Anti-NMDA-receptor antibody in initial diagnosis of mood disorder

Hiroki Kawai, Manabu Takaki, Shinji Sakamoto, Takashi Shibata, Ayaka Tsuchida, Bunta Yoshimura, Yuji Yada, Namiko Matsumoto, Kota Sato, Koji Abe, Yuko Okahisa, Yoshiki Kishi, Soshi Takao, Ko Tsutsui, Takashi Kanbayashi, Keiko Tanaka, Norihito Yamada

Research output: Contribution to journalArticle

Abstract

Anti-NMDAR encephalitis is increasingly recognized as one etiology of psychiatric symptoms, but there is not enough evidence on patients with mood disorder. We assayed anti-NR1/NR2B IgG antibodies in serum and/or cerebrospinal fluid of 62 patients initially diagnosed with mood disorder by a cell-based assay. We also investigated the specific patient characteristics and psychotic symptoms. At first admission, the patients showed only psychiatric symptoms without typical neurological signs or abnormal examination findings. Four of the 62 patients had anti-NR1/NR2B IgG antibodies. The anti-NR1/NR2B IgG antibody-positive patients showed more super- or abnormal sensitivity (P = 0.00088), catatonia (P = 0.049), and more conceptual disorganization (P < 0.0001), hostility (P = 0.0010), suspiciousness (P < 0.0001), and less emotional withdrawal (P < 0.0001) and motor retardation (P < 0.0001) on the Brief Psychiatric Rating Scale than the antibody-negative patients. During the clinical course, anti-NR1/NR2B IgG antibody-positive patients showed more catatonia (P = 0.0042) and met Graus's criteria for diagnosis of anti-NMDAR encephalitis, but negative patients did not. Immunotherapy was effective for anti-NR1/NR2B IgG antibody-positive patients, and there was the weak relationship (R² = 0.318) between the anti-NR1/NR2B IgG antibody titer in the cerebrospinal fluid and the Brief Psychiatric Rating Scale score.

Original languageEnglish
JournalEuropean Neuropsychopharmacology
DOIs
Publication statusPublished - Jan 1 2019

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N-Methyl-D-Aspartate Receptors
Mood Disorders
Antibodies
Immunoglobulin G
Anti-N-Methyl-D-Aspartate Receptor Encephalitis
Catatonia
Brief Psychiatric Rating Scale
Psychiatry
Cerebrospinal Fluid
Hostility
Patient Admission
Immunotherapy
Serum

Keywords

  • Anti-NR1/NR2B IgG antibodies
  • Brief Psychiatric Rating Scale
  • Catatonia
  • Cell-based assay
  • Mood disorder
  • Super- or abnormal sensitivity

ASJC Scopus subject areas

  • Pharmacology
  • Neurology
  • Clinical Neurology
  • Psychiatry and Mental health
  • Biological Psychiatry
  • Pharmacology (medical)

Cite this

Anti-NMDA-receptor antibody in initial diagnosis of mood disorder. / Kawai, Hiroki; Takaki, Manabu; Sakamoto, Shinji; Shibata, Takashi; Tsuchida, Ayaka; Yoshimura, Bunta; Yada, Yuji; Matsumoto, Namiko; Sato, Kota; Abe, Koji; Okahisa, Yuko; Kishi, Yoshiki; Takao, Soshi; Tsutsui, Ko; Kanbayashi, Takashi; Tanaka, Keiko; Yamada, Norihito.

In: European Neuropsychopharmacology, 01.01.2019.

Research output: Contribution to journalArticle

Kawai, Hiroki ; Takaki, Manabu ; Sakamoto, Shinji ; Shibata, Takashi ; Tsuchida, Ayaka ; Yoshimura, Bunta ; Yada, Yuji ; Matsumoto, Namiko ; Sato, Kota ; Abe, Koji ; Okahisa, Yuko ; Kishi, Yoshiki ; Takao, Soshi ; Tsutsui, Ko ; Kanbayashi, Takashi ; Tanaka, Keiko ; Yamada, Norihito. / Anti-NMDA-receptor antibody in initial diagnosis of mood disorder. In: European Neuropsychopharmacology. 2019.
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AU - Kawai, Hiroki

AU - Takaki, Manabu

AU - Sakamoto, Shinji

AU - Shibata, Takashi

AU - Tsuchida, Ayaka

AU - Yoshimura, Bunta

AU - Yada, Yuji

AU - Matsumoto, Namiko

AU - Sato, Kota

AU - Abe, Koji

AU - Okahisa, Yuko

AU - Kishi, Yoshiki

AU - Takao, Soshi

AU - Tsutsui, Ko

AU - Kanbayashi, Takashi

AU - Tanaka, Keiko

AU - Yamada, Norihito

PY - 2019/1/1

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N2 - Anti-NMDAR encephalitis is increasingly recognized as one etiology of psychiatric symptoms, but there is not enough evidence on patients with mood disorder. We assayed anti-NR1/NR2B IgG antibodies in serum and/or cerebrospinal fluid of 62 patients initially diagnosed with mood disorder by a cell-based assay. We also investigated the specific patient characteristics and psychotic symptoms. At first admission, the patients showed only psychiatric symptoms without typical neurological signs or abnormal examination findings. Four of the 62 patients had anti-NR1/NR2B IgG antibodies. The anti-NR1/NR2B IgG antibody-positive patients showed more super- or abnormal sensitivity (P = 0.00088), catatonia (P = 0.049), and more conceptual disorganization (P < 0.0001), hostility (P = 0.0010), suspiciousness (P < 0.0001), and less emotional withdrawal (P < 0.0001) and motor retardation (P < 0.0001) on the Brief Psychiatric Rating Scale than the antibody-negative patients. During the clinical course, anti-NR1/NR2B IgG antibody-positive patients showed more catatonia (P = 0.0042) and met Graus's criteria for diagnosis of anti-NMDAR encephalitis, but negative patients did not. Immunotherapy was effective for anti-NR1/NR2B IgG antibody-positive patients, and there was the weak relationship (R² = 0.318) between the anti-NR1/NR2B IgG antibody titer in the cerebrospinal fluid and the Brief Psychiatric Rating Scale score.

AB - Anti-NMDAR encephalitis is increasingly recognized as one etiology of psychiatric symptoms, but there is not enough evidence on patients with mood disorder. We assayed anti-NR1/NR2B IgG antibodies in serum and/or cerebrospinal fluid of 62 patients initially diagnosed with mood disorder by a cell-based assay. We also investigated the specific patient characteristics and psychotic symptoms. At first admission, the patients showed only psychiatric symptoms without typical neurological signs or abnormal examination findings. Four of the 62 patients had anti-NR1/NR2B IgG antibodies. The anti-NR1/NR2B IgG antibody-positive patients showed more super- or abnormal sensitivity (P = 0.00088), catatonia (P = 0.049), and more conceptual disorganization (P < 0.0001), hostility (P = 0.0010), suspiciousness (P < 0.0001), and less emotional withdrawal (P < 0.0001) and motor retardation (P < 0.0001) on the Brief Psychiatric Rating Scale than the antibody-negative patients. During the clinical course, anti-NR1/NR2B IgG antibody-positive patients showed more catatonia (P = 0.0042) and met Graus's criteria for diagnosis of anti-NMDAR encephalitis, but negative patients did not. Immunotherapy was effective for anti-NR1/NR2B IgG antibody-positive patients, and there was the weak relationship (R² = 0.318) between the anti-NR1/NR2B IgG antibody titer in the cerebrospinal fluid and the Brief Psychiatric Rating Scale score.

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