A large majority of persons diagnosed with schizophrenia or bipolar disorder may actually have a treatable immune system issue, according to researchers.
This study by the Houston Methodist researchers could have a big influence on the millions of people who have schizophrenia or bipolar disorder, including many homeless people. The research was inspired by the 2007 discovery of anti-NMDA receptor encephalitis, a disease that exhibits symptoms comparable to schizophrenia or bipolar disorder but is treatable with known immunotherapy medicines. “We suspect that a significant number of people believed to have schizophrenia or bipolar disorder actually have an immune system disorder that affects the brain’s receptors,” said Joseph Masdeu, M.D., Ph.D., the study’s principal investigator and a neurologist with the Houston Methodist Neurological Institute. “If true, those people have diseases that are completely reversible — they just need a proper diagnosis and treatment to help them return to normal lives.”
Conditions that cause the brain’s receptors to malfunction are frequently misdiagnosed as schizophrenia or bipolar disorder
Antibodies are generally produced by the immune system to target foreign things in the body, such as bacteria. When this process fails, antibodies are created that assault brain receptors, causing the receptor to stop listening to the messages that are transmitted to it. Antibodies assault N-methyl-D-aspartate (NMDA) receptors in the brain in cases of anti-NMDA receptor encephalitis. Conditions that cause the brain’s receptors to malfunction are frequently misdiagnosed as schizophrenia or bipolar disorder because these diseases are associated with a decrease in the activity of the NMDA receptors, which control how people think, make decisions, and perceive their surroundings. Hearing voices and paranoia are classic schizophrenia and bipolar disorder symptoms reported in anti-NMDA receptor encephalitis and comparable disorders. “We know that nearly 1 percent of the U.S. population — or more than 3.5 million people — have schizophrenia,” Masdeu said. “Another 2.6 percent of American adults have bipolar disorder. What we don’t know is how many of these patients actually have one of these treatable immune system disorders.”
Study results to develop more sensitive tests to aid in the detection of attacking antibodies
The study will include 150 patients with schizophrenia or bipolar disorder, as well as 50 healthy people between the ages of 18 and 35 who are willing to have a spinal tap to collect a small amount of cerebral spinal fluid, which will be screened for the presence of antibodies attacking NMDA and other receptors. If aberrant antibodies are detected, researchers will contact the patient or carer so that they can discuss treatment options with their healthcare practitioner, such as using current medications to inhibit the development of the attacking antibodies. Masdeu intends to use the findings of the study to develop more sensitive tests to aid in the detection of attacking antibodies. While working at the National Institutes of Health in the early 2010s, he began exploring possible autoimmune origins of schizophrenia and published early articles on the issue. Masdeu is now working alongside Josep Dalmau, M.D., Ph.D., the first person to describe how antibodies assault NMDA receptors.
Materials provided by Houston Methodist. Note: Content may be edited for style and length.
Houston Methodist. “Treatable condition could be mistaken for schizophrenia or bipolar disorder.” ScienceDaily. ScienceDaily, 13 December 2017. <www.sciencedaily.com/releases/2017/12/171213130504.htm>.
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