Autoimmune disorder may lead to psychosis in children

Researchers have revealed the presence of two antibodies in a subgroup of children experiencing their first episode of psychosis, affirming a longstanding recognition that autoimmune disorders play a significant role in psychiatric illness.

Researchers from the Kids Research Institute at The Children’s Hospital at Westmead and the University of Sydney detected antibodies to the dopamine-2 receptor (D2R) or the glutamatergic N-methyl-D-aspartate receptor (NMDAR) among eight out of 43 children experiencing their first episode of psychosis, but no such antibodies in healthy children. Both receptors are key neural signalling proteins previously implicated in psychosis.

Dopamine is a chemical messenger aiding the transmission of signals in the brain and other areas of the body. Abnormalities in dopaminergic neurotransmission play a key role in the pathogenesis of psychosis.

It is also likely that glutamatergic dysfunction also plays a role in psychotic disease as glutamatergic agents directly modulate the excitatory amino acid system in the brain. The new study suggests that specific pathologies and processes affecting D2R and NMDAR could define biological subgroups and may be involved in the pathogenesis of psychosis and other psychiatric illnesses such as schizophrenia.

“The antibodies we have detected in children having a first episode of acute psychosis suggest there is a distinct subgroup for whom autoimmunity plays a role in their illness,” said senior author Dr Fabienne Brilot, the head of the Neuroimmunology Group at The Children’s Hospital.

“The finding suggests that better interventions are possible, providing hope that major disability can be prevented for the subset of children experiencing acute psychosis with antibodies.

“Further research will reveal whether these antibodies are the mark of a clinically relevant subset of patients and, if so, whether immunosuppressive therapies can effectively treat children with these debilitating illnesses.”

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