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Association between schizophrenia and an autoimmune bullous skin disease-pemphigus: a population-based large-scale study

Published online by Cambridge University Press:  25 September 2017

K. Kridin ,
S. Zelber-Sagi ,
D. Comaneshter  and
A. D. Cohen
K. Kridin*
Affiliation:
Department of Dermatology, Rambam Health Care Campus, Haifa, Israel
S. Zelber-Sagi
Affiliation:
School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
D. Comaneshter
Affiliation:
Department of Quality Measurements and Research, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
A. D. Cohen
Affiliation:
Department of Quality Measurements and Research, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
*
*Address for correspondence: K. Kridin, Department of Dermatology, Rambam Health Care Campus, POB 9602, Haifa 31096, Israel. (Email: dr_kridin@hotmail.com)
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Abstract

Aims.

Immunological hypotheses have become increasingly prominent suggesting that autoimmunity may be involved in the pathogenesis of schizophrenia. Schizophrenia was found to be associated with a wide range of autoimmune diseases. However, the association between pemphigus and schizophrenia has not been established yet. We aimed to estimate the association between pemphigus and schizophrenia using a large-scale real-life computerised database.

Methods.

This study was conducted as a cross-sectional study utilising the database of Clalit Health Services. The proportion of schizophrenia was compared between patients diagnosed with pemphigus and age-, gender- and ethnicity-matched control subjects. Univariate analysis was performed using χ2 and Student's t-test and a multivariate analysis was performed using a logistic regression model.

Results.

A total of 1985 pemphigus patients and 9874 controls were included in the study. The prevalence of schizophrenia was greater in patients with pemphigus as compared to the control group (2.0% v. 1.3%, respectively; p = 0.019). In a multivariate analysis, pemphigus was significantly associated with schizophrenia (OR, 1.5; 95% CI, 1.1–2.2). The association was more prominent among females, patients older than 60 years, and Jews.

Conclusions.

Pemphigus is significantly associated with schizophrenia. Physicians treating patients with pemphigus should be aware of this possible association. Patients with pemphigus should be carefully assessed for comorbid schizophrenia and be treated appropriately.

Keywords

Associationcross-sectionalimmunological hypothesispemphigusschizophrenia
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 28 , Issue 2 , April 2019 , pp. 191 - 198
Copyright
Copyright © Cambridge University Press 2017 

