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Clinical and Developmental Immunology
Volume 2013, Article ID 257184, 10 pages
Review Article

Autoantibodies and the Immune Hypothesis in Psychotic Brain Diseases: Challenges and Perspectives

1Neuroimmunology Group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children’s Hospital at Westmead, University of Sydney, Locked Bag 4001, Westmead, NSW 2145, Australia
2Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Westmead, NSW 2145, Australia
3The Walker Unit, Concord Centre for Mental Health, Concord West, NSW 2138, Australia
4Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia

Received 22 May 2013; Revised 23 July 2013; Accepted 24 July 2013

Academic Editor: Carlos Barcia

Copyright © 2013 Karrnan Pathmanandavel et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The pathophysiology of psychosis is poorly understood, with both the cognitive and cellular changes of the disease process remaining mysterious. There is a growing body of evidence that points to dysfunction of the immune system in a subgroup of patients with psychosis. Recently, autoantibodies directed against neuronal cell surface targets have been identified in a range of syndromes that feature psychosis. Of interest is the detection of autoantibodies in patients whose presentations are purely psychiatric, such as those suffering from schizophrenia. Autoantibodies have been identified in a minority of patients, suggesting that antibody-associated mechanisms of psychiatric disease likely only account for a subgroup of cases. Recent work has been based on the application of cell-based assays—a paradigm whose strength lies in the expression of putative antigens in their natural conformation on the surface of live cells. The responsiveness of some of these newly described clinical syndromes to immune therapy supports the hypothesis that antibody-associated mechanisms play a role in the pathogenesis of psychotic disease. However, further investigation is required to establish the scope and significance of antibody pathology in psychosis. The identification of a subgroup of patients with antibody-mediated disease would promise more effective approaches to the treatment of these high-morbidity conditions.