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The Epidemiologic Evidence Linking Autoimmune Diseases and Psychosis

  • Michael E. Benros
    Correspondence
    Address correspondence to Michael E. Benrós, M.D., Ph.D., Aarhus University, National Centre for Register-Based Research, Fuglesangs allé 4, Aarhus V 8210, Denmark
    Affiliations
    National Centre for Register-Based Research, Aarhus University, Aarhus

    Mental Health Centre Copenhagen, University of Copenhagen, Faculty of Health Sciences, Copenhagen

    The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
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  • William W. Eaton
    Affiliations
    Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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  • Preben B. Mortensen
    Affiliations
    National Centre for Register-Based Research, Aarhus University, Aarhus

    The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
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Published:November 06, 2013DOI:https://doi.org/10.1016/j.biopsych.2013.09.023
      This review summarizes the epidemiologic evidence linking autoimmune diseases and psychosis. The associations between autoimmune diseases and psychosis have been studied for more than a half century, but research has intensified within the last decades, since psychosis has been associated with genetic markers of the immune system and with excess autoreactivity and other immune alterations. A range of psychiatric disorders, including psychosis, have been observed to occur more frequently in some autoimmune diseases, such as systemic lupus erythematosus and multiple sclerosis. Many autoimmune diseases involve multiple organs and general dysfunction of the immune system, which could affect the brain and induce psychiatric symptoms. Most studies have been cross-sectional, observing an increased prevalence of a broad number of autoimmune diseases in people with psychotic disorders. Furthermore, there is some evidence of associations of psychosis with a family history of autoimmune disorders and vice versa. Additionally, several autoimmune diseases, individually and in aggregate, have been identified as raising the risk for psychotic disorders in longitudinal studies. The associations have been suspected to be caused by inflammation or brain-reactive antibodies associated with the autoimmune diseases. However, the associations could also be caused by shared genetic factors or common etiologic components such as infections. Infections can induce the development of autoimmune diseases and autoantibodies, possibly affecting the brain. Autoimmune diseases and brain-reactive antibodies should be considered by clinicians in the treatment of individuals with psychotic symptoms, and even if the association is not causal, treatment would probably still improve quality of life and survival.

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      References

        • Benros M.E.
        • Mortensen P.B.
        • Eaton W.W.
        Autoimmune diseases and infections as risk factors for schizophrenia.
        Ann N Y Acad Sci. 2012; 1262: 56-66
        • Davidson A.
        • Diamond B.
        Autoimmune diseases.
        N Engl J Med. 2001; 345: 340-350
        • Sullivan P.F.
        • Kendler K.S.
        • Neale M.C.
        Schizophrenia as a complex trait: Evidence from a meta-analysis of twin studies.
        Arch Gen Psychiatry. 2003; 60: 1187-1192
        • Cho J.H.
        • Gregersen P.K.
        Genomics and the multifactorial nature of human autoimmune disease.
        N Engl J Med. 2011; 365: 1612-1623
        • Jones A.L.
        • Mowry B.J.
        • Pender M.P.
        • Greer J.M.
        Immune dysregulation and self-reactivity in schizophrenia: Do some cases of schizophrenia have an autoimmune basis?.
        Immunol Cell Biol. 2005; 83: 9-17
        • Stefansson H.
        • Ophoff R.A.
        • Steinberg S.
        • Andreassen O.A.
        • Cichon S.
        • Rujescu D.
        • et al.
        Common variants conferring risk of schizophrenia.
        Nature. 2009; 460: 744-747
        • Schizophrenia Psychiatric Genome-Wide Association Study (GWAS) Consortium
        Genome-wide association study identifies five new schizophrenia loci.
        Nat Genet. 2011; 43: 969-976
        • Nikkila H.V.
        • Muller K.
        • Ahokas A.
        • Rimon R.
        • Andersson L.C.
        Increased frequency of activated lymphocytes in the cerebrospinal fluid of patients with acute schizophrenia.
