Autoimmune psychosis: Psychopathological patterns and outcome after immunotherapy

IF 3.6 2区医学 Q1 PSYCHIATRY

Schizophrenia Research Pub Date : 2025-04-29 DOI:10.1016/j.schres.2025.04.024

Jesus Ramirez-Bermudez , Mariana Espinola-Nadurille , Miguel Restrepo-Martinez , Victoria Martínez-Ángeles , Francisco Martínez-Carrillo , Lissy Cascante , Paloma Valdeiglesias , Monserrat Mondragón , Jazmín Armenta , Josué García Almánzar , Verónica Rivas-Alonso , José Flores-Rivera , Oscar Arias-Carrión , Tomas A. Pollak

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引用次数: 0

Abstract

Background

The diagnostic criteria for “autoimmune psychosis” have been proposed to identify patients presenting with psychotic symptoms of autoimmune origin. Here, we aim to characterize the psychopathological features and outcomes of patients diagnosed with autoimmune psychosis.

Methods

We describe a cohort study conducted at the National Institute of Neurology and Neurosurgery of Mexico, including patients with psychotic symptoms exhibiting features of possible autoimmune psychosis: a) catatonia, b) dyskinesia, c) seizures, d) signs of neuroleptic malignant syndrome or clinical worsening after use of antipsychotics, or e) severe cognitive impairment.

Results

Of 195 psychotic patients under assessment, 164 patients were diagnosed as having psychosis of autoimmune origin and received immunotherapy. Hallucinations were present in 83 %, delusions in 77 %, and disorganized speech in 64 % of the cases. Severe cognitive dysfunction was present in 75 % while 64 % were diagnosed with catatonia. Seizures were the most common neurological feature (63 %), followed by movement disorders and autonomic abnormalities. Most patients (71%) were diagnosed as having definite anti- NMDAR encephalitis. A significant proportion of the cases (39 %) had been previously misdiagnosed as having a primary psychiatric disorder. After immunotherapy, most patients with anti-NMDA receptor encephalitis, or with a negative determination of NMDA receptor antibodies, experienced cognitive and functional improvement, and a significant reduction in psychotic symptoms.

Conclusions

Our study supports previous observations about the value of the autoimmune psychosis construct, the pleomorphic psychopathological patterns of autoimmune encephalitis, and the significant improvement of psychopathology after immunotherapy

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自身免疫性精神病：免疫治疗后的精神病理模式和结果

背景：“自身免疫性精神病”的诊断标准已被提出，以确定出现自身免疫性起源的精神病症状的患者。在这里，我们的目的是表征自身免疫性精神病患者的精神病理特征和预后。方法：我们描述了在墨西哥国家神经病学和神经外科研究所进行的一项队列研究，包括精神病症状表现出可能的自身免疫性精神病特征的患者：a)紧张症，b)运动障碍，c)癫痫发作，d)抗精神病药恶性综合征体征或使用抗精神病药物后临床恶化，或e)严重认知障碍。结果195例精神病患者中，164例诊断为自身免疫性精神病并接受免疫治疗。幻觉占83%，妄想占77%，言语混乱占64%。75%的患者存在严重的认知功能障碍，而64%的患者被诊断为紧张症。癫痫发作是最常见的神经系统特征（63%），其次是运动障碍和自主神经异常。大多数患者（71%）被诊断为明确的抗NMDAR脑炎。相当大比例的病例（39%）以前被误诊为患有原发性精神障碍。免疫治疗后，大多数抗NMDA受体脑炎患者，或NMDA受体抗体检测阴性的患者，认知和功能得到改善，精神病症状显著减轻。结论本研究支持了前人关于自身免疫性精神病构建的价值、自身免疫性脑炎的多形性精神病理模式以及免疫治疗后精神病理的显著改善

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Schizophrenia Research 医学-精神病学

CiteScore

7.50

自引率

8.90%

发文量

429

审稿时长

10.2 weeks

期刊介绍： As official journal of the Schizophrenia International Research Society (SIRS) Schizophrenia Research is THE journal of choice for international researchers and clinicians to share their work with the global schizophrenia research community. More than 6000 institutes have online or print (or both) access to this journal - the largest specialist journal in the field, with the largest readership! Schizophrenia Research''s time to first decision is as fast as 6 weeks and its publishing speed is as fast as 4 weeks until online publication (corrected proof/Article in Press) after acceptance and 14 weeks from acceptance until publication in a printed issue. The journal publishes novel papers that really contribute to understanding the biology and treatment of schizophrenic disorders; Schizophrenia Research brings together biological, clinical and psychological research in order to stimulate the synthesis of findings from all disciplines involved in improving patient outcomes in schizophrenia.