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Autoimmune diseases, bipolar disorder, and non-affective psychosis

Authors

  • William W Eaton,

    1. Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
    2. National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
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  • Marianne G Pedersen,

    1. National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
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  • Philip R Nielsen,

    1. National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
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  • Preben Bo Mortensen

    1. Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
    2. National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
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  • The authors of this paper do not have any commercial associations that might pose a conflict of interest in connection with this manuscript.

Corresponding author:
William W. Eaton, Ph.D.
Department of Mental Health
Bloomberg School of Public Health
Johns Hopkins University
624 North Broadway, Room 852
Baltimore, MD 21205, USA
Fax: 410-614-7469
E-mail: weaton@jhsph.edu

Abstract

Eaton WW, Pedersen MG, Nielsen PR, Mortensen PB. Autoimmune diseases, bipolar disorder, and non-affective psychosis. Bipolar Disord 2010: 12: 638–646. © 2010 The Authors. Journal compilation © 2010 John Wiley & Sons A/S.

Objective:  Clinic-based studies of immune function, as well as comorbidity of autoimmune diseases, bipolar disorder, and schizophrenia, suggest a possible autoimmune etiology. Studies of non-affective psychosis and schizophrenia suggest common etiologies. The objective was to determine the degree to which 30 different autoimmune diseases are antecedent risk factors for bipolar disorder, schizophrenia, and non-affective psychosis.

Methods:  A cohort of 3.57 million births in Denmark was linked to the Psychiatric Case Register and the National Hospital Register. There were 20,317 cases of schizophrenia, 39,076 cases of non-affective psychosis, and 9,920 cases of bipolar disorder.

Results:  As in prior studies, there was a range of autoimmune diseases which predicted raised risk of schizophrenia in individuals who had a history of autoimmune diseases, and also raised risk in persons whose first-degree relatives had an onset of autoimmune disease prior to onset of schizophrenia in the case. These relationships also existed for the broader category of non-affective psychosis. Only pernicious anemia in the family was associated with raised risk for bipolar disorder (relative risk: 1.7), suggesting a small role for genetic linkage. A history of Guillain-Barré syndrome, Crohn’s disease, and autoimmune hepatitis in the individual was associated with raised risk of bipolar disorder.

Conclusions:  The familial relationship of schizophrenia to a range of autoimmune diseases extends to non-affective psychosis, but not to bipolar disorder. The data suggest that autoimmune processes precede onset of schizophrenia, but also non-affective psychosis and bipolar disorder.

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