Autoimmune encephalitis as a differential diagnosis of schizophreniform psychosis: clinical symptomatology, pathophysiology, diagnostic approach, and therapeutic considerations

Abstract

Primary schizophreniform psychoses are thought to be caused by complex gene-environment interactions. Secondary forms are based on a clearly identifiable organic cause, in terms of either an etiological or a relevant pathogenetic factor. The secondary or "symptomatic" forms of psychosis have reentered the focus stimulated by the discovery of autoantibody (Ab)associated autoimmune encephalitides (AEs), such as anti-NMDA-R encephalitis, which can at least initially mimic variants of primary psychosis. These newly described secondary, immune-mediated schizophreniform psychoses typically present with the acute onset of polymorphic psychotic symptoms. Over the course of the disease, other neurological phenomena, such as epileptic seizures, movement disorders, or reduced levels of consciousness, usually arise. Typical clinical signs for AEs are the acute onset of paranoid hallucinatory symptoms, atypical polymorphic presentation, psychotic episodes in the context of previous AE, and additional neurological and medical symptoms such as catatonia, seizure, dyskinesia, and autonomic instability. Predominant psychotic courses of AEs have also been described casuistically. The term autoimmune psychosis (AP) was recently suggested for these patients. Paraclinical alterations that can be observed in patients with AE/AP are inflammatory cerebrospinal fluid (CSF) pathologies, focal or generalized electroencephalographic slowing or epileptic activity, and/or suspicious "encephalitic" imaging findings. The antibody analyses in these patients include the testing of the most frequently found Abs against cell surface antigens (

Parkinsonian Syndrome with Frontal Lobe Involvement and Anti-Glycine Receptor Antibodies

“…Secondary forms of movement disorders may occur in the context of autoimmune encephalitis with different antineuronal antibodies [ 12 , 13 , 14 , 15 ]. Dyskinesias are found in anti-NMDA-receptor (R) encephalitis.…”

SOP Somatische Diagnostik bei Verdacht auf immunologische Psychosen

“…▶ Tab. 3 Spezifische Empfehlungen zur organischen Diagnostik bei immunologischen Psychosen (gemäß [7][8][9]). [11,16].…”

“…Zu den Zweitlinienverfahren gehören Rituximab und Cyclophosphamid, wobei Rituximab zunehmend wichtiger wird [9,[11][12][13][14][15]. Während ein Therapieversuch mit Kortison dabei auch im klassischen Setting der Psychiatrie meist gut umgesetzt werden kann, muss bei weiterer Therapieeskalation die Zusammenarbeit mit der Neurologie, Immunologie und Nephrologie gesucht werden.…”

“…Für viele Menschen mit immunologischer Psychose hat eine Immuntherapie zu sehr weitreichenden klinischen Besserungen bis hin zu fast kompletten Heilungen des psychotischen Prozesses geführt [6,9,17]. ▶ Abb.…”

Novel Antineuronal Autoantibodies With Somatodendritic Staining Pattern in a Patient With Autoimmune Psychosis

“…Autoimmune encephalitis, such as anti-NMDA-receptor encephalitis, is typically associated with a subacute onset of neuropsychiatric symptoms, and can often be identified by the presence of antineuronal autoantibodies or inflammatory changes in the cerebrospinal fluid (CSF), electroencephalography (EEG) pathologies, and evidence of encephalitis in magnetic resonance imaging (MRI) or [18F]fluorodeoxyglucose positron emission tomography (FDG PET; [1][2][3][4][5]. Until now, a series of antineuronal autoantibodies against surface (e.g., NMDA-R, LGI1, CASPR2, AMPA1/2-R, GABA-B-R, DPPX) or intracellular antigens (e.g., Yo, Hu, CV2/CRMP5, Ri, Ma1/2, SOX1, GAD65, amphiphysin), or "potentially antineuronal" systemic antibodies (e.g., antinuclear antibodies [ANAs] against double-stranded [ds]-DNA or gliadin autoantibodies) (3)(4)(5) are known. The associated neuropsychiatric syndromes are classically characterized by a combination of neurological (e.g., seizures, movement disorders, focalneurological deficits, or reduced consciousness) and psychiatric (e.g., psychosis, mania, or catatonia) symptoms (3,6,7).…”