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Autoantibodies to the N-Methyl-D-Aspartate Receptor in Adolescents with Early Onset Psychosis and Healthy Controls

By Kristine Engen, Laura Anne Wortinger, Kjetil Nordbø Jørgensen, Mathias Lundberg, Hannes Bohman, Runar Elle Smelror, Anne Margrethe Myhre, Leslie Jacobson, Angela Vincent, Ingrid Agartz

Posted 10 Jan 2020
medRxiv DOI: 10.1101/2020.01.06.20016626

BackgroundAutoantibodies to the N-methyl-D-aspartate receptor (NMDAR-Abs) in autoimmune encephalitis have been associated with prominent psychiatric symptoms. The aims of the present study are to identify the prevalence of NMDAR-Abs in adolescents with early onset psychosis disorders (EOP) and healthy controls (HC) and examine its clinical significance. MethodPlasma samples were acquired from 46 adolescent EOP patients and 69 age- and sex matched HC, and assessed for the presence of immunoglobulin G NMDAR-Abs. All participants underwent psychiatric evaluation, neurological examination and head magnetic resonance imaging. ResultsNMDAR-Abs were detected in three of 46 (6.5%) EOP patients and in two of 69 (2.9%) HC. One NMDAR-Abs EOP patient presented with unusual psychopathology and minor T1 weighted lesions of vasculopathological origin located bi-frontally and in the basal ganglia, and had a recent diagnosis of a separate autoimmune disease. One NMDAR-Abs HC displayed a T2 weighted FLAIR hyperintensity lesion in the left frontal lobe. The remaining three NMDAR-Abs participants were two EOP patients without neurological or radiological findings, and one HC without any clinical findings. ConclusionsWe report the presence of NMDAR-Abs in both adolescent EOP patients and HC, similar to the incidence in other studies. This may support the hypothesis of an immunological disease component in a small proportion of adolescent psychosis, but the positive antibody tests must be carefully interpreted and reviewed within the individual clinical context.

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