Recent research studies of early onset-obsessive compulsive disorder (OCD) and Tourette's
syndrome have questioned whether autoimmunity could play a role in the development of these
conditions. As a result, there has been an increased interest in the field of research on
the potential involvement of autoimmunity in other psychiatric conditions like
Autoimmune conditions occur when the normal immune system of the body begins working against
itself. The immune system recognizes cells as foreign and begins to attack them.
There are several similarities between autoimmune diseases and schizophrenia. Genetics play
some role in the development of both diseases. Both conditions show a similar course, and
both conditions tend to show worsening of symptoms when exposed to stress.
Previous research studies have shown intravenous immunoglobulin to be safe and effective
when used in neurologic diseases involving the immune system. Presently the NIMH is testing
the effectiveness of IVIg in OCD and Tourette's syndrome.
Intravenous Immunoglobulin IVIg is a medication that has been used to treat diseases like
Kawasaki disease, systemic juvenile rheumatoid arthritis, lupus nephritis, and idiopathic
thrombocytopenic purpura. The drug modifies the body's natural immune reactions.
This research study is a 13-week trial of intravenous immunoglobulin (IVIg) on patients
suffering from childhood-onset schizophrenia, who have failed to respond to other therapies.
Recent developments in the study of early-onset obsessive-compulsive disorder (OCD) and
Tourette's syndrome have implicated an autoimmune etiology in a subset of these conditions,
and renewed interest into the possibility of autoimmune pathophysiology underlying other
psychiatric disorders. There are several clinical and epidemiologic similarities between
autoimmune diseases and schizophrenia: genetic predisposition, but with twin concordance
below 50%; waxing and waning course; exacerbation of symptoms or precipitation of relapse by
psychosocial stress. However, other mixed evidence has engendered considerable debate in
the literature regarding the role of immune mechanisms in schizophrenia. The clinical
efficacy and safety of intravenous immunoglobulin (IVIg) in immune-mediated neurological
diseases has been documented, and clinical studies of the efficacy of IVIg in the treatment
of both Tourette's syndrome and OCD are currently ongoing at the NIMH (see protocol
92-M-0132). In this protocol, we propose a 13-week placebo-controlled double-blind
crossover study of IVIg in 25 patients suffering from treatment-refractory childhood-onset
schizophrenia. After the first 5 patients have completed the trial, this data will be
presented to the NIMH Institutional Review Board and a decision will be made as to whether
this trial should proceed.
Patients will be recruited from both professional referrals and patient advocacy sources,
subject to medical and psychiatric screening.
Children and adolescents will be sought who meet DSM-III-R and DSM-IV criteria for
schizophrenia, with onset of psychotic symptoms before age twelve, and who have no
concurrent substance abuse disorders or other active medical conditions. In addition,
they will have failed adequate trials of at least two typical neuroleptics, and not
benefited from either olanzapine or clozapine.