Psychosis: an autoimmune disease?

Immunology. 2017 Nov;152(3):388-401. doi: 10.1111/imm.12795. Epub 2017 Aug 3.


Psychotic disorders are common and disabling. Overlaps in clinical course in addition to epidemiological and genetic associations raise the possibility that autoimmune mechanisms may underlie some psychoses, potentially offering novel therapeutic approaches. Several immune loci including the major histocompatibility complex and B-cell markers CD19 and CD20 achieve genome-wide significance in schizophrenia. Emerging evidence suggests a potential role via neurodevelopment in addition to classical immune pathways. Additionally, lymphocyte biology is increasingly investigated. Some reports note raised peripheral CD19+ and reduced CD3+ lymphocyte counts, with altered CD4 : CD8 ratios in acute psychosis. Also, post-mortem studies have found CD3+ and CD20+ lymphocyte infiltration in brain regions that are of functional relevance to psychosis. More specifically, the recent paradigm of neuronal surface antibody-mediated (NSAb) central nervous system disease provides an antigen-specific model linking adaptive autoimmunity to psychopathology. NSAbs bind extracellular epitopes of signalling molecules that are classically implicated in psychosis such as NMDA and GABA receptors. This interaction may cause circuit dysfunction leading to psychosis among other neurological features in patients with autoimmune encephalitis. The detection of these cases is crucial as autoimmune encephalitis is ameliorated by commonly available immunotherapies. Meanwhile, the prevalence and relevance of these antibodies in people with isolated psychotic disorders is an area of emerging scientific and clinical interest. Collaborative efforts to achieve larger sample sizes, comparison of assay platforms, and placebo-controlled randomized clinical trials are now needed to establish an autoimmune contribution to psychosis.

Keywords: autoimmunity; neuronal surface antibody; psychosis; schizophrenia.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adoptive Transfer
  • Animals
  • Antipsychotic Agents / therapeutic use
  • Autoantibodies / blood*
  • Autoimmune Diseases / drug therapy
  • Autoimmune Diseases / immunology*
  • Autoimmune Diseases / physiopathology
  • Autoimmune Diseases / psychology
  • Autoimmunity* / drug effects
  • Brain / drug effects
  • Brain / immunology*
  • Brain / physiopathology
  • Disease Models, Animal
  • Genetic Predisposition to Disease
  • Humans
  • Immune System / drug effects
  • Immune System / immunology*
  • Immune System / physiopathology
  • Immunologic Factors / therapeutic use
  • Lymphocytes / immunology*
  • Neurons / immunology*
  • Phenotype
  • Psychotic Disorders / drug therapy
  • Psychotic Disorders / immunology*
  • Psychotic Disorders / physiopathology
  • Psychotic Disorders / psychology
  • Risk Factors


  • Antipsychotic Agents
  • Autoantibodies
  • Immunologic Factors