Diagnosing Organic Causes of Schizophrenia Spectrum Disorders: Findings from a One-Year Cohort of the Freiburg Diagnostic Protocol in Psychosis (FDPP)

Abstract

Introduction: Secondary schizophrenia spectrum disorders (SSDs) have clearly identifiable causes. The Department for Psychiatry and Psychotherapy at the University Hospital Freiburg has continued to expand its screening practices to clarify the organic causes of SSDs. This retrospective analysis was carried out to analyze whether a comprehensive organic diagnostic procedure could be informative in patients with SSDs. Methods and Participants: The “Freiburg Diagnostic Protocol in Psychosis” (FDPP) included basic laboratory analyses (e.g., thyroid hormones), metabolic markers, pathogens, vitamin status, different serological autoantibodies, rheumatic/immunological markers (e.g., complement factors), cerebrospinal fluid (CSF) basic and antineuronal antibody analyses, as well as cranial magnetic resonance imaging (cMRI) and electroencephalography (EEG). The findings of 76 consecutive patients with SSDs (55 with paranoid–hallucinatory; 14 with schizoaffective; 4 with hebephrenic; and 1 each with catatonic, acute polymorphic psychotic, and substance-induced psychotic syndromes) were analyzed. Results: Overall, vitamin and trace element deficiency was identified in 92%. Complement factor analyses detected reduced C3 levels in 11%. Immunological laboratory alterations were detected in 76%. CSF analysis revealed general alterations in 54% of the patients, mostly with signs of blood–brain barrier dysfunction. cMRI analyses showed chronic inflammatory lesions in 4%. Combination of EEG, cMRI, and CSF revealed alterations in 76% of the patients. In three patients, autoimmune psychosis was suspected (4%). Discussion: On the basis of these findings, we conclude that a comprehensive diagnostic procedure according to the FDPP in patients with SSD is worthwhile, considering the detection of secondary, organic forms of SSDs, as well as alterations in “modulating factors” of the disease course, such as vitamin deficiency. Larger studies using comprehensive diagnostic protocols are warranted to further validate this approach.

Anti-MOG autoantibody-associated schizophreniform psychosis

“…396/18). The positive anti-MOG antibody finding in patient 2 has already been reported in earlier papers (Endres et al, 2020b(Endres et al, , 2020c, but written informed consent was obtained additionally from both patients for the preparation of this cumulative case report. Two thoroughly investigated cases of patients with schizophreniform psychosis and anti-MOG antibodies in serum can therefore be presented.…”

“…Two thoroughly investigated cases of patients with schizophreniform psychosis and anti-MOG antibodies in serum can therefore be presented. Both patients were diagnosed following the principles of the Freiburg Diagnostic Protocol in Psychosis (Endres et al, 2020b).…”

“…with anti-Hu antibodies) (Pollak et al, 2020). However, the role of anti-myelin antibodies against MOG in this context remained unclear, and they are usually not examined in the routine workup of patients with psychosis (Endres et al, 2020a;2020b;Pollak et al, 2020). Anti-MOG antibodies were originally assumed to be involved in multiple sclerosis (MS) (Lalive et al, 2006).…”

When does schizophrenia really begin? - A case report confirming the neurodevelopmental theory of schizophrenia

“…Moreover, taking into account the patient's medical history, it would be important to consider organic delusional disorders in the differential diagnosis. The patient experienced persecutory delusions that can occur both in paranoid schizophrenia and in organic delusional disorders [36]. However, the diagnosis of schizophrenia was supported by other symptoms reported by her, which are characteristic of this disease entity: commentary hallucinations, delusions of reference, and negative symptoms such as flattened affect, apathy, impoverished thinking, and speech [1,2].…”

“…Ponadto zważając na historię choroby pacjentki w diagnostyce różnicowej istotnym byłoby wziąć pod uwagę organiczne zaburzenia urojeniowe. Chora doświadczała urojeń prześladowczych, które mogą wystąpić zarówno we schizofrenii paranoidalnej jak i w organicznych zaburzeniach urojeniowych [36]. Jednakże, za rozpoznaniem u pacjentki schizofrenii przemawiały inne zgłaszane przez nią objawy, które są charakterystyczne dla tej jednostki chorobowej: omamy słuchowe komentujące i ksobne oraz objawy negatywne takie jak spłycony afekt, apatia, zubożenie myślenia i wypowiedzi [1,2].…”