The prevalence and treatment outcomes of antineuronal antibody-positive patients admitted with first episode of psychosis
James G. Scott,
David Gillis,
Alex E. Ryan,
Hethal Hargovan,
Nagaraj Gundarpi,
Gemma McKeon,
Sean Hatherill,
Martin P. Newman,
Peter Parry,
Kerri Prain,
Sue Patterson,
Richard C. W. Wong,
Robert J. Wilson,
Stefan Blum
Affiliations
James G. Scott
Centre for Clinical Research, The University of Queensland (UQCCR), Metro North Mental Health, Royal Brisbane and Women's Hospital (RBWH), and the Queensland Centre for Mental Health Research (QCMHR), Australia
David Gillis
Division of Immunology, Pathology Queensland Central Laboratory, RBWH, Australia
Alex E. Ryan
UQCCR and QCMHR, Australia
Hethal Hargovan
Metro North Mental Health, RBWH, Australia
Nagaraj Gundarpi
Metro North Mental Health, RBWH, Australia
Gemma McKeon
MAPS, UQCCR and QCMHR, Australia
Sean Hatherill
Metro South Addiction and Mental Health Service, Child and Youth Academic Clinical Unit, Queensland, Australia
Martin P. Newman
Division of Immunology, Pathology Queensland Central Laboratory, RBWH, and Faculty of Medicine, University of Queensland, Australia
Peter Parry
Child and Youth Mental Health Service, Children's Health Queensland, Australia
Kerri Prain
Division of Immunology, Pathology Queensland Central Laboratory, RBWH, Australia
Sue Patterson
Metro North Mental Health, RBWH, and Department of Applied Psychology, Griffith University, Queensland, Australia
Richard C. W. Wong
Division of Immunology, Pathology Queensland Central Laboratory, RBWH, and Department of Immunology, Princess Alexandra Hospital, Queensland, Australia
Robert J. Wilson
Division of Immunology, Pathology Queensland Central Laboratory, RBWH, and Department of Immunology, Princess Alexandra Hospital, Queensland, Australia
Stefan Blum
Faculty of Medicine, University of Queensland and Department of Neurology, Princess Alexandra Hospital, Queensland, Australia.
Background Antineuronal antibodies are associated with psychosis, although their clinical significance in first episode of psychosis (FEP) is undetermined. Aims To examine all patients admitted for treatment of FEP for antineuronal antibodies and describe clinical presentations and treatment outcomes in those who were antibody positive. Method Individuals admitted for FEP to six mental health units in Queensland, Australia, were prospectively tested for serum antineuronal antibodies. Antibody-positive patients were referred for neurological and immunological assessment and therapy. Results Of 113 consenting participants, six had antineuronal antibodies (anti-N-methyl-D-aspartate receptor antibodies [n = 4], voltage-gated potassium channel antibodies [n = 1] and antibodies against uncharacterised antigen [n = 1]). Five received immunotherapy, which prompted resolution of psychosis in four. Conclusions A small subgroup of patients admitted to hospital with FEP have antineuronal antibodies detectable in serum and are responsive to immunotherapy. Early diagnosis and treatment is critical to optimise recovery. Declaration of interest None.