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References

Al Hawsawi, K, Pope, E (2011). Pediatric psychocutaneous disorders: a review of primary psychiatric disorders with dermatologic manifestations. American Journal of Clinical Dermatology 12, 247–257.Google Scholar
Arbabi, M, Ghodsi, Z, Mahdanian, A, Noormohammadi, N, Shalileh, K, Darvish, F, Ashrafinia, N, Chams, C (2011). Mental health in patients with pemphigus: an issue to worth consideration. Medknow publications. Indian Journal of Dermatology 56, 541–545.Google Scholar
Ballok, DA (2007). Neuroimmunopathology in a murine model of neuropsychiatric lupus. Brain Research Reviews 54, 67–79.Google Scholar
Benrós, ME, Mortensen, PB (2015). The role of infections and autoimmune diseases for schizophrenia and depression: findings from large-scale epidemiological studies. Immunology and Psychiatry 1–20.Google Scholar
Benros, ME, Nielsen, PR, Nordentoft, M, Eaton, WW, Dalton, SO, Mortensen, PB (2011). Autoimmune diseases and severe infections as risk factors for schizophrenia: a 30-year population-based register study. American Journal of Psychiatry 168, 1303–1310.Google Scholar
Benros, ME, Pedersen, MG, Rasmussen, H, Eaton, WW, Nordentoft, M, Mortensen, PB (2014). A nationwide study on the risk of autoimmune diseases in individuals with a personal or a family history of schizophrenia and related psychosis. American Journal of Psychiatry 171, 218–226.Google Scholar
Bystryn, JC, Rudolph, JL (2005). Pemphigus. Lancet 366, 61–73.Google Scholar
Bystryn, JC, Steinman, NM (1996). The adjuvant therapy of pemphigus. An update. Archives of Dermatology 132, 203–212.Google Scholar
Cascella, NG, Kryszak, D, Bhatti, B, Gregory, P, Kelly, DL, Mc Evoy, JP, Fasano, A, Eaton, WW (2011). Prevalence of Celiac disease and Gluten sensitivity in the United States clinical antipsychotic trials of intervention effectiveness study population. Schizophrenia Bulletin 37, 94–100.Google Scholar
Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases 40, 373–383.Google Scholar
Chen, SJ, Chao, YL, Chen, CY, Chang, CM, Wu, ECH, Wu, CS, Yeh, HH, Chen, CH, Tsai, HJ (2012). Prevalence of autoimmune diseases in in-patients with schizophrenia: Nationwide population-based study. British Journal of Psychiatry 200, 374–380.Google Scholar
Dantzer, R, O'Connor, JC, Freund, GG, Johnson, RW, Kelley, KW (2008). From inflammation to sickness and depression: when the immune system subjugates the brain. NIH Public Access. Nature Reviews. Neuroscience 9, 46–56.Google Scholar
Darnell, RB, Posner, JB (2003). Paraneoplastic syndromes involving the nervous system. New England Journal of Medicine 349, 1543–1554.Google Scholar
Drexhage, RC, Weigelt, K, van Beveren, N, Cohen, D, Versnel, MA, Nolen, WA, Drexhage, HA (2011). Immune and neuroimmune alterations in mood disorders and schizophrenia. International Review of Neurobiology 101, 169–201.Google Scholar
Eaton, WW, Byrne, M, Ewald, H, Mors, O, Chen, CY, Agerbo, E, Mortensen, PB (2006). Association of schizophrenia and autoimmune diseases: linkage of Danish national registers. American Journal of Psychiatry 163, 521–528.Google Scholar
Groves, RW (2009). Pemphigus: a brief review. Royal College of Physicians. Clinical Medicine (London, England) 9, 371–375.Google Scholar
Gupta, MA, Gupta, AK (2003). Psychiatric and psychological co-morbidity in patients with dermatologic disorders: epidemiology and management. American Journal of Clinical Dermatology 4, 833–842.Google Scholar
Höfler, M (2005). The Bradford Hill considerations on causality: a counterfactual perspective. Emerging Themes in Epidemiology 2, 11.Google Scholar
Irani, S, Lang, B (2008). Autoantibody-mediated disorders of the central nervous system. Autoimmunity 41, 55–65.Google Scholar
Kalaydjian, AE, Eaton, W, Cascella, N, Fasano, A (2006). The gluten connection: the association between schizophrenia and celiac disease. Acta Psychiatrica Scandinavica 113, 82–90.Google Scholar
Kayser, MS, Kohler, CG, Dalmau, J (2010). Psychiatric manifestations of paraneoplastic disorders. American Journal of Psychiatry 167, 1039–1050.Google Scholar
Kljuic, A, Christiano, AM (2003). A novel mouse desmosomal cadherin family member, desmoglein 1 gamma. Experimental Dermatology 12, 20–29.Google Scholar
Kowal, C, DeGiorgio, LA, Nakaoka, T, Hetherington, H, Huerta, PT, Diamond, B, Volpe, BT (2004). Cognition and immunity: antibody impairs memory. Immunity 21, 179–188.Google Scholar
Kridin, K, Zelber-Sagi, S, Khamaisi, M, Cohen, AD, Bergman, R (2016). Remarkable differences in the epidemiology of pemphigus among two ethnic populations in the same geographic region. Journal of the American Academy of Dermatology.Google Scholar
Kridin, K, Sagi, S, Bergman, R (2017). Mortality and cause of death in Israeli patients with pemphigus. Acta Dermato Venereologica.Google Scholar
Kumar, V, Mattoo, SK, Handa, S (2013). Psychiatric morbidity in pemphigus and psoriasis: a comparative study from India. Asian Journal of Psychiatry 6, 151–156.Google Scholar
