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For the first time specific antibodies have been found to be associated with the onset of schizophrenia in a study led by Professor Belinda Lennox.

The study – ‘Prevalence and clinical characteristics of serum neuronal cell surface antibodies in first episode psychosis’ -  published in The Lancet Psychiatry, reveals that certain kinds of antibodies appear in the blood of a significant percentage of people presenting with a first episode of psychosis. These antibodies, including those against the ‘NMDA receptor’, have previously been shown to cause encephalitis, a life threatening inflammation of the brain. This study now shows for the first time, that these same antibodies are also found in people with early presentations of schizophrenia.

Professor Belinda Lennox from the Department of Psychiatry, University of Oxford and Oxford Health NHS FT who led the study, says: ‘We have shown that 8.8% of people with a first episode of psychosis have an antibody in their blood that may be responsible for their illness. The only way to detect these antibodies is through doing a blood test, as patients with antibodies do not have different symptoms from other people with psychosis.’

The discovery offers fresh hope in terms of new treatment possibilities for people experiencing psychosis. This is because the rapid identification and removal of the same antibodies associated with encephalitis leads to a dramatic improvement, and often complete a cure from the illness. Professor Lennox and her team have successfully treated a number of patients experiencing psychosis, who have these antibodies, using this pioneering form of immunotherapy.

 

The next important step for this study is to work out whether removing the antibodies will treat psychosis in the same established way as is now used for encephalitis. To do this the research team are starting a randomised controlled trial of immune treatment in people with psychosis and antibodies, starting in 2017. - Professor Belinda Lennox

Sarah, patient of Professor Lennox: “It began with a devastating psychotic episode and subsequent issues with my memory, sleep, temperature and emotional control.  My mood was in total flux, swinging from hallucinations and insomnia to sleeping all day and getting severely depressed.  It took over a year before the autoimmune side of my illness was picked up on through a fortunate research trial.  Three years following my episode I have finally responded after two infusions of immune drugs. I am regaining nearly all of my previous function.  It has been like a miracle cure.  It is terrifying to imagine that without the correct treatment my symptoms might never have improved. Psychosis, caused by NMDA antibodies, could have dominated and even claimed my life.”

 

This study, funded by the Medical Research Council, recruited 228 people with psychosis from Early Intervention in Psychosis services from across England, including Oxford Health NHS Foundation Trust. People were tested within the first six weeks of treatment. The study also tested a comparison group of healthy controls. They found NMDAR antibodies as well as other antibodies, in patients with psychosis. They did not find any NMDAR antibodies in healthy control subjects. When the patients with antibodies were compared with those patients without antibodies there were no differences in their symptoms or illness course.

Antibodies are produced by the immune system to fight infection and protect the body. Sometimes, however, the antibodies cause more problems than they solve – in so-called auto-immune disorders, such as diabetes, multiple sclerosis and rheumatoid arthritis. Psychosis – which is a term for the symptoms seen in schizophrenia – is where a person may experience hallucinations, delusions and confused and disturbed thoughts.

The story of first-hand experience of NMDAR encephalitis was eloquently described by Susannah Cahalan, the New York Post journalist in her book ‘Brain on Fire’, which has since been made into a feature film released this year.

BBC Radio 4 broadcast an exploration into this new understanding of psychiatric disorders earlier this year: The Inflamed Mind.

Read the full paper in The Lancet Psychiatry.

Blood tests for antibodies are being offered through the Prevalence of pathogenic antibodies in psychosis study, which is running across most of England. If you, or someone you know has psychosis and would like to take part then please send your contact details to ppip@psych.ox.ac.uk and we will link you up to the research team near you. 

 

Media coverage:

Radio: BBC Radio 4, Today
08/12/2016, 06:33, 07:22
Oxford University scientists say some cases of psychosis could be caused by an immune disorder, meaning that some people could have been sectioned for illnesses which could be treated by immune therapy.  Sarah, a patient who is responding to treatment, is interviewed. She had been sectioned for psychotic symptoms, including hallucinations, but a blood test showed that she had an unusual level of NMDA receptor antibodies, which are associated with immune disorders such as autoimmune encephalitis. Treatment targeting the immune system has helped Sarah to recover at least partially. Professor Belinda Lennox, a researcher at the Department of Psychiatry, is interviewed in her lab about the research. Her study, published in Lancet Psychiatry, suggests that 3% of newly-diagnosed psychiatric patients had these antibodies, and up to 11% of patients may have different antibodies attaching different parts of the brain. “I think this is a really exciting advance for psychiatry as a whole,” said Professor Lennox. “Every psychiatrist and every patient with psychosis needs to be aware of this.”
 
