TY - JOUR
T1 - 31. The Association Between Psychosis and Nonneurological Autoimmune Disorders
T2 - A Systematic Review and Meta-Analysis of the Evidence to Date
AU - Cullen, Alexis
AU - Holmes, Scarlett
AU - Pollak, Thomas Arthur Nicholls
AU - Blackman, Graham
AU - Murray, Robin MacGregor
AU - McGuire, Philip
AU - Mondelli, Valeria
PY - 2017/3/1
Y1 - 2017/3/1
N2 - Background: Epidemiological studies conducted over the past 50 years have observed an increased prevalence of psychosis among individuals with nonneurological autoimmune disorders relative to the general population, with the notable exception of rheumatoid arthritis. Whether this association reflects shared risk factors (e.g., infections or genetic liability) or a causal relationship (mediated by inflammation or brain-reactive antibodies) is yet to be determined. Quantifying the extent to which psychosis is associated with individual nonneurological autoimmune disorders may help to address this issue. A systematic review of studies investigating the comorbidity of psychosis and nonneurological autoimmune disorders was therefore conducted to clarify the nature of this association; meta-analyses were performed for individual autoimmune disorders where possible.
Methods: PubMed, PsycINFO, and EMBASE were systematically searched, and supplemented with manual searching, to identify studies examining (1) the prevalence of psychotic disorders among individuals with nonneurological autoimmune disorders, or (ii) the prevalence of nonneurological autoimmune disorders among individuals with psychotic disorders. Studies were assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Raw (unadjusted) data were extracted from studies and used to compute odds ratios (OR).
Results: Fourteen studies were suitable for inclusion, the majority of which met STROBE criteria for methodology reporting. These studies provided useable data for 35 non-neurological autoimmune disorders, from which 60 individual effect sizes were computed. Overall, individuals with non-neurological autoimmune disorders were significantly more likely to have a psychotic disorder (OR = 1.51; 95% CI: 1.47–1.56; P < .0001). Meta-analyses for individual disorders were conducted where possible (i.e., when three or more studies were available) and indicated that psychosis was positively associated with autoimmune anaemia (OR = 1.87, P < .0001), type 1 diabetes (OR = 1.40, P < .0001), and coeliac disease (OR = 8.40, P < .0001). In contrast, psychosis was negatively associated with rheumatoid arthritis (OR = 0.75, P = .02) and alopecia areata (OR = .73, P = .04), while associations with ankylosing spondylitis and ulcerative colitis were not statistically significant.
Conclusion: This is the first systematic review of the relationship between nonneurological autoimmune disorders and psychosis. Whilst an overall positive association was observed, individual meta-analyses indicated that the strength and direction of this association varied considerably across non-neurological autoimmune disorders types. The implications of these findings for elucidating the mechanisms underlying this association will be discussed.
AB - Background: Epidemiological studies conducted over the past 50 years have observed an increased prevalence of psychosis among individuals with nonneurological autoimmune disorders relative to the general population, with the notable exception of rheumatoid arthritis. Whether this association reflects shared risk factors (e.g., infections or genetic liability) or a causal relationship (mediated by inflammation or brain-reactive antibodies) is yet to be determined. Quantifying the extent to which psychosis is associated with individual nonneurological autoimmune disorders may help to address this issue. A systematic review of studies investigating the comorbidity of psychosis and nonneurological autoimmune disorders was therefore conducted to clarify the nature of this association; meta-analyses were performed for individual autoimmune disorders where possible.
Methods: PubMed, PsycINFO, and EMBASE were systematically searched, and supplemented with manual searching, to identify studies examining (1) the prevalence of psychotic disorders among individuals with nonneurological autoimmune disorders, or (ii) the prevalence of nonneurological autoimmune disorders among individuals with psychotic disorders. Studies were assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Raw (unadjusted) data were extracted from studies and used to compute odds ratios (OR).
Results: Fourteen studies were suitable for inclusion, the majority of which met STROBE criteria for methodology reporting. These studies provided useable data for 35 non-neurological autoimmune disorders, from which 60 individual effect sizes were computed. Overall, individuals with non-neurological autoimmune disorders were significantly more likely to have a psychotic disorder (OR = 1.51; 95% CI: 1.47–1.56; P < .0001). Meta-analyses for individual disorders were conducted where possible (i.e., when three or more studies were available) and indicated that psychosis was positively associated with autoimmune anaemia (OR = 1.87, P < .0001), type 1 diabetes (OR = 1.40, P < .0001), and coeliac disease (OR = 8.40, P < .0001). In contrast, psychosis was negatively associated with rheumatoid arthritis (OR = 0.75, P = .02) and alopecia areata (OR = .73, P = .04), while associations with ankylosing spondylitis and ulcerative colitis were not statistically significant.
Conclusion: This is the first systematic review of the relationship between nonneurological autoimmune disorders and psychosis. Whilst an overall positive association was observed, individual meta-analyses indicated that the strength and direction of this association varied considerably across non-neurological autoimmune disorders types. The implications of these findings for elucidating the mechanisms underlying this association will be discussed.
U2 - 10.1093/schbul/sbx021.050
DO - 10.1093/schbul/sbx021.050
M3 - Meeting abstract
SN - 0586-7614
VL - 43
SP - S19-S19
JO - Schizophrenia Bulletin
JF - Schizophrenia Bulletin
IS - suppl_1
ER -