Laan, W, Smeets, H, de Wit, NJ, Kahn, RS, Grobbee, DE, Burger, H (2009). Glucocorticosteroids associated with a decreased risk of psychosis. Journal of Clinical Psychopharmacology 29, 288–290.Google Scholar
Laske, C, Zank, M, Klein, R, Stransky, E, Batra, A, Buchkremer, G, Schott, K (2008). Autoantibody reactivity in serum of patients with major depression, schizophrenia and healthy controls. Psychiatry Research 158, 83–86.Google Scholar
Lencz, T, Guha, S, Liu, C, Rosenfeld, J, Mukherjee, S, DeRosse, P, John, M, Cheng, L, Zhang, C, Badner, JA, Ikeda, M, Iwata, N, Cichon, S, Rietschel, M, Nöthen, MM, Cheng, ATA, Hodgkinson, C, Yuan, Q, Kane, JM, Lee, AT, Pisanté, A, Gregersen, PK, Pe'er, I, Malhotra, AK, Goldman, D, Darvasi, A (2013). Genome-wide association study implicates NDST3 in schizophrenia and bipolar disorder. Nature Communications 4, 2739.Google Scholar
Margutti, P, Delunardo, F, Ortona, E (2006). Autoantibodies associated with psychiatric disorders. Current Neurovascular Research 3, 149–157.Google Scholar
Mayrshofer, F, Hertl, M, Sinkgraven, R, Sticherling, M, Pfeiffer, C, Zillikens, D, Messer, G, Rzany fur die deutscheBSD-Studiengr B (2005). Deutliche Einschrankung der Lebensqualitat bei Patienten mit Pemphigus vulgaris: Ergebnisse der deutschen Bullous Skin Disease (BSD)-Studiengruppe. Significant decrease in quality of life in patients with pemphigus vulgaris: results from the German Bullous Skin Disease (BSD) study group. Journal der Deutschen Dermatologischen Gesellschaft 3, 431–435.Google Scholar
Miyata, S, Yoshikawa, K, Taniguchi, M, Ishikawa, T, Tanaka, T, Shimizu, S, Tohyama, M (2015). Sgk1 regulates desmoglein 1 expression levels in oligodendrocytes in the mouse corpus callosum after chronic stress exposure. Biochemical and Biophysical Research Communications 464, 76–82.Google Scholar
Müller, N, Schwarz, MJ (2010). Immune system and schizophrenia. Current Immunology Reviews 6, 213–220.Google Scholar
Paradisi, A, Sampogna, F, Di Pietro, C, Cianchini, G, Didona, B, Ferri, R, Abeni, D, Tabolli, S (2009). Quality-of-life assessment in patients with pemphigus using a minimum set of evaluation tools. Journal of the American Academy of Dermatology 60, 261–269.Google Scholar
Pearce, N (2016). Analysis of matched case-control studies. BMJ (Clinical Research ed.) 352, i969.Google Scholar
Pérez España, L, Hervella Garcés, M, Belén Piteiro, A, Casado Jiménez, M (2003). Haloperidol induced pemphigus foliaceus. Medicina Clinica 120, 117–118.Google Scholar
Reichelt, KL, Landmark, J (1995). Specific IgA antibody increases in schizophrenia. Biological Psychiatry 37, 410–413.Google Scholar
Rennert, G, Peterburg, Y (2001). Prevalence of selected chronic diseases in Israel. The Israel Medical Association Journal 3, 404–408.Google Scholar
Risser, J, Lewis, K, Weinstock, MA (2009). Mortality of bullous skin disorders from 1979 through 2002 in the United States. Archives of Dermatology 145, 1005–1008.Google Scholar
Rivest, S (2010). Interactions between the immune and neuroendocrine systems. Progress in Brain Research 181, 43–53.Google Scholar
Samaroo, D, Dickerson, F, Kasarda, DD, Green, PHR, Briani, C, Yolken, RH, Alaedini, A (2010). Novel immune response to gluten in individuals with schizophrenia. Schizophrenia Research 118, 248–255.Google Scholar
Sundquist, K, Li, X, Hemminki, K, Sundquist, J (2008). Subsequent risk of hospitalization for neuropsychiatric disorders in patients with rheumatic diseases: a nationwide study from Sweden. Archives of General Psychiatry 65, 501–507.Google Scholar
Sung, JY, Roh, MR, Kim, S-C (2015). Quality of life assessment in Korean patients with pemphigus. Annals of Dermatology 27, 492–498.Google Scholar
Tabolli, S, Mozzetta, A, Antinone, V, Alfani, S, Cianchini, G, Abeni, D (2008). The health impact of pemphigus vulgaris and pemphigus foliaceus assessed using the Medical Outcomes Study 36-item short form health survey questionnaire. The British Journal of Dermatology 158, 1029–1034.Google Scholar
Tabolli, S, Pagliarello, C, Paradisi, A, Cianchini, G, Giannantoni, P, Abeni, D (2014). Burden of disease during quiescent periods in patients with pemphigus. British Journal of Dermatology 170, 1087–1091.Google Scholar
Tanaka, S, Matsunaga, H, Kimura, M, Tatsumi, KI, Hidaka, Y, Takano, T, Uema, T, Takeda, M, Amino, N (2003). Autoantibodies against four kinds of neurotransmitter receptors in psychiatric disorders. Journal of Neuroimmunology 141, 155–164.Google Scholar
Terrab, Z, Benchikhi, H, Maaroufi, A, Hassoune, S, Amine, M, Lakhdar, H (2005). Quality of life and pemphigus. Annales de dermatologie et de venereologie 132, 321–328.Google Scholar
Uzun, S, Durdu, M, Akman, A, Gunasti, S, Uslular, C, Memisoglu, HR, Alpsoy, E (2006). Pemphigus in the Mediterranean region of Turkey: a study of 148 cases. International Journal of Dermatology 45, 523–528.Google Scholar
Wakkee, M, Nijsten, T (2009). Comorbidities in dermatology. Dermatologic Clinics 27, 137–147.Google Scholar
Wohl, Y, Mashiah, J, Kutz, A, Hadj-Rabia, S, Cohen, AD (2015). Pemphigus and depression comorbidity: a case control study. European Journal of Dermatology 25, 602–605.Google Scholar