A very exciting and potentially groundbreaking observation in patients with schizophrenia was just published by Johann Steiner and colleagues from the Department of Psychiatry (Chairman: Bernhard Bogerts) of the University of Magdeburg in JAMA Psychiatry (formerly Archives of General Psychiatry – online first on January 23, 2013). They found in 9.9% (n = 15) in a cohort of 121 patients with a schizophrenic disorder antibodies against NMDA (N-methyl-D-aspartate) receptors (Steiner et al., 2013). Such antibodies were found only in 0.4% of the 230 control subjects studied, in none of 38 patients with borderline personality disorder and 2.8% of 70 patients with a depressive disorder. This difference was highly statistically significant even if two patients from the group of those with a diagnosis of schizophrenia were excluded, who later received a diagnosis of anti-NMDA receptor encephalitis. The finding is so exciting because an insufficient function of glutamatergic neurotransmission via the NMDA receptor is believed to be a key pathophysiological component in schizophrenia (see also my lecture on Jan 25th 2013) and because the so-called anti-NMDA receptor encephalitis usually begins with mostly psychiatric symptoms, particularly psychosis.
The anti-NMDA receptor encephalitis was first described in 2007 by the group led by neurologist Josep Dalmau from the University of Pennsylvania in Philadelphia (Dalmau et al., 2007). It begins with nonspecific, flu-like symptoms, which are followed by a variety of psychiatric disorders (anxiety, delirium, psychotic states). Therefore, many of the patients are initially admitted to psychiatric treatment. Later, seizures, movement disorders and autonomic dysfunction will emerge, often leading to coma. Young women are mostly affected, in whom quite often a teratoma (with nerve cells) can be found. The disease then represents a paraneoplastic syndrome, and antibodies against NMDA receptors can be found regularly. Treatment consists of immunosuppressive therapy.
The findings now published represent an important milestone in the subclassification of schizophrenic disorders, because it may have been possible for the first time to subdivide a subset of patients from the large, heterogeneous group of schizophrenias, and assign them a differentiated pathophysiology, possibly leading to a differential treatment.
If you want to read the original article by Steiner et al., please send me a message using the contact form, I will then send you the PDF.
This post is also available in: German