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Research Letter
November 20, 2019

Absence of Autoantibodies Against Neuronal Surface Antigens in Sera of Patients With Psychotic Disorders

Author Affiliations
  • 1School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
  • 2Department of Neurology, Erasmus Medical Centre, Rotterdam, the Netherlands
JAMA Psychiatry. Published online November 20, 2019. doi:https://doi.org/10.1001/jamapsychiatry.2019.3679

Patients with antibodies against neuronal surface antigens (NSAbs), including the N-methyl-d-aspartate receptor (NMDAR), typically develop autoimmune encephalitis with characteristic neurological and psychiatric symptoms.1 In 4% of individuals with NMDAR encephalitis, isolated psychotic episodes occur without simultaneous neurological involvement.2 This raises the question of whether NSAbs are underdiagnosed in patients with psychotic disorders. Results of studies testing this, however, are contradictory,3-5 possibly because of differences in the methods of antibody detection. Previously, in a cohort of 475 patients with schizophrenia, we found no one with NMDAR antibodies after excluding 2 false-positive results by combined immunohistochemistry (IHC) tests and cell-based assays (CBAs) across laboratories.6 In this analysis, we extend these studies to other common NSAbs known to cause encephalitis, aiming to expand the clinical spectrum of psychosis potentially caused by autoantibodies.

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