Endres Dominique, Matysik Miriam, Feige Bernd, Venhoff Nils, Schweizer Tina, Michel Maike, Meixensberger Sophie, Runge Kimon, Maier Simon J, Nickel Kathrin, Bechter Karl, Urbach Horst, Domschke Katharina, Tebartz van Elst Ludger
Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany.
Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany.
Diagnostics (Basel). 2020 Sep 14;10(9):691. doi: 10.3390/diagnostics10090691.
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. 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. 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%). 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.
继发性精神分裂症谱系障碍（SSDs）有明确可辨的病因。弗莱堡大学医院精神科和心理治疗科不断扩大其筛查方法，以明确SSDs的器质性病因。开展这项回顾性分析是为了探讨全面的器质性诊断程序对SSDs患者是否具有参考价值。“弗莱堡精神病诊断方案”（FDPP）包括基础实验室分析（如甲状腺激素）、代谢标志物、病原体、维生素状态、不同的血清学自身抗体、风湿/免疫标志物（如补体因子）、脑脊液（CSF）基础及抗神经元抗体分析，以及头颅磁共振成像（cMRI）和脑电图（EEG）。对76例连续的SSDs患者（55例偏执幻觉型；14例精神分裂症情感障碍型；4例青春型；1例紧张型、急性多形性精神病型和物质所致精神病综合征各1例）的检查结果进行了分析。总体而言，92%的患者存在维生素和微量元素缺乏。补体因子分析发现11%的患者C3水平降低。76%的患者检测到免疫实验室指标改变。CSF分析显示54%的患者有一般性改变，大多有血脑屏障功能障碍的迹象。cMRI分析显示4%的患者有慢性炎性病变。EEG、cMRI和CSF联合检查发现76%的患者有改变。3例患者疑似自身免疫性精神病（4%）。基于这些发现，我们得出结论，对于SSDs患者，按照FDPP进行全面诊断程序是有价值的，这有助于发现继发性器质性SSDs形式，以及病程“调节因子”的改变，如维生素缺乏。有必要开展更大规模的使用全面诊断方案的研究，以进一步验证这种方法。
