Autoimmune Schizophrenia? Psychiatric Manifestations of Hashimoto's Encephalitis

Abstract

Hashimoto’s encephalitis (HE), also known as steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), can be a debilitating manifestation of an autoimmune reaction against the thyroid that is often under-diagnosed primarily due to a lack of definitive diagnostic criteria. This is a case of a 52-year-old woman who has been diagnosed with HE after presenting with recurrent and severe psychosis in conjunction with paranoia and a thyroidopathy. Her symptoms are chronic, having first been documented as presenting 15 years prior and showing progressive exacerbation in both frequency and severity. The patient’s paranoia often manifested as delusions involving family members or close friends and consequently introduced an opportunity for harm to herself and others. She showed great conviction with self-diagnoses that were proven incorrect, resulting in occasional non-compliance. Between episodes, the patient did not show evidence of symptoms. This patient struggled with several incorrect diagnoses and treatments for several years before the correct diagnosis of HE was made and displayed extreme improvement upon corticosteroid administration. This case illustrates the importance of increasing awareness of HE as well as including HE in a differential diagnosis when any patient presents with psychosis and concurrent thyroidopathy. Hashimoto’s encephalitis follows putative characteristics of autoimmune diseases, exhibiting a higher incidence in women as compared to men, presenting with increased titers of autoantibodies, and showing dramatic amelioration when treated with corticosteroids.

Hashimoto’s thyroiditis presenting as acute psychosis with religious delusion: a case report

“…This confusion leads to delayed treatment and a high likelihood of increased morbidity. Hashimoto's thyroiditis might be linked to psychotic phenomenon independent of its hormonal status with autoimmunity as a possible etiology, similar to the case of Hashimoto's encephalitis (8). Treatment of this condition is controversial.…”

Енцефалопатія Хашимото Із Тоніко-Клонічними Нападами: Клінічний Випадок

“…HE is characterized by features of autoimmune disease, found more often among women in comparison with the men [1,5,9]. It is represented by variable neurological symptoms, augmentation of antithyroid peroxidase and has a positive response to the corticosteroid therapy [1,15].…”

Psychiatric Presentations Heralding Hashimoto’s Encephalopathy: A Systematic Review and Analysis of Cases Reported in Literature

“…The flowchart depicting the results of the literature search is shown in Figure 1 . The majority ( n = 27, 67.5%) of the case reports/series were published after 2010[ 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 ] perhaps indicating an increased awareness of the protean manifestations of HE. After following the inclusion and exclusion criteria and removing duplicates, a total of forty articles describing 46 cases were identified.…”

“…After following the inclusion and exclusion criteria and removing duplicates, a total of forty articles describing 46 cases were identified. These reports varyingly described one,[ 12 14 15 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 33 34 35 36 38 39 40 41 42 43 44 45 46 47 48 49 ] two,[ 32 37 50 ] or a maximum of three cases. [ 13 16 ] Table 1 summarizes the age and gender distribution of the cases included for review.…”