Liebrand Matthias, Rebsamen Michael, Nakamura-Utsunomiya Akari, von den Driesch Luisa, Köck Patrick, Caccia Julien, Hamann Christoph, Wiest Roland, Kaess Michael, Walther Sebastian, Tschumi Sibylle, Hiyama Takeshi Y, Kindler Jochen
University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Front Psychiatry. 2023 Jul 19;14:1206226. doi: 10.3389/fpsyt.2023.1206226. eCollection 2023.
This is the first description of a patient in which adipsic hypernatremia, a rare autoimmune encephalitis, presented in combination with complex psychiatric symptomatology, including psychosis and catatonia. Adipsic hypernatremia is characterized by autoantibodies against the thirst center of the brain. These autoantibodies cause inflammation and apoptosis in key regions of water homeostasis, leading to lack of thirst and highly increased serum sodium. To date, the symptoms of weakness, fatigue and drowsiness have been associated with adipsic hypernatremia, but no psychiatric symptