Steiner J, Prüß H, Köhler S, Hasan A, Falkai P
Klinik für Psychiatrie und Psychotherapie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland.
Center for Behavioral Brain Sciences, Magdeburg, Deutschland.
Nervenarzt. 2018 May;89(5):530-538. doi: 10.1007/s00115-018-0499-z.
Despite intensive research, a precise cause of schizophrenic and schizoaffective disorders has not yet been identified. Therefore, psychiatric diagnoses are still made based on clinical ICD-10/DSM‑5 criteria and not on any objective markers; however, various causes or pathophysiological processes may ultimately lead to similar symptoms. An important task for the future of psychiatry is to identify disease subtypes with a distinct pathophysiology to develop more specific and causally acting therapies. A new diagnostic entity has become established in clinical neurology and psychiatry in recent years: autoimmune encephalitis with psychotic symptoms caused by specific antineuronal antibodies has been identified as a rare but potentially treatable cause of psychotic disorders; however, these inflammatory brain diseases are not reliably detected by routine psychiatric diagnostics. Therefore, this qualitative review is intended to provide structured support for clinical practice, which, guided by clinical warning signals, enables a rapid and reliable diagnosis as well as the initiation of immunotherapy. In the case of psychiatric symptoms, the additional onset of focal neurological signs, disturbances of consciousness and orientation, autonomic instability or epileptic seizures and electroencephalograph (EEG) abnormalities should always be followed by a more specific cerebrospinal fluid analysis with determination of antineuronal autoantibodies. Although the scientific evidence indicates that only a small subgroup of patients is affected, the swift and correct diagnosis is of high therapeutic and prognostic relevance for the affected individuals.
尽管进行了深入研究，但精神分裂症和分裂情感性障碍的确切病因尚未确定。因此，精神病学诊断仍然基于临床ICD - 10/DSM - 5标准，而非任何客观标志物；然而，各种病因或病理生理过程最终可能导致相似的症状。精神病学未来的一项重要任务是识别具有独特病理生理学的疾病亚型，以开发更具特异性和因果作用的治疗方法。近年来，临床神经病学和精神病学中确立了一种新的诊断实体：由特定抗神经元抗体引起的伴有精神病症状的自身免疫性脑炎已被确认为一种罕见但可能可治疗的精神病性障碍病因；然而，这些炎症性脑病无法通过常规精神病学诊断可靠检测出来。因此，本定性综述旨在为临床实践提供结构化支持，在临床警示信号的指导下，实现快速可靠的诊断以及免疫治疗的启动。对于出现精神症状的情况，如果同时伴有局灶性神经体征、意识和定向障碍、自主神经不稳定或癫痫发作以及脑电图（EEG）异常，应始终进一步进行更具特异性的脑脊液分析，以测定抗神经元自身抗体。尽管科学证据表明只有一小部分患者受影响，但快速正确的诊断对受影响个体具有高度的治疗和预后意义。
