Inflammatory and autoimmune disorders in neuropsychiatry

Evidence continues to be found to suggest a close link between the central nervous system and the immune system in neuropsychiatric disorders. With increasing interest over the last decade in autoimmune encephalitides, caused by the interaction of neuronal surface antibodies (NSAbs) with proteins, such as the NMDA receptor (NMDAR) and leucine-rich glioma inactivated 1 (LGI1), the clinical interface between psychiatry and neurology has undergone significant advances. This chapter provides a basic overview of autoimmunity, before discussing recent findings. Firstly, autoimmune disorders which commonly present with psychiatric comorbidities are explored such as systemic lupus erythematosus (SLE) and multiple sclerosis (MS). Then, the psychiatric presentations of various autoimmune forms of encephalitis are discussed, along with their treatment and outcomes. Finally, the relevance of NSAbs to psychiatry is discussed in greater detail.

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Autoantibodies in Neuropsychiatric Systemic Lupus Erythematosus (NPSLE): Can They Be Used as Biomarkers for the Differential Diagnosis of This Disease?

Clinical Reviews in Allergy & Immunology ◽

10.1007/s12016-021-08865-2 ◽

2021 ◽

Author(s):

Elias Manca

Keyword(s):

Systemic Lupus Erythematosus ◽

Central Nervous System ◽

Nervous System ◽

Differential Diagnosis ◽

Human Body ◽

Lupus Erythematosus ◽

Neuropsychiatric Symptoms ◽

Systemic Lupus ◽

Neuropsychiatric Systemic Lupus Erythematosus ◽

The Central Nervous System

AbstractSystemic lupus erythematosus is a complex immunological disease where both environmental factors and genetic predisposition lead to the dysregulation of important immune mechanisms. Eventually, the combination of these factors leads to the production of self-reactive antibodies that can target any organ or tissue of the human body. Autoantibodies can form immune complexes responsible for both the organ damage and the most severe complications. Involvement of the central nervous system defines a subcategory of the disease, generally known with the denomination of neuropsychiatric systemic lupus erythematosus. Neuropsychiatric symptoms can range from relatively mild manifestations, such as headache, to more severe complications, such as psychosis. The evaluation of the presence of the autoantibodies in the serum of these patients is the most helpful diagnostic tool for the assessment of the disease. The scientific progresses achieved in the last decades helped researchers and physicians to discover some of autoepitopes targeted by the autoantibodies, although the majority of them have not been identified yet. Additionally, the central nervous system is full of epitopes that cannot be found elsewhere in the human body, for this reason, autoantibodies that selectively target these epitopes might be used for the differential diagnosis between patients with and without the neuropsychiatric symptoms. In this review, the most relevant data is reported with regard to mechanisms implicated in the production of autoantibodies and the most important autoantibodies found among patients with systemic lupus erythematosus with and without the neuropsychiatric manifestations.

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