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Tijdschrift voor Psychiatrie 57 (2015) 3, 183 - 191

Review article

Auto-immune disorders as a possible cause of neuropsychiatric syndromes

P. Martinez-Martinez*, P.C. Molenaar*, M. Losen, C. Hoffmann, J. Stevens, L.D. de Witte, T. van Amelsvoort, J. van Os, B.P.F. Rutten

background Changes that occur in the behaviour of voltage-gated ion channels and ligand-gated receptor channels due to gene mutations or auto-immune attack are the cause of channelopathies in the central and peripheral nervous system. Although the relation between molecular channel defects and clinical symptoms has been explained in the case of many neuromuscular channelopathies, the pathophysiology of auto-immunity in neuropsychiatric syndromes is still unclear.
aim To review recent findings regarding neuronal auto-immune reactions in severe neuropsychiatric syndromes.
method Using PubMed, we consulted the literature published between 1990 and August 2014 relating to the occurrence of auto-immune antibodies in severe and persistent neuropsychiatric syndromes.
results Auto-antibodies have only limited access to the central nervous system, but if they do enter the system they can, in some cases, cause disease. We discuss recent findings regarding the occurrence of auto-antibodies against ligand-activated receptor channels and potassium channels in neuropsychiatric and neurological syndromes, including schizophrenia and limbic encephalitis.
conclusion Although the occurrence of several auto-antibodies in schizophrenia has been confirmed, there is still no proof of a causal relationship in the syndrome. We still have no evidence of the prevalence of auto-immunity in neuropsychiatric syndromes. The discovery that an antibody against an ion channel is associated with some neuropsychiatric disorders may mean that in future it will be possible to treat patients by means of immunosuppression, which could lead to an improvement in a patient’s cognitive abilities.

keywords auto-immune disease, encephalitis, epilepsy, Morvan’s syndrome, psychosis, schizophrenia, stiff person syndrome