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Risk for Autoimmune Disease Increases After Psychotic Illness

Summary and Comment |
October 31, 2013

Risk for Autoimmune Disease Increases After Psychotic Illness

  1. Joel Yager, MD

Both schizophrenia-like and bipolar psychoses are associated with increased risks.

  1. Joel Yager, MD

Considerable literature suggests that autoimmune diseases confer risk for schizophrenia and related psychoses, partly attributed to inflammatory processes and infections causing neuropsychiatric difficulties (NEJM JW Psychiatry Jan 9 2012). In a first-of-its-kind, partly industry-supported study, the current researchers used large Danish registries to ascertain whether the reverse might be true — i.e., whether schizophrenia or related psychoses confer risk for subsequent autoimmune disorders; 30 types of autoimmune disorders were examined (39,364 patients with schizophrenia-like psychoses from 1987 [or age 10 years] through 2010; 142,328 patients with autoimmune disease).

Having a schizophrenia-like psychosis increased the risk for one or more new autoimmune diagnoses (incident rate ratio, 1.53; 1401 people); nine disorders were identified. The highest risk was associated with brain-reactive antibodies (IRR, 1.91) — specifically, autoimmune hepatitis, Guillain-Barré syndrome, multiple sclerosis, and type 1 diabetes. Risk was also elevated for primary adrenocortical deficiency, pernicious anemia, primary biliary cirrhosis, Crohn disease, and psoriasis. Having a history of hospital contact for infection further increased the risk (IRR, 2.70; 793 individuals with later autoimmune disorders). Family histories of schizophrenia were associated with slightly elevated risks for autoimmune disease. In a comparison study, bipolar disorder with psychosis also showed elevated risks for autoimmune disease (IRR, 1.71).

Comment

This study involves two complex sets of conditions: schizophrenia or related psychoses and autoimmune disorders. Understanding exactly what these possible associations might signify gets complicated. Are common genetics at play? Do behavioral factors that lead to inflammation or infection increase risks for both conditions? Overall, these results suggest that processes contributing to inflammation and infection plausibly contribute to the pathogenesis of both schizophrenia-like psychoses and several autoimmune disorders and that either can appear first. Clinicians treating psychotic patients should be alert to comorbid autoimmune disorders, whether at initial presentation or subsequently.

  • Disclosures for Joel Yager, MD at time of publication Editorial boards Bulletin of the Menninger Clinic; Eating Disorders: Journal of Treatment and Research; Eating Disorders Review (Editor-in-Chief); Harvard Review of Psychiatry; International Journal of Eating Disorders; UpToDate Leadership positions in professional societies American Psychiatric Association (Chair, Steering Committee and Executive Committee on Practice Guidelines; Co-Chair, DSM5 Clinical and Public Health Committee; Chair, Council on Research and Quality Care)

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