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The relationship between autoimmune diseases and psychotic disorders is examined by Mrs. Eleni Komninou, Rheumatologist and Director of the Autoimmune Rheumatic Disease Clinic at Metropolitan General
The immune pathways that play a role in the etiology of a range of psychotic disorders have received increased interest in recent decades.
Genetic findings link genetic markers related to the immune system, with schizophrenia. Clinical studies find elevated levels of inflammatory markers in patients with psychosis.
Several large-scale epidemiological studies have found positive associations between Autoimmune Diseases and Psychosis. Specifically, autoimmune diseases such as Multiple Sclerosis and Systemic Lupus Erythematosusare known to have higher frequencies of neuropsychiatric symptoms, including psychosis, compared to healthy controls.
There is a two-way association between several autoimmune diseases and increased risks associated with schizophrenia. Focusing on the relationship between autoimmunity and psychosis, regardless of etiology, is importantnot only for researchers but also for each patient.
Patients suffering from schizophrenia are known to have excessively premature mortality, with a life expectancy of up to 13.5 years less than the general population, mainly due to physical illnesses.
With this in mind, and considering that patients with psychotic disorders may have difficulty reporting physical symptoms, it is important for clinicians to be aware of an increased prevalence of autoimmune diseases in this group.
The symptoms of a disease such as celiac disease or rheumatoid arthritis could well be ignored and brushed aside as part of the patient’s psychosis, or possibly adverse effects caused by their treatment. With more and more adequate treatment strategies in autoimmune diseases, overlooking and therefore not treating these diseases, the health gap between people with schizophrenia and the general population is increasing even more.
Epidemiological evidence on associations between autoimmune diseases and psychosis.
The worldwide prevalence of schizophrenia is known to be around 1% and the prevalence of autoimmune diseases has been found in a nationwide study to be 4%.
The vast majority of epidemiological studies have found a general association between autoimmunity and psychotic disorders.
Additionally, a diagnosis of schizophrenia increases the prevalence of autoimmune diseases. A recent meta-analysis found that the risk of developing an autoimmune disease was 55% higher among those with a previous diagnosis of a psychotic disorder.
Autoimmune diseases and psychosis are not only related on an individual level. Having a first-degree relative with schizophrenia has also been found to increase the risk of autoimmune diseases by 6%, and a family history of autoimmune disease has been found to increase the risk of both schizophrenia and non-affective psychoses by 10%.
Mechanisms responsible for the association: The possible etiological background and the many factors that can influence the relationship between autoimmune diseases and psychosis are numerous.
in conclusion
Increasing knowledge about the potential involvement of inflammatory processes in mental disorders, and the associations found between autoimmunity and psychotic disorders, may aid the expanding field of immunopsychiatry and impact patient outcomes.
Risk factors for both autoimmune diseases and schizophrenia involve an interaction between environmental factors, such as infections and stress, with genetic factors involving the HLA region.
Therefore, patients with a psychotic disorder should be thoroughly examined and especially when they present symptoms that may be related to an autoimmune disease or other health problems.