Abstract Background When psychosis develops in NMDAR antibody encephalitis it usually has an acute or subacute onset, and antipsychotic treatment may be ineffective and associated with adverse effects. Serum NMDAR antibodies have been reported in a minority of patients with first episode psychosis (FEP), but their role in psychosis onset and response to antipsychotic treatment is unclear. Methods Sera from 387 patients with FEP (duration of psychosis ClinicalTrials.gov number NCT01248195) were tested for NMDAR IgG antibodies using a live cell-based assay (CBA). Symptom severity was assessed using the Positive and Negative Symptom Scale (PANSS) and the clinical global impression (CGI) at baseline and again after 4 weeks of treatment with amisulpride. Results At baseline, 15 patients were seropositive for NMDAR antibodies and 372 were seronegative. Seropositive patients had similar symptom profiles and demographic features to seronegative patients but a shorter duration of psychosis (median 1.5 versus 4.0 months; p=0.031). 11 seropositive and 284 seronegative patients completed 4 weeks of amisulpride treatment: following treatment, there was no between-groups difference in improvement in PANSS scores, nor in the frequency of adverse medication effects. Conclusions These data suggest that, in FEP, NMDAR antibody seropositivity alone is not an indication for using immunotherapy instead of antipsychotic medications. Further studies are required to establish what proportion of NMDAR antibody seropositive FEP patients have coexisting CSF inflammatory changes or other paraclinical evidence suggestive of likely benefit from immunotherapy.

中文翻译：

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首发精神病患者血清 NMDA 受体抗体与抗精神病药物治疗反应的关系

摘要 背景 当 NMDAR 抗体脑炎出现精神病时，通常呈急性或亚急性起病，抗精神病药物治疗可能无效并伴有不良反应。在少数首发精神病 (FEP) 患者中报告了血清 NMDAR 抗体，但它们在精神病发作和抗精神病药物治疗反应中的作用尚不清楚。方法 使用基于活细胞的测定法 (CBA) 对来自 387 名 FEP 患者（精神病持续时间 ClinicalTrials.gov 编号 NCT01248195）的血清进行 NMDAR IgG 抗体检测。使用阳性和阴性症状量表 (PANSS) 和临床总体印象 (CGI) 在基线时以及在氨磺必利治疗 4 周后再次评估症状严重程度。结果 在基线时，15 名患者的 NMDAR 抗体呈血清反应阳性，372 名患者呈血清反应阴性。血清反应阳性患者与血清反应阴性患者具有相似的症状特征和人口统计学特征，但精神病持续时间较短（中位数 1.5 对 4.0 个月；p=0.031）。11 名血清反应阳性和 284 名血清反应阴性患者完成了 4 周的氨磺必利治疗：治疗后，PANSS 评分的改善和药物不良反应的发生率没有组间差异。结论 这些数据表明，在 FEP 中，单独的 NMDAR 抗体血清阳性并不是使用免疫疗法代替抗精神病药物的指征。需要进一步研究以确定 NMDAR 抗体血清阳性 FEP 患者中有多少比例同时存在 CSF 炎症变化或其他临床证据表明可能从免疫治疗中获益。