Restrepo-Martínez Miguel, López-Hernández Juan Carlos, Espinola-Nadurille Mariana, Bayliss Leo, Medina-Rioja Raúl, Martínez-Ángeles Victoria, Galnares-Olalde Javier, Téllez-Martínez José Alberto, Ramírez-Bermúdez Jesús
Instituto Nacional de Neurología y Neurocirugía, Departamento de Neuropsiquiatría, Ciudad de México, México.
Rev Alerg Mex. 2021 Oct-Dec;68(4):276-290. doi: 10.29262/ram.v68i4.981.
With the advent of the description of autoimmune encephalitis by different neuronal cell-surface antibodies (anti-NMDAr, among others) and that psychosis may be the only manifestation without neurological symptoms (epilepsy, movement disorders, autonomic dysfunction, altered state of consciousness) in 6.5 % of patients, the term "autoimmune psychosis" has become remarkably interesting among researchers. In 2020, an international consensus for the description and diagnostic approach of autoimmune psychosis was created. Through this consensus, by taking different criteria into account, the definition of autoimmune psychosis was proposed at different degrees of certainty (possible, probable, and defined). The purpose of these criteria is to underpin the autoimmune origin in patients who present psychosis with atypical characteristics, thus justifying the realization of laboratory studies and complementary clinical tests (lumbar puncture, electroencephalogram, and magnetic resonance imaging of the brain); in addition, these criteria are applied in patients with psychosis without neurological symptoms that do not fully meet the criteria of autoimmune encephalitis. As in autoimmune encephalitis, the early initiation of immunotherapy has a direct impact on the functional prognosis of patients, so an early initiation of treatment must be considered in clinical scenarios of probable or definite autoimmune psychosis.
随着不同神经元细胞表面抗体（尤其是抗NMDAr）对自身免疫性脑炎的描述出现，以及在6.5%的患者中精神病可能是唯一无神经症状（癫痫、运动障碍、自主神经功能障碍、意识状态改变）的表现，“自身免疫性精神病”一词在研究人员中变得非常有趣。2020年，形成了关于自身免疫性精神病描述和诊断方法的国际共识。通过这一共识，考虑到不同标准，在不同确定程度（可能、很可能和明确）上提出了自身免疫性精神病的定义。这些标准的目的是在表现出非典型特征精神病的患者中支持自身免疫起源，从而为进行实验室研究和补充临床检查（腰椎穿刺、脑电图和脑部磁共振成像）提供依据；此外，这些标准适用于无神经症状且不完全符合自身免疫性脑炎标准的精神病患者。与自身免疫性脑炎一样，免疫治疗的早期启动对患者的功能预后有直接影响，因此在可能或明确的自身免疫性精神病临床情况下必须考虑早期开始治疗。
