiatric symptoms were as follows: depressive (9), catatonic (9), disorganized (8), anxious (8), psychotic (7), manic (6), and suicidal (3). Catatonic symptoms were more common in the 12 NMDA receptor IgG-positive patients than in the 12 group 1 patients with high likelihood of encephalitis (p = 0.002). Antibody positivities were usually low positive in value among healthy controls (12 of 16 vs 3 of 12 group 1 encephalitis cases, p = 0.025). NMDA receptor IgG was not detected in any healthy control subject. CONCLUSIONS: A spectrum of psychiatric autoimmunity beyond NMDA-R IgG may be under-recognized. Diagnosis is facilitated by combining results of comprehensive psychiatric, laboratory, radiologic, and electrophysiologic evaluations. SN - 1545-7206 UR - https://www.unboundmedicine.com/medline/citation/25975857/Psychiatric_Autoimmunity:_N_Methyl_D_Aspartate_Receptor_IgG_and_Beyond_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0033-3182(15)00004-3 DB - PRIME DP - Unbound Medicine ER -