        Schizophr Res. 2001; 49: 99-105
        • Miller B.J.
        • Gassama B.
        • Sebastian D.
        • Buckley P.
        • Mellor A.
        Meta-analysis of lymphocytes in schizophrenia: Clinical status and antipsychotic effects.
        Biol Psychiatry. 2013; 73: 993-999
        • Muller N.
        • Schwarz M.J.
        Immune system and schizophrenia.
        Curr Immunol Rev. 2010; 6: 213-220
        • Potvin S.
        • Stip E.
        • Sepehry A.A.
        • Gendron A.
        • Bah R.
        • Kouassi E.
        Inflammatory cytokine alterations in schizophrenia: A systematic quantitative review.
        Biol Psychiatry. 2008; 63: 801-808
        • Suvisaari J.
        • Loo B.M.
        • Saarni S.E.
        • Haukka J.
        • Perala J.
        • Saarni S.I.
        • et al.
        Inflammation in psychotic disorders: A population-based study.
        Psychiatry Res. 2011; 189: 305-311
        • Radewicz K.
        • Garey L.J.
        • Gentleman S.M.
        • Reynolds R.
        Increase in HLA-DR immunoreactive microglia in frontal and temporal cortex of chronic schizophrenics.
        J Neuropathol Exp Neurol. 2000; 59: 137-150
        • van Berckel B.N.
        • Bossong M.G.
        • Boellaard R.
        • Kloet R.
        • Schuitemaker A.
        • Caspers E.
        • et al.
        Microglia activation in recent-onset schizophrenia: A quantitative (R)-[11C]PK11195 positron emission tomography study.
        Biol Psychiatry. 2008; 64: 820-822
        • Benros M.E.
        • Nielsen P.R.
        • Nordentoft M.
        • Eaton W.W.
        • Dalton S.O.
        • Mortensen P.B.
        Autoimmune diseases and severe infections as risk factors for schizophrenia: A 30-year population-based register study.
        Am J Psychiatry. 2011; 168: 1303-1310
        • Yolken R.H.
        • Torrey E.F.
        Are some cases of psychosis caused by microbial agents? A review of the evidence.
        Mol Psychiatry. 2008; 13: 470-479
        • Trevathan R.
        • Tatum J.C.
        Rarity of concurrence of psychosis and rheumatoid arthritis in individual patients.
        J Nerv Ment Dis. 1953; 120: 83-84
        • Pilkington T.
        The coincidence of rheumatoid arthritis and schizophrenia.
        J Nerv Ment Dis. 1955; 124: 604-606
        • Bender L.
        Childhood schizophrenia.
        Psychiatr Q. 1953; 27: 663-681
        • Graff H.
        • Handford A.
        Celiac syndrome in the case histories of five schizophrenics.
        Psychiatr Q. 1961; 35: 306-313
        • Fessel W.J.
        Autoimmunity and mental illness. A preliminary report.
        Arch Gen Psychiatry. 1962; 6: 320-323
        • Heath R.G.
        • Krupp I.M.
        Schizophrenia as an immunologic disorder. I. Demonstration of antibrain globulins by fluorescent antibody techniques.
        Arch Gen Psychiatry. 1967; 16: 1-9
        • Heath R.G.
        • Krupp I.M.
        Catatonia induced in monkeys by antibrain antibody.
        Am J Psychiatry. 1967; 123: 1499-1504
        • Eaton W.W.
        • Byrne M.
        • Ewald H.
        • Mors O.
        • Chen C.Y.
        • Agerbo E.
        • Mortensen P.B.
        Association of schizophrenia and autoimmune diseases: Linkage of Danish national registers.
        Am J Psychiatry. 2006; 163: 521-528
        • Graus F.
        • Saiz A.
        • Dalmau J.
        Antibodies and neuronal autoimmune disorders of the CNS.
        J Neurol. 2010; 257: 509-517
        • Steiner J.
