title: Beyond the association. Toxoplasma gondii in schizophrenia, bipolar disorder, and addiction: systematic review and meta-analysis.
abstract: OBJECTIVE
  To perform a meta-analysis on studies reporting prevalence of Toxoplasma gondii (T. gondii) infection in any psychiatric disorder compared with healthy controls. Our secondary objective was to analyze factors possibly moderating heterogeneity.
  
  
  METHODS
  A systematic search was performed to identify studies into T. gondii infection for all major psychiatric disorders versus healthy controls. Methodological quality, publication bias, and possible moderators were assessed.
  
  
  RESULTS
  A total of 2866 citations were retrieved and 50 studies finally included. Significant odds ratios (ORs) with IgG antibodies were found in schizophrenia (OR 1.81, P < 0.00001), bipolar disorder (OR 1.52, P = 0.02), obsessive-compulsive disorder (OR 3.4, P < 0.001), and addiction (OR 1.91, P < 0.00001), but not for major depression (OR 1.21, P = 0.28). Exploration of the association between T. gondii and schizophrenia yielded a significant effect of seropositivity before onset and serointensity, but not IgM antibodies or gender. The amplitude of the OR was influenced by region and general seroprevalence. Moderators together accounted for 56% of the observed variance in study effects. After controlling for publication bias, the adjusted OR (1.43) in schizophrenia remained significant.
  
  
  CONCLUSIONS
  These findings suggest that T. gondii infection is associated with several psychiatric disorders and that in schizophrenia reactivation of latent T. gondii infection may occur.
authors: Department of Psychiatry, Academic Medical Centre (AMC), Amsterdam, the Netherlands.
authors: A L
authors: AL
authors: Sutterland
authors: AP-HP, DHU Pe-PSY, Pôle de Psychiatrie et d'addictologie des Hôpitaux Universitaires H Mondor, INSERM U955, Eq 15 Psychiatrie Translationnelle, Université Paris Est-Créteil, Créteil, France.|Fondation Fondamental, Créteil, France.
authors: G
authors: G
authors: Fond
authors: Department of Psychiatry, Academic Medical Centre (AMC), Amsterdam, the Netherlands.
authors: A
authors: A
authors: Kuin
authors: Department of Psychiatry, Academic Medical Centre (AMC), Amsterdam, the Netherlands.
authors: M W J
authors: MW
authors: Koeter
authors: Departments of Experimental Immunology and Respiratory Medicine, Academic Medical Centre (AMC), Amsterdam, the Netherlands.
authors: R
authors: R
authors: Lutter
authors: Department of Parasitology, Academic Medical Centre (AMC), Amsterdam, the Netherlands.
authors: T
authors: T
authors: van Gool
authors: Stanley Neurovirology Laboratory, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors: R
authors: R
authors: Yolken
authors: AP-HP, DHU Pe-PSY, Pôle de Psychiatrie et d'addictologie des Hôpitaux Universitaires H Mondor, INSERM U955, Eq 15 Psychiatrie Translationnelle, Université Paris Est-Créteil, Créteil, France.|Fondation Fondamental, Créteil, France.
authors: A
authors: A
authors: Szoke
authors: AP-HP, DHU Pe-PSY, Pôle de Psychiatrie et d'addictologie des Hôpitaux Universitaires H Mondor, INSERM U955, Eq 15 Psychiatrie Translationnelle, Université Paris Est-Créteil, Créteil, France.|Fondation Fondamental, Créteil, France.
authors: M
authors: M
authors: Leboyer
authors: Department of Psychiatry, Academic Medical Centre (AMC), Amsterdam, the Netherlands.
authors: L
authors: L
authors: de Haan
mesh_terms: D016739:Behavior, Addictive / Q000276:immunology / Q000469:parasitology* / Q000523:psychology; D001714:Bipolar Disorder / Q000276:immunology / Q000469:parasitology*; D016022:Case-Control Studies; D003865:Major Depressive Disorder / Q000276:immunology / Q000469:parasitology; D006801:Humans; D009771:Obsessive-Compulsive Disorder / Q000276:immunology / Q000469:parasitology; D012559:Schizophrenia / Q000276:immunology / Q000469:parasitology*; D019966:Substance-Related Disorders / Q000276:immunology / Q000469:parasitology* / Q000523:psychology; D014122:Toxoplasma / Q000302:isolation & purification*; D014123:Toxoplasmosis / Q000276:immunology / Q000469:parasitology / Q000523:psychology*
keywords: Toxoplasma gondii; bipolar disorder; meta-analysis; schizophrenia; substance abuse disorder