Identifying the prevalence of antibodies to neuronal membrane targets in first episode psychosis

在过去的十年中，在发现边缘系统脑炎的新的治疗反应原因方面取得了突破。这是一种罕见的，危及生命的大脑疾病。这些新的原因是针对脑细胞表面目标的抗体。在对这些新疾病的描述中，患者通常表现出明显的精神症状，如幻觉和妄想、思维障碍和记忆力受损等精神病症状。然而，他们也会出现痉挛、失去意识、血压控制或电解质紊乱等困难，这意味着他们最终会接受神经科医生或重症监护专家的治疗，而不是精神科医生。我们感兴趣的是，是否有一部分患有这种疾病的纯精神症状的患者也会有这些抗体。因此，我们测试了47例首次精神病发作的患者，没有边缘系统脑炎的其他特征，发现其中3人确实有这些抗体。此后，我们在没有系统筛查的情况下又确定了9名患者，并通过治疗免疫系统而不是传统的精神病药物治疗了其中4名患者。这进一步支持了抗体导致这些患者精神病的理论。我们现在想确定这种疾病有多普遍。我们想对更多的病人进行筛查，寻找所有已知的能引起边缘系统脑炎的抗体。这将有助于我们估计这是一种多么严重的疾病，并有助于规划临床服务。

In the last ten years there have been breakthroughs in the discovery of new treatment responsive causes of limbic encephalitis. This is a rare, life threatening brain disorder. These new causes have been antibodies against targets on the surface of brain cells. In the descriptions of these new disorders patients often present with promninent psychiatric symptoms, with symptoms of psychosis such as hallucinations and delusions and disordered thinking and impaired memory. However they also develop difficulties with fits, loss of unconsciousness, blood pressure control or electrolyte disturbance which means that they end up under the management of neurologists or intensive care specialists rather than psychiatrists. We were interested whether a proportion of patients with purely psychiatric symptoms of the disorder would also have these antibodies. We therefore tested 47 patients with a first episode of psychosis, without other features of limbic encephalitis and found that 3 of them did have these antibodies. We have since identified, without systematic screening a further 9 patients, and have treated 4 of these by treating their immune system rather than traditional psychiatric medication. This gives further support to the theory that the antibodies are causing the psychosis in these patients. We now wish to establish just how common this disorder is. We want to screen a larger number of patients for all known antibodies that can cause limbic encephalitis. This will help us to estimate how significant a disorder this is, and help with planning clinical services.