        • Bogerts B.
        • Sarnyai Z.
        • Walter M.
        • Gos T.
        • Bernstein H.G.
        • Myint A.M.
        Bridging the gap between the immune and glutamate hypotheses of schizophrenia and major depression: Potential role of glial NMDA receptor modulators and impaired blood-brain barrier integrity.
        World J Biol Psychiatry. 2012; 13: 482-492
        • Zandi M.S.
        • Irani S.R.
        • Lang B.
        • Waters P.
        • Jones P.B.
        • McKenna P.
        • et al.
        Disease-relevant autoantibodies in first episode schizophrenia.
        J Neurol. 2010; 258: 686-688
        • Steiner J.
        • Walter M.
        • Glanz W.
        • Sarnyai Z.
        • Bernstein H.G.
        • Vielhaber S.
        • et al.
        Increased prevalence of diverse N-methyl-D-aspartate glutamate receptor antibodies in patients with an initial diagnosis of schizophrenia: Specific relevance of IgG NR1a antibodies for distinction from N-methyl-D-aspartate glutamate receptor encephalitis.
        JAMA Psychiatry. 2013; 70: 271-278
        • Saha S.
        • Chant D.
        • Welham J.
        • McGrath J.
        A systematic review of the prevalence of schizophrenia.
        PLoS Med. 2005; 2: e141
        • Eaton W.W.
        • Pedersen M.G.
        • Atladottir H.O.
        • Gregory P.E.
        • Rose N.R.
        • Mortensen P.B.
        The prevalence of 30 ICD-10 autoimmune diseases in Denmark.
        Immunol Res. 2010; 47: 228-231
        • Benros M.E.
        • Pedersen M.G.
        • Rasmussen H.
        • Eaton W.W.
        • Nordentoft M.
        • Mortensen P.B.
        A nationwide study on the risk of autoimmune diseases in individuals with a personal or a family history of schizophrenia and related psychosis [published online ahead of print October 16].
        Am J Psychiatry. 2013;
        • Eaton W.W.
        • Pedersen M.G.
        • Nielsen P.R.
        • Mortensen P.B.
        Autoimmune diseases, bipolar disorder, and non-affective psychosis.
        Bipolar Disord. 2010; 12: 638-646
        • Chen S.J.
        • Chao Y.L.
        • Chen C.Y.
        • Chang C.M.
        • Wu E.C.
        • Wu C.S.
        • et al.
        Prevalence of autoimmune diseases in in-patients with schizophrenia: Nationwide population-based study.
        Br J Psychiatry. 2012; 200: 374-380
        • Kalaydjian A.E.
        • Eaton W.
        • Cascella N.
        • Fasano A.
        The gluten connection: The association between schizophrenia and celiac disease.
        Acta Psychiatr Scand. 2006; 113: 82-90
        • Hadjivassiliou M.
        • Sanders DSGRA
        • Woodroofe N.
        • Boscolo S.
        • Aeschlimann D.
        Gluten sensitivity: From gut to brain.
        Lancet Neurol. 2010; 9: 318-330
        • Jackson J.R.
        • Eaton W.W.
        • Cascella N.G.
        • Fasano A.
        • Kelly D.L.
        Neurologic and psychiatric manifestations of celiac disease and gluten sensitivity.
        Psychiatr Q. 2012; 83: 91-102
        • Irani S.
        • Lang B.
        Autoantibody-mediated disorders of the central nervous system.
        Autoimmunity. 2008; 41: 55-65
        • Dohan F.C.
        Wheat “consumption” and hospital admissions for schizophrenia during World War II. A preliminary report.
        Am J Clin Nutr. 1966; 18: 7-10
        • Dohan F.C.
        Coeliac disease and schizophrenia.
        Lancet. 1970; 1: 897-898
        • Dohan F.C.
        • Harper E.H.
        • Clark M.H.
        • Rodrigue R.B.
        • Zigas V.
