New Horizons in First Episode Psychosis

NEW HORIZONS IN FIRST EPISODE PSYCHOSIS

An investigation of auto antibodies in first episode psychosis

Identifying the causes of the functional psychoses (i.e. those with no known aetiology) is paramount to effective intervention. Cutting edge research demonstrates that a proportion (estimated at between 3 and 5%) of young people presenting with their first episode of psychosis, initially thought to be of indeterminate aetiology, have treatable encephalitis due to auto antibodies – specifically anti-N-methyl D-aspartate receptor (NMDAR) antibodies (Barry et al. 2011). There have also been other auto antibodies, known as GAD (Glutamic Acid Decarboxylase) and VGKC (Voltage Gated Potassium Channel) antibodies which are thought to be much rarer but also affect the brain and can cause psychosis. This provides a window of hope, both directly and in suggesting that other, as yet unidentified auto antibodies may account for some psychoses and that appropriate treatments may avoid the social and cognitive deterioration associated with chronic psychotic illnesses.

This project will:

  1. Measure the prevalence of auto antibodies in patients presenting with a first episode of psychosis (FEP) of unknown origin.
  2. Establish a bio bank using blood samples to test for newly identified auto-immune and other causes of psychosis.
  3. Describe the clinical course and response to treatment of psychosis in people who test positive for auto antibodies.
  4. Compare the clinical course of FEP in young people who test positive for auto antibodies with sex matched, antibody negative, controls also experiencing FEP.

The research will be conducted over three studies: Study 1 is a cross-sectional prevalence study. The purpose of Study 2 is to establish a bio bank using blood samples to test for newly identified auto-immune, genetic and other causes of psychosis. Study 3 is a longitudinal case-control design investigating clinical course of disease.