Hansen Niels, Lipp Michael, Vogelgsang Jonathan, Vukovich Ruth, Zindler Tristan, Luedecke Daniel, Gingele Stefan, Malchow Berend, Frieling Helge, Kühn Simone, Denk Johannes, Gallinat Jürgen, Skripuletz Thomas, Moschny Nicole, Fiehler Jens, Riedel Christian, Wiedemann Klaus, Wattjes Mike P, Zerr Inga, Esselmann Hermann, Bleich Stefan, Wiltfang Jens, Neyazi Alexandra
Department of Psychiatry and Psychotherapy, University Medical Center Göttingen (UMG), Von-Siebold-Str. 5, 37075, Goettingen, Germany.
Department of Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany.
Brain Behav Immun Health. 2020 Oct 1;9:100154. doi: 10.1016/j.bbih.2020.100154. eCollection 2020 Dec.
Autoimmune-mediated encephalitis is a disease that often encompasses psychiatric symptoms as its first clinical manifestation's predominant and isolated characteristic. Novel guidelines even distinguish autoimmune psychosis from autoimmune encephalitis. The aim of this review is thus to explore whether a wide range of psychiatric symptoms and syndromes are associated or correlate with autoantibodies.
We conducted a PubMed search to identify appropriate articles concerning serum and/or cerebrospinal fluid (CSF) autoantibodies associated with psychiatric symptoms and syndromes between 2000 and 2020. Relying on this data, we developed a diagnostic approach to optimize the detection of autoantibodies in psychiatric patients, potentially leading to the approval of an immunotherapy.
We detected 10 major psychiatric symptoms and syndromes often reported to be associated with serum and/or CSF autoantibodies comprising altered consciousness, disorientation, memory impairment, obsessive-compulsive behavior, psychosis, catatonia, mood dysfunction, anxiety, behavioral abnormalities (autism, hyperkinetic), and sleeping dysfunction. The following psychiatric diagnoses were associated with serum and/or CSF autoantibodies: psychosis and schizophrenia spectrum disorders, mood disorders, minor and major neurocognitive impairment, obsessive-compulsive disorder, autism spectrum disorders (ASD), attention deficit hyperactivity disorder (ADHD), anxiety disorders, eating disorders and addiction. By relying on these symptom clusters and diagnoses in terms of onset and their duration, we classified a subacute or subchronic psychiatric syndrome in patients that should be screened for autoantibodies. We propose further diagnostics entailing CSF analysis, electroencephalography and magnetic resonance imaging of the brain. Exploiting these technologies enables standardized and accurate diagnosis of autoantibody-associated psychiatric symptoms and syndromes to deliver early immunotherapy.
We have developed a clinical diagnostic pathway for classifying subgroups of psychiatric patients whose psychiatric symptoms indicate a suspected autoimmune origin.
自身免疫介导的脑炎是一种常以精神症状作为其首发临床表现的主要和孤立特征的疾病。新指南甚至将自身免疫性精神病与自身免疫性脑炎区分开来。因此，本综述的目的是探讨广泛的精神症状和综合征是否与自身抗体相关或存在关联。
我们在PubMed上进行检索，以识别2000年至2020年间有关与精神症状和综合征相关的血清和/或脑脊液（CSF）自身抗体的合适文章。基于这些数据，我们制定了一种诊断方法，以优化对精神科患者自身抗体的检测，这可能会促成免疫疗法的获批。
我们检测到10种常被报道与血清和/或脑脊液自身抗体相关的主要精神症状和综合征，包括意识改变、定向障碍、记忆障碍、强迫行为、精神病、紧张症、情绪功能障碍、焦虑、行为异常（自闭症、多动）和睡眠功能障碍。以下精神科诊断与血清和/或脑脊液自身抗体相关：精神病和精神分裂症谱系障碍、情绪障碍、轻度和重度神经认知障碍、强迫症、自闭症谱系障碍（ASD）、注意力缺陷多动障碍（ADHD）、焦虑症、饮食失调和成瘾。根据这些症状群以及发病时的诊断及其持续时间，我们对应该进行自身抗体筛查的患者中的亚急性或亚慢性精神综合征进行了分类。我们建议进一步进行脑脊液分析、脑电图和脑部磁共振成像等诊断。利用这些技术能够对自身抗体相关的精神症状和综合征进行标准化和准确的诊断，从而提供早期免疫治疗。
我们已经制定了一种临床诊断途径，用于对精神症状表明疑似自身免疫起源的精神科患者亚组进行分类。