Also:
Some psychosis cases an 'immune disorder'
BBC News online, 08/12/2016, James Gallagher
http://www.bbc.co.uk/news/health-38220610
Schizophrenia ‘could be down to antibodies attacking the brain’, research suggests
ITV News online, 08/12/2016
http://www.itv.com/news/2016-12-08/schizophrenia-could-be-down-to-antibodies-attacking-the-brain-research-suggests/
Some cases of schizophrenia and bipolar disorder could be misdiagnosed immune disorders
Daily Telegraph online, 08/12/2016
http://www.telegraph.co.uk/news/2016/12/08/cases-schizophrenia-bipolar-disorder-could-misdiagnosed-immune/
Sufferers of psychotic illnesses ‘may have treatable immune disorder’
Mail Online UK, 08/12/2016
http://www.dailymail.co.uk/wires/pa/article-4012262/Sufferers-psychotic-illnesses-treatable-immune-disorder.html
Sufferers of psychotic illnesses 'may have treatable immune disorder'
Oxford Times online, 08/12/2016
http://www.oxfordtimes.co.uk/news/14953907.Sufferers_of_psychotic_illnesses__may_have_treatable_immune_disorder_/
Sufferers of psychotic illnesses 'may have treatable immune disorder'
Oxford Mail online, 08/12/2016
http://www.oxfordmail.co.uk/news/14953907.Sufferers_of_psychotic_illnesses__may_have_treatable_immune_disorder_/
Radio: BBC World Service, News
07/12/2016, 23:32, 01:32
Radio: BBC Radio 5, Up All Night
08/12/2016, 04:02
Radio: BBC World Service, Newsday
08/12/2016, 05:06
Radio: BBC Radio 4, As BBC World Service
08/12/2016, 05:06
Radio: BBC Radio Oxford, Charles Nove
08/12/2016, 06:03
TV: BBC News Channel, Breakfast
08/12/2016, 06:08, 06:34
TV: BBC One, Breakfast
08/12/2016, 06:08
Radio: BBC Radio Oxford, Charles Nove
08/12/2016, 06:33
Radio: BBC Radio Wales, Good Morning Wales
08/12/2016, 06:57

Sufferers of psychotic illnesses may have treatable immune disorder
The Independent, 08/12/2016, Ryan Wilkinson
Some sufferers of psychotic illnesses like schizophrenia may have a treatable immune disorder, research by Oxford University scientists suggests.

In a nationwide study, Oxford researchers found up to one in 11 cases of psychosis may involve a condition where antibodies attack the brain.

The team suggested that all patients displaying signs of psychosis for the first time should be screened for the antibodies to see if alternative treatments may be possible.
The study, published in The Lancet, was led by Professor Belinda Lennox, a clinical psychiatrist at the University of Oxford. She told the BBC: “The implications of this are that there are patients in mental health services now who will have these antibodies and could potentially be treated in a very different way. “I think this is a really exciting advance for psychiatry as a whole, and every psychiatrist and patient with psychosis needs to be aware of this and to look for it and treat it assertively when we find it.”
http://www.independent.co.uk/life-style/health-and-families/health-news/mental-health-patients-psychotic-illnesses-schizophrenia-treatable-immune-disorder-university-oxford-a7462641.html

Also:
Schizophrenia may be linked to antibodies
The Times (Main), 09/12/2016, p.20, Unattributed
http://www.thetimes.co.uk/article/hope-for-schizophrenia-sufferers-as-scientists-find-antibodies-link-fh0bswww3
Schizophrenia patients 'may actually be physically ill'
Daily Mail (Main), 09/12/2016, p.26, Victoria Allen
Sufferers of schizophrenia 'may have a treatable immune disorder' that could be completely cured
Mail Online UK, 08/12/2016, Stephen Matthews
http://www.dailymail.co.uk/health/article-4012262/Sufferers-psychotic-illnesses-treatable-immune-disorder.html
Psychosis could be a treatable immune disorder, study finds
The Daily Telegraph (Main), 09/12/2016, p.10, Unattributed
Antibodies linked to psychosis
Daily Express (Main), 09/12/2016, p.7, Unattributed
Psychotic patients 'may have immune issue'
Metro (Main), 09/12/2016, p.21, Unattributed
Radio: BBC Radio 4, Six O’Clock News
08/12/2016, 18:23
TV: BBC One (& BBC News), Breakfast
08/12/2016, 07:09
TV: BBC News, Victoria Derbyshire
08/12/2016, 10:46
Radio: BBC World Service, World Update
08/12/2016, 10:26
Radio: BBC Radio 5 Live, 5 Live Daily with Emma Barnett
08/12/2016, 11:03
Radio: BBC World Service, The Newsroom
08/12/2016, 13:19
TV: BBC One Oxford, South Today
08/12/2016, 18:32
Radio: BBC Radio Oxford, Howard Bentham
08/12/2016, 07:03


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