National Centre for Register-Based Research, Aarhus University, Aarhus; Mental Health Centre Copenhagen, University of Copenhagen, Faculty of Health Sciences, Copenhagen; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark.
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Biol Psychiatry. 2014 Feb 15;75(4):300-6. doi: 10.1016/j.biopsych.2013.09.023. Epub 2013 Oct 3.
This review summarizes the epidemiologic evidence linking autoimmune diseases and psychosis. The associations between autoimmune diseases and psychosis have been studied for more than a half century, but research has intensified within the last decades, since psychosis has been associated with genetic markers of the immune system and with excess autoreactivity and other immune alterations. A range of psychiatric disorders, including psychosis, have been observed to occur more frequently in some autoimmune diseases, such as systemic lupus erythematosus and multiple sclerosis. Many autoimmune diseases involve multiple organs and general dysfunction of the immune system, which could affect the brain and induce psychiatric symptoms. Most studies have been cross-sectional, observing an increased prevalence of a broad number of autoimmune diseases in people with psychotic disorders. Furthermore, there is some evidence of associations of psychosis with a family history of autoimmune disorders and vice versa. Additionally, several autoimmune diseases, individually and in aggregate, have been identified as raising the risk for psychotic disorders in longitudinal studies. The associations have been suspected to be caused by inflammation or brain-reactive antibodies associated with the autoimmune diseases. However, the associations could also be caused by shared genetic factors or common etiologic components such as infections. Infections can induce the development of autoimmune diseases and autoantibodies, possibly affecting the brain. Autoimmune diseases and brain-reactive antibodies should be considered by clinicians in the treatment of individuals with psychotic symptoms, and even if the association is not causal, treatment would probably still improve quality of life and survival.
这篇综述总结了将自身免疫性疾病与精神病联系起来的流行病学证据。自身免疫性疾病与精神病之间的关联已经研究了半个多世纪，但在过去几十年中，由于精神病与免疫系统的遗传标志物以及过度自身反应性和其他免疫改变有关，研究已经加强。一系列精神疾病，包括精神病，在某些自身免疫性疾病中更为常见，如系统性红斑狼疮和多发性硬化症。许多自身免疫性疾病涉及多个器官和免疫系统的一般功能障碍，这可能会影响大脑并引发精神症状。大多数研究都是横断面研究，观察到患有精神病障碍的人群中广泛存在多种自身免疫性疾病的患病率增加。此外，有一些证据表明精神病与自身免疫性疾病家族史之间存在关联，反之亦然。此外，在纵向研究中，一些自身免疫性疾病个体和综合因素被确定为增加精神病发病风险的因素。这些关联可能是由与自身免疫性疾病相关的炎症或大脑反应性抗体引起的。然而，这些关联也可能是由共同的遗传因素或共同的病因成分（如感染）引起的。感染可能会引发自身免疫性疾病和自身抗体的发展，从而可能影响大脑。在治疗有精神病症状的个体时，临床医生应考虑自身免疫性疾病和大脑反应性抗体，即使关联不是因果关系，治疗也可能仍会改善生活质量和生存率。
