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@ARTICLE{Endres:269340,
author = {Endres, Dominique and von Zedtwitz, Katharina and Nickel,
Kathrin and Runge, Kimon and Maier, Alexander and Domschke,
Katharina and Salzer, Ulrich and Prüss, Harald and Venhoff,
Nils and van Elst, Ludger Tebartz},
title = {{A}ssociation of rheumatological markers with neuronal
antibodies, cerebrospinal fluid, electroencephalography, and
magnetic resonance imaging findings in 224 patients with
psychotic syndromes},
journal = {Brain, behavior and immunity},
volume = {119},
issn = {0889-1591},
address = {Orlando, Fla.},
publisher = {Academic Press},
reportid = {DZNE-2024-00509},
pages = {482 - 493},
year = {2024},
abstract = {Psychotic syndromes can have autoimmune-mediated causes in
some patients. Thus, this retrospective work aims to
investigate the role of rheumatological markers in the
development of psychosis.In total, 224 patients with
psychotic syndromes receiving a 'rheumatological laboratory
screening' (including C-reactive protein [CRP],
immunofixation, complement factors, rheumatoid factor [RF],
antiphospholipid antibodies [APAs], antineutrophil
cytoplasmic antibodies [ANCAs], and antinuclear antibodies
[ANAs]) were analyzed. A further diagnostic work-up included
investigations of neuronal antibodies and cerebrospinal
fluid (CSF), as well as electroencephalography (EEG) and
magnetic resonance imaging (MRI) of the brain. ANA testing
was routinely performed in all patients using serum on human
epithelioma-2 (Hep2) cells, and a subset of patients (N =
73) also underwent tissue-based assays from serum and CSF.
The number of cases with autoimmune psychotic syndromes was
descriptively collected, and ANA-positive and -negative
patients were compared in detail.CRP was elevated in 9 $\%$
of patients, immunofixation identified alterations in 8
$\%,$ complement factor C3 was decreased in 14 $\%,$ RF was
elevated in 1 $\%,$ APAs were elevated in 7 $\%,$ ANCAs were
not clearly positive, and ANAs were positive in 19 $\%$
(extractable nuclear antigen [ENA] differentiation resulted
in positive findings in 14 patients). From the 73 patient
samples additionally investigated using tissue-based assays,
there were 26 positive results for some kind of ANA (36
$\%),$ and overall using both methods, 54 patients (24 $\%)$
were considered positive for ANAs. A neuropsychiatric
evaluation revealed a possible autoimmune psychotic syndrome
in seven patients (3 $\%)$ and a probable autoimmune
psychotic syndrome in two patients (1 $\%).$ ANA-positive
patients were more frequently treated with antidepressants
(p = 0.040) and had a higher number of somatic comorbidities
(p < 0.001). In addition, (chronic) inflammatory MRI lesions
(p = 0.008) and focal atrophies (p = 0.012) were found more
frequently in ANA-positive than ANA-negative
patients.Rheumatological screening led to suspicion of a
possible or probable autoimmune psychotic syndrome in $4\%.$
ANAs were associated with MRI pathologies. Therefore,
rheumatological processes may contribute to the development
of psychotic syndromes in rare cases.},
keywords = {Humans / Psychotic Disorders: immunology / Male / Female /
Adult / Electroencephalography: methods / Middle Aged /
Magnetic Resonance Imaging: methods / Retrospective Studies
/ Biomarkers: cerebrospinal fluid / Biomarkers: blood /
C-Reactive Protein: analysis / C-Reactive Protein:
metabolism / Autoantibodies: cerebrospinal fluid /
Autoantibodies: blood / Antibodies, Antinuclear:
cerebrospinal fluid / Aged / Brain: diagnostic imaging /
Brain: metabolism / Young Adult / Autoimmune Diseases:
cerebrospinal fluid / Neurons: metabolism / Adolescent /
Rheumatic Diseases: cerebrospinal fluid / ANA (Other) /
Antibody (Other) / Autoimmune psychosis (Other) / Complement
(Other) / Immunological (Other) / Biomarkers (NLM Chemicals)
/ C-Reactive Protein (NLM Chemicals) / Autoantibodies (NLM
Chemicals) / Antibodies, Antinuclear (NLM Chemicals)},
cin = {AG Prüß},
ddc = {150},
cid = {I:(DE-2719)1810003},
pnm = {353 - Clinical and Health Care Research (POF4-353)},
pid = {G:(DE-HGF)POF4-353},
typ = {PUB:(DE-HGF)16},
pubmed = {pmid:38599500},
doi = {10.1016/j.bbi.2024.04.001},
url = {https://pub.dzne.de/record/269340},
}