title: Anti-NMDAR antibodies in new-onset psychosis. Positive results in an HIV-infected patient.
abstract: The role of neuronal surface autoantibodies (NSAs) in non-encephalitic psychosis is of recent and controversial interest. Most of the studies relating NSAs with psychosis are retrospective and only focused on the N-methyl-d-aspartate glutamate receptor (NMDAR). Our goal was to evaluate the prevalence of IgG antibodies against the NMDAR NR1 subunit (NMDAR-Abs) along with five additional NSAs in 61 first psychotic episode patients and 47 matched controls. We found two patients positive for NMDAR-Abs (3.3%). One of them was eventually considered to have been misdiagnosed and reclassified as encephalitis. The other met the criteria for bipolar I disorder, presented no neurological symptoms and had a comorbid HIV infection of vertical transmission. This is the first reported case of an HIV-infected patient with psychosis associated with NSAs. This study shows that patients presenting with clinically incomplete forms of anti-NMDAR encephalitis, with predominant or isolated psychiatric symptoms, can remain undetected if no ancillary tests are performed. To improve patient diagnosis and treatment of individuals with a first psychotic episode, more detailed neurological examinations might be needed. Further studies are required to better clarify the role of NSAs in the neuropsychiatric effects of HIV infection.
authors.affiliation: Department of Psychiatry, Hospital Universitari Son Espases, Carretera de Valldemossa 79, 07120 Palma de Mallorca, Spain; Faculty of Medicine, Universitat de Barcelona, C/Casanova 143, 08036 Barcelona, Spain. Electronic address: smarboleya@gmail.com.
authors.forename: Susana
authors.initials: S
authors.lastname: Arboleya
authors.affiliation: Department of Immunology, Hospital Universitari Son Espases, Carretera de Valldemossa 79, 07120 Palma de Mallorca, Spain; Institut d'Investigacio Sanitaria de Palma (IdISPa), Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Clemente
authors.affiliation: Department of Psychiatry, Hospital Universitari Son Espases, Carretera de Valldemossa 79, 07120 Palma de Mallorca, Spain.
authors.forename: Savannah
authors.initials: S
authors.lastname: Deng
authors.affiliation: Department of Psychiatry, Hospital Universitari Son Espases, Carretera de Valldemossa 79, 07120 Palma de Mallorca, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Bedmar
authors.affiliation: Department of Psychiatry, Hospital Universitari Son Espases, Carretera de Valldemossa 79, 07120 Palma de Mallorca, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Salvador
authors.affiliation: Department of Psychiatry, Hospital Universitari Son Espases, Carretera de Valldemossa 79, 07120 Palma de Mallorca, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Herbera
authors.affiliation: Department of Immunology, Hospital Universitari Son Espases, Carretera de Valldemossa 79, 07120 Palma de Mallorca, Spain.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Cunill
authors.affiliation: Research Unit, Hospital Universitari Son Espases, Carretera de Valldemossa 79, 07120 Palma de Mallorca, Spain; Institut d'Investigacio Sanitaria de Palma (IdISPa), Spain.
authors.forename: Cristòfol
authors.initials: C
authors.lastname: Vives-Bauza
authors.affiliation: Parc Sanitari Sant Joan de Déu (PSSJD), CIBERSAM, C/Antoni Pujadas 42, 08830 Sant Boi de Llobregat, Barcelona, Spain; Faculty of Medicine, Universitat de Barcelona, C/Casanova 143, 08036 Barcelona, Spain.
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Haro
authors.affiliation: Department of Psychiatry, Hospital Universitari Son Espases, Carretera de Valldemossa 79, 07120 Palma de Mallorca, Spain; Institut d'Investigacio Sanitaria de Palma (IdISPa), Spain.
authors.forename: Francesca
authors.initials: F
authors.lastname: Canellas
authors.affiliation: Department of Immunology, Hospital Universitari Son Espases, Carretera de Valldemossa 79, 07120 Palma de Mallorca, Spain; Institut d'Investigacio Sanitaria de Palma (IdISPa), Spain.
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: Julià
mesh_terms: D000328:Adult; D000954:Antigens, Surface / Q000276:immunology*; D001323:Autoantibodies / Q000097:blood*; D001714:Bipolar Disorder / Q000276:immunology*; D005260:Female; D006679:HIV Seropositivity / Q000276:immunology*; D006801:Humans; D008297:Male; D011618:Psychotic Disorders / Q000276:immunology*; D016194:Receptors, N-Methyl-D-Aspartate / Q000276:immunology*; D055815:Young Adult
chemical_list: D000954:Antigens, Surface; D001323:Autoantibodies; C409466:NR1 NMDA receptor; D016194:Receptors, N-Methyl-D-Aspartate
keywords: Autoimmunity; Encephalitis; HIV; Mania; NMDAR; Psychosis; Schizophrenia