Long-Term Course of Neural Autoantibody-Associated Psychiatric Disorders: Retrospective Data from a Specifically Immunopsychiatric Outpatient Clinic

Abstract

Background: Autoantibody-associated psychiatric disorders are a new terrain that is currently underrepresented considering immunopsychiatry's potential importance for therapeutic aspects. The aim of our research was thus to present initial pilot data on the long-term clinical course of our patients in an outpatient clinic specializing in autoantibody-associated psychiatric disorders. Methods: Thirty-seven patients were examined clinically in our outpatient clinic at regular intervals over a 1.5-year period. We collected clinical data on their demographics, psychopathology, and cognition, and magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) data as well as the status of neural autoantibodies in blood and/or serum. Results: Our main finding was that affective, psychotic, and cognitive symptoms did not change significantly over the 1.5-year period, thus revealing no progression. We divided the entire cohort of autoantibody-positive patients (n = 32) into subgroups consisting of patients with dementia (n = 14), mild cognitive impairment (MCI) (n = 7), psychotic disorders (n = 6), and a CSF profile of Alzheimer's disease (n = 6). Relying on established classification schemes, we identified the following percentages in our autoantibody-positive cohort: 28% with autoimmune encephalitis, 15% with autoimmune psychosis, and 63% with autoimmune psychiatric syndromes. Discussion: These initial pilot results suggest that autoantibody-associated diseases do not show a significantly progressive course in the long-term and are often characterized by impaired verbal memory recall when cognitive impairment progresses to dementia. These initial data need to be verified in larger cohorts. We believe that this pilot study underscores the importance of promoting such a specialized outpatient clinic to better characterize various aspects of autoantibody-mediated psychiatric disorders.

Keywords: neural autoantibody; outpatients; psychiatry.

Figure 1

Cognitive profiles of the complete cohort, mild cognitive impairment patients, and dementia patients associated with neural autoantibodies. The cognitive profile, presented as z-scores of the CERAD test battery of the whole cohort, is shown in (A), dementia patients in (B), and mild cognitive impairment (MCI) patients in (C). Dementia patients with neuronal autoantibodies (B) were more impaired in verbal memory recall than mild cognitive impairment (MCI) patients with neuronal autoantibodies (C) * p < 0.005.