        Is schizophrenia rare if grain is rare?.
        Biol Psychiatry. 1984; 19: 385-399
        • De Santos Addolorato G.
        • Romito A.
        • Caputo S.
        • Giordano A.
        • Gambassi G.
        • et al.
        Schizophrenic symptoms and SPECT abnormalities in a coeliac patient: Regression after a gluten-free diet.
        J Intern Med. 1997; 242: 421-423
        • Jackson J.
        • Eaton W.
        • Cascella N.
        • Fasano A.
        • Warfel D.
        • Feldman S.
        • et al.
        A gluten-free diet in people with schizophrenia and anti-tissue transglutaminase or anti-gliadin antibodies.
        Schizophr Res. 2012; 140: 262-263
        • Singh M.M.
        • Kay S.R.
        Wheat gluten as a pathogenic factor in schizophrenia.
        Science. 1976; 191: 401-402
        • Cascella N.G.
        • Kryszak D.
        • Bhatti B.
        • Gregory P.
        • Kelly D.L.
        • Mc Evoy J.P.
        • et al.
        Prevalence of celiac disease and gluten sensitivity in the United States clinical antipsychotic trials of intervention effectiveness study population.
        Schizophr Bull. 2011; 37: 94-100
        • Reichelt K.L.
        • Landmark J.
        Specific IgA antibody increases in schizophrenia.
        Biol Psychiatry. 1995; 37: 410-413
        • Jin S.Z.
        • Wu N.
        • Xu Q.
        • Zhang X.
        • Ju G.Z.
        • Law M.H.
        • Wei J.
        A study of circulating gliadin antibodies in schizophrenia among a Chinese population.
        Schizophr Bull. 2012; 38: 514-518
        • Samaroo D.
        • Dickerson F.
        • Kasarda D.D.
        • Green P.H.
        • Briani C.
        • Yolken R.H.
        • Alaedini A.
        Novel immune response to gluten in individuals with schizophrenia.
        Schizophr Res. 2010; 118: 248-255
        • Sidhom O.
        • Laadhar L.
        • Zitouni M.
        • Ben A.N.
        • Rafrafi R.
        • Kallel-Sellami M.
        • et al.
        Spectrum of autoantibodies in Tunisian psychiatric inpatients.
        Immunol Invest. 2012; 41: 538-549
        • Dickerson F.
        • Stallings C.
        • Origoni A.
        • Vaughan C.
        • Khushalani S.
        • Leister F.
        • et al.
        Markers of gluten sensitivity and celiac disease in recent-onset psychosis and multi-episode schizophrenia.
        Biol Psychiatry. 2010; 68: 100-104
        • Peleg R.
        • Ben-Zion Z.I.
        • Peleg A.
        • Gheber L.
        • Kotler M.
        • Weizman Z.
        • et al.
        “Bread madness” revisited: Screening for specific celiac antibodies among schizophrenia patients.
        Eur Psychiatry. 2004; 19: 311-314
        • Jungerius B.J.
        • Bakker S.C.
        • Monsuur A.J.
        • Sinke R.J.
        • Kahn R.S.
        • Wijmenga C.
        Is MYO9B the missing link between schizophrenia and celiac disease?.
        Am J Med Genet B Neuropsychiatr Genet. 2008; 147: 351-355
        • Ludvigsson J.F.
        • Osby U.
        • Ekbom A.
        • Montgomery S.M.
        Coeliac disease and risk of schizophrenia and other psychosis: A general population cohort study.
        Scand J Gastroenterol. 2007; 42: 179-185
        • Eaton W.W.
        • Hayward C.
        • Ram R.
        Schizophrenia and rheumatoid arthritis: A review.
        Schizophr Res. 1992; 6: 181-192
        • Vinogradov S.
        • Gottesman II,
        • Moises H.W.
        • Nicol S.
        Negative association between schizophrenia and rheumatoid arthritis.
