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Open Access Highly Accessed Research article

Anti-NMDA-receptor antibody detected in encephalitis, schizophrenia, and narcolepsy with psychotic features

Ko Tsutsui1, Takashi Kanbayashi1*, Keiko Tanaka2, Shuken Boku3, Wakako Ito14, Jun Tokunaga1, Akane Mori1, Yasuo Hishikawa15, Tetsuo Shimizu1 and Seiji Nishino6

Author affiliations

1 Akita University, Department of Neuropsychiatry, Akita, Japan

2 Kanazawa Medical University, Department of Neurology, Ishikawa, Japan

3 Hokkaido University, Department of Neuropsychiatry, Sapporo, Japan

4 University of South Carolina, Department of Exercise Science, Columbia, SC, USA

5 Akita Kaiseikai Hospital, Department of Psychiatry, Akita, Japan

6 Stanford University, Sleep and Circadian Neurobiology Laboratory, Palo Alto, CA, USA

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Citation and License

BMC Psychiatry 2012, 12:37  doi:10.1186/1471-244X-12-37

Published: 8 May 2012

Abstract

Background

Causative role of encephalitis in major psychotic features, dyskinesias (particularly orofacial), seizures, and autonomic and respiratory changes has been recently emphasized. These symptoms often occur in young females with ovarian teratomas and are frequently associated with serum and CSF autoantibodies to the NMDA receptor (NMDAR).

Methods

The study included a total of 61 patients from age 15 to 61 and was carried out between January 1, 2005, and Dec 31, 2010. The patients were divided into the following three clinical groups for comparison. Group A; Patients with typical clinical characteristics of anti-NMDAR encephalitis. Group B; Patients with narcolepsy with severe psychosis. Group C; Patients with schizophrenia or schizo-affective disorders.

Results

Ten out of 61 cases were anti-NMDAR antibody positive in typical encephalitis cases (group A: 3 of 5 cases) and cases in a broader range of psychiatric disorders including narcolepsy (group B: 3 of 5 cases) and schizophrenia (group C: 4 of 51 cases).

Conclusion

In addition to 3 typical cases, we found 7 cases with anti-NMDAR antibody associated with various psychotic and sleep symptoms, which lack any noticeable clinical signs of encephalitis (seizures and autonomic symptoms) throughout the course of the disease episodes; this result suggest that further discussion on the nosology and pathophysiology of autoimmune-mediated atypical psychosis and sleep disorders is required.