Department of Neurology, Zucker School of Medicine at Hofstra/Northwell, 8 Black Hall, 130 E 77th Street, New York, NY, 10075, USA.
Department of Psychiatry, University of Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany.
J Neuroinflammation. 2018 Feb 13;15(1):40. doi: 10.1186/s12974-018-1067-y.
Growing data point to the overlap between psychosis and pathological processes associated with immunological dysregulation as well as inflammation. Notably, the recent discovery of antibodies against synaptic and neuronal cell membrane proteins such as anti-N-methyl-D-aspartate receptor provides more direct evidence of the etiological connection between autoimmunity and subsequent hazard of psychosis. Here, we advocate the use of term "autoimmune psychosis," as this term suggests that autoimmune disorders can masquerade as drug-resistant primary psychosis, and this subtype of psychosis has anatomical and immunological footprints in the brain, despite the frequent absence of structural abnormalities on conventional brain MRI. Furthermore, this term might serve as a reminder not to overlook appropriate neurological workup such as neuroimaging and EEG testing, as well as CSF analysis, for cases with acute or subacute atypical onset of neuropsychiatric presentations including those dominated by acute psychotic symptoms. We propose etiologically and serologically oriented subclassification as well as multi-modal diagnostic approach to address some of the challenges inherent to early diagnosis of patients presenting with atypical and refractory new-onset psychotic symptoms of autoimmune origin. This is particularly relevant to the diagnosis of seronegative but probable autoimmune psychosis (SPAP) that might masquerade as antipsychotic drug-resistant primary psychotic disorder. This distinction is therapeutically important as autoimmune-related psychotic symptomatology can frequently respond well to timely treatment with proper immune modulatory therapies.
越来越多的数据表明，精神病与免疫失调以及炎症相关的病理过程之间存在重叠。值得注意的是，最近发现了针对突触和神经元细胞膜蛋白的抗体，例如抗 N-甲基-D-天冬氨酸受体抗体，这为自身免疫与随后精神病发病风险之间的病因联系提供了更直接的证据。在这里，我们提倡使用“自身免疫性精神病”这一术语，因为该术语表明自身免疫性疾病可能伪装为耐药性原发性精神病，并且这种类型的精神病在大脑中有解剖学和免疫学的痕迹，尽管在常规脑 MRI 上经常没有结构异常。此外，该术语可能提醒人们不要忽视适当的神经科检查，例如神经影像学和 EEG 测试，以及 CSF 分析，对于具有急性或亚急性非典型神经精神表现的病例，包括以急性精神病症状为主的病例。我们提出了基于病因和血清学的分类以及多模态诊断方法，以解决自身免疫性精神病患者早期诊断中固有的一些挑战。这对于诊断血清阴性但可能为自身免疫性精神病（SPAP）的患者尤为重要，因为该疾病可能伪装为抗精神病药物耐药性原发性精神病障碍。这种区分在治疗上很重要，因为与自身免疫相关的精神病症状通常可以对及时进行适当的免疫调节治疗做出很好的反应。