        Schizophr Bull. 1991; 17: 669-678
        • Mors O.
        • Mortensen P.B.
        • Ewald H.
        A population-based register study of the association between schizophrenia and rheumatoid arthritis.
        Schizophr Res. 1999; 40: 67-74
        • Torrey E.F.
        • Yolken R.H.
        The schizophrenia-rheumatoid arthritis connection: Infectious, immune, or both?.
        Brain Behav Immun. 2001; 15: 401-410
        • Margutti P.
        • Delunardo F.
        • Ortona E.
        Autoantibodies associated with psychiatric disorders.
        Curr Neurovasc Res. 2006; 3: 149-157
        • Gilvarry C.M.
        • Sham P.C.
        • Jones P.B.
        • Cannon M.
        • Wright P.
        • Lewis S.W.
        • et al.
        Family history of autoimmune diseases in psychosis.
        Schizophr Res. 1996; 19: 33-40
        • Yarlagadda A.
        • Helvink B.
        • Chou C.
        • Clayton A.H.
        Blood brain barrier: The role of GAD antibodies in psychiatry.
        Psychiatry (Edgmont). 2007; 4: 57-59
        • Wright P.
        • Sham P.C.
        • Gilvarry C.M.
        • Jones P.B.
        • Cannon M.
        • Sharma T.
        • Murray R.M.
        Autoimmune diseases in the pedigrees of schizophrenic and control subjects.
        Schizophr Res. 1996; 20: 261-267
        • Finney G.O.
        Juvenile onset diabetes and schizophrenia?.
        Lancet. 1989; 2: 1214-1215
        • Juvonen H.
        • Reunanen A.
        • Haukka J.
        • Muhonen M.
        • Suvisaari J.
        • Arajarvi R.
        • et al.
        Incidence of schizophrenia in a nationwide cohort of patients with type 1 diabetes mellitus.
        Arch Gen Psychiatry. 2007; 64: 894-899
        • Ballok D.A.
        Neuroimmunopathology in a murine model of neuropsychiatric lupus.
        Brain Res Rev. 2007; 54: 67-79
        • Degiorgio L.A.
        • Konstantinov K.N.
        • Lee S.C.
        • Hardin J.A.
        • Volpe B.T.
        • Diamond B.
        A subset of lupus anti-DNA antibodies cross-reacts with the NR2 glutamate receptor in systemic lupus erythematosus.
        Nat Med. 2001; 7: 1189-1193
        • Rice J.S.
        • Kowal C.
        • Volpe B.T.
        • Degiorgio L.A.
        • Diamond B.
        Molecular mimicry: Anti-DNA antibodies bind microbial and nonnucleic acid self-antigens.
        Curr Top Microbiol Immunol. 2005; 296: 137-151
        • Balu D.T.
        • Coyle J.T.
        Neuroplasticity signaling pathways linked to the pathophysiology of schizophrenia.
        Neurosci Biobehav Rev. 2011; 35: 848-870
        • van Dam A.P.
        Diagnosis and pathogenesis of CNS lupus.
        Rheumatol Int. 1991; 11: 1-11
        • Feinstein A.
        Neuropsychiatric syndromes associated with multiple sclerosis.
        J Neurol. 2007; 254: II73-II76
        • Kosmidis M.H.
        • Giannakou M.
        • Messinis L.
        • Papathanasopoulos P.
        Psychotic features associated with multiple sclerosis.
        Int Rev Psychiatry. 2010; 22: 55-66
        • Minagar A.
        • Carpenter A.
        • Alexander J.S.
        The destructive alliance: Interactions of leukocytes, cerebral endothelial cells, and the immune cascade in pathogenesis of multiple sclerosis.
        Int Rev Neurobiol. 2007; 79: 1-11
        • Patten S.B.
        • Svenson L.W.
        • Metz L.M.
        Psychotic disorders in MS: Population-based evidence of an association.
        Neurology. 2005; 65: 1123-1125
        • Kimura A.
