Endres Dominique, Bechter Karl, Prüss Harald, Hasan Alkomiet, Steiner Johann, Leypoldt Frank, Tebartz van Elst Ludger
Sektion für experimentelle Neuropsychiatrie, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hauptstr. 5, 79104, Freiburg, Deutschland.
Klinik für Psychiatrie und Psychotherapie II, Bezirkskrankenhaus Günzburg, Universität Ulm, Günzburg, Deutschland.
Nervenarzt. 2019 May;90(5):547-563. doi: 10.1007/s00115-019-0700-z.
According to present concepts, primary psychotic disorders in the schizophrenia spectrum are probably caused by a complex interaction between multigenetic vulnerability and causally relevant environmental factors. In contrast, secondary psychotic disorders are the result of likely identifiable organic factors either in terms of a first causation (etiology) or a secondary cause (pathogenesis). In this context, autoantibody(ab)-associated autoimmune encephalitis (AE) plays an increasingly important role. Within the group of ab-associated AE with neuropsychiatric symptoms, anti-N-methyl-D-aspartate receptor encephalitis is the most prevalent one. Psychopathologically, polymorphic psychotic symptoms are often observed at onset of AE; however, over the course of this condition or even initially other neuropsychiatric phenomena are also common. The ill-defined entity of a steroid-responsive encephalopathy with thyroid antibodies (Hashimoto's encephalitis) is a heterogeneous syndrome that may also comprise isolated psychotic disorders presenting as classical schizophrenia.
根据目前的概念,精神分裂症谱系中的原发性精神障碍可能是由多基因易感性与因果相关环境因素之间的复杂相互作用引起的。相比之下,继发性精神障碍是由可能可识别的有机因素导致的结果,这些因素要么是首要病因(病因学),要么是次要病因(发病机制)。在这种情况下,自身抗体(ab)相关的自身免疫性脑炎(AE)发挥着越来越重要的作用。在伴有神经精神症状的ab相关AE组中,抗N-甲基-D-天冬氨酸受体脑炎最为常见。在精神病理学上,AE发病时经常观察到多形性精神症状;然而,在这种疾病过程中,甚至在最初阶段,其他神经精神现象也很常见。伴有甲状腺抗体的类固醇反应性脑病(桥本脑病)这一界定不清的实体是一种异质性综合征,也可能包括表现为典型精神分裂症的孤立性精神障碍。