AUTOIMMUNITY AND NEUROPSYCHIATRY

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Abstract

Tim Nicholson My undergraduate medical training was at the Royal Free Hospital and School of Medicine during which I did a BSc (UCL) and an MSc (Oxford) in Biological Anthropology to pursue my interest in evolutionary biology, particularly in the factors that have driven the evolution of human biology and behaviour. I was first exposed to neuropsychiatry as a neurology trainee on Hughlings Jackson ward at the National Hospital for Neurology at Queen square which inspired my clinical and academic interest in this area, particularly in the fields of CNS autoimmunity and functional / conversion disorders. I then trained as a psychiatrist at the Maudsley Hospital, including jobs on the Lishman (neuropsychiatry) unit and a research post at both the Institute of Psychiatry and the neuroimmunology department at the Institute of Neurology. I have just completed my PhD in psychological stressors and emotion processing in conversion disorder at the Institute of Psychiatry where I am an Academic Clinical Lecturer in the Section of Cognitive Neuropsychiatry.

Autoimmune causes are on differential diagnosis lists for many neurological, some neuropsychiatric but few, if any, purely psychiatric presentations. Why is this? Do autoimmune processes preferentially affect parts of the brain resulting in neurological, rather than psychiatric, symptoms? I propose that this is unlikely and that soon autoimmunity will be found to be the cause of a proportion (albeit probably small) of an increasing number of neuropsychiatric and even some purely psychiatric presentations. In the last few years there has been some accumulating evidence in support of this with specific antibodies associated with neuropsychiatric and pure psychiatric presentations and I will briefly review the key papers.

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