        • Sakurai T.
        • Koumura A.
        • Yamada M.
        • Hayashi Y.
        • Tanaka Y.
        • et al.
        High prevalence of autoantibodies against phosphoglycerate mutase 1 in patients with autoimmune central nervous system diseases.
        J Neuroimmunol. 2010; 219: 105-108
        • Butterworth R.F.
        Hepatic encephalopathy: A central neuroinflammatory disorder?.
        Hepatology. 2011; 53: 1372-1376
        • Diamond B.
        • Huerta P.T.
        • Mina-Osorio P.
        • Kowal C.
        • Volpe B.T.
        Losing your nerves? Maybe it’s the antibodies.
        Nat Rev Immunol. 2009; 9: 449-456
        • Rose N.R.
        The role of infection in the pathogenesis of autoimmune disease.
        Semin Immunol. 1998; 10: 5-13
        • Benros M.E.
        • Waltoft B.L.
        • Nordentoft M.
        • Ostergaard S.D.
        • Eaton W.W.
        • Krogh J.
        • Mortensen P.B.
        Autoimmune diseases and severe infections as risk factors for mood disorders: A nationwide study.
        JAMA Psychiatry. 2013; 70: 812-820
        • Goldsmith C.A.
        • Rogers D.P.
        The case for autoimmunity in the etiology of schizophrenia.
        Pharmacotherapy. 2008; 28: 730-741
        • Kayser M.S.
        • Dalmau J.
        Anti-NMDA receptor encephalitis in psychiatry.
        Curr Psychiatry Rev. 2011; 7: 189-193
        • Katzav A.
        • Solodeev I.
        • Brodsky O.
        • Chapman J.
        • Pick C.G.
        • Blank M.
        • et al.
        Induction of autoimmune depression in mice by anti-ribosomal P antibodies via the limbic system.
        Arthritis Rheum. 2007; 56: 938-948
        • Kowal C.
        • Degiorgio L.A.
        • Nakaoka T.
        • Hetherington H.
        • Huerta P.T.
        • Diamond B.
        • Volpe B.T.
        Cognition and immunity; antibody impairs memory.
        Immunity. 2004; 21: 179-188
        • Goldman L.S.
        Medical illness in patients with schizophrenia.
        J Clin Psychiatry. 1999; 60: 10-15
        • Harris E.C.
        • Barraclough B.
        Excess mortality of mental disorder.
        Br J Psychiatry. 1998; 173: 11-53
        • Laursen T.M.
        • Munk-Olsen T.
        • Nordentoft M.
        • Mortensen P.B.
        Increased mortality among patients admitted with major psychiatric disorders: A register-based study comparing mortality in unipolar depressive disorder, bipolar affective disorder, schizoaffective disorder, and schizophrenia.
        J Clin Psychiatry. 2007; 68: 899-907
        • Laursen T.M.
        • Munk-Olsen T.
        • Gasse C.
        Chronic somatic comorbidity and excess mortality due to natural causes in persons with schizophrenia or bipolar affective disorder.
        PLoS One. 2011; 6: e24597
        • Meyer U.
        • Schwarz M.J.
        • Muller N.
        Inflammatory processes in schizophrenia: A promising neuroimmunological target for the treatment of negative/cognitive symptoms and beyond.
        Pharmacol Ther. 2011; 132: 96-110
        • Eaton W.W.
        • Rose N.R.
        • Kalaydjian A.
        • Pedersen M.G.
        • Mortensen P.B.
        Epidemiology of autoimmune diseases in Denmark.
        J Autoimmun. 2007; 29: 1-9
        • Dantzer R.
        • O’Connor J.C.
        • Freund G.G.
        • Johnson R.W.
        • Kelley K.W.
        From inflammation to sickness and depression: When the immune system subjugates the brain.
        Nat Rev Neurosci. 2008; 9: 46-56
        • Hickie I.B.
        • Banati R.
        • Stewart C.H.
        • Lloyd A.R.
        Are common childhood or adolescent infections risk factors for schizophrenia and other psychotic disorders?.
        Med J Aust. 2009; 190: S17-S21
        • Bayer T.A.
        • Buslei R.
        • Havas L.
        • Falkai P.
        Evidence for activation of microglia in patients with psychiatric illnesses.
        Neurosci Lett. 1999; 271: 126-128
        • Pedersen M.S.
        • Benros M.E.
        • Agerbo E.
        • Borglum A.D.
        • Mortensen P.B.
        Schizophrenia in patients with atopic disorders with particular emphasis on asthma: A Danish population-based study.
        Schizophr Res. 2012; 138: 58-62
        • Meyer U.
        • Feldon J.
        • Dammann O.
        Schizophrenia and autism: Both shared and disorder-specific pathogenesis via perinatal inflammation?.
        Pediatr Res. 2011; 69: 26R-33R
        • Gardner R.M.
        • Dalman C.
        • Wicks S.
        • Lee B.K.
        • Karlsson H.
        Neonatal levels of acute phase proteins and later risk of non-affective psychosis.
        Transl Psychiatry. 2013; 3: e228
        • Yum S.Y.
        • Yum S.K.
        • Kim T.
        • Hwang M.Y.
        Clinical perspectives on autoimmune processes in schizophrenia.
        Psychiatr Clin North Am. 2009; 32: 795-808
        • Tanaka S.
        • Matsunaga H.
        • Kimura M.
        • Tatsumi K.
        • Hidaka Y.
        • Takano T.
        • et al.
        Autoantibodies against four kinds of neurotransmitter receptors in psychiatric disorders.
        J Neuroimmunol. 2003; 141: 155-164
        • Laske C.
        • Zank M.
        • Klein R.
        • Stransky E.
        • Batra A.
        • Buchkremer G.
        • Schott K.
        Autoantibody reactivity in serum of patients with major depression, schizophrenia and healthy controls.
        Psychiatry Res. 2008; 158: 83-86
        • Schott K.
        • Schaefer J.E.
        • Richartz E.
        • Batra A.
        • Eusterschulte B.
        • Klein R.
        • et al.
        Autoantibodies to serotonin in serum of patients with psychiatric disorders.
        Psychiatry Res. 2003; 121: 51-57
        • Ganguli R.
        • Rabin B.S.
        • Kelly R.H.
        • Lyte M.
        • Ragu U.
        Clinical and laboratory evidence of autoimmunity in acute schizophrenia.
        Ann N Y Acad Sci. 1987; 496: 676-685
        • Bechter K.
        • Reiber H.
        • Herzog S.
        • Fuchs D.
        • Tumani H.
        • Maxeiner H.G.
        Cerebrospinal fluid analysis in affective and schizophrenic spectrum disorders: Identification of subgroups with immune responses and blood-CSF barrier dysfunction.
        J Psychiatr Res. 2010; 44: 321-330
        • Kranaster L.
        • Koethe D.
        • Hoyer C.
        • Meyer-Lindenberg A.
        • Leweke F.M.
        Cerebrospinal fluid diagnostics in first-episode schizophrenia.
        Eur Arch Psychiatry Clin Neurosci. 2011; 261: 529-530
        • Laursen T.M.
        Life expectancy among persons with schizophrenia or bipolar affective disorder.
        Schizophr Res. 2011; 131: 101-104

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      • Is There a Flame in the Brain in Psychosis?
        Biological PsychiatryVol. 75Issue 4
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          For many decades, it was believed that the brain was immunologically privileged, hence it was surprising when Shatz and colleagues (1) reported in 2000 that a number of immune proteins (cytokines and major histocompatibility complex [MHC] proteins) were not just present in the brain but were localized at functional synapses. Subsequent work has shown that these molecules play a major role in brain development as well as in mature synaptic function and plasticity (2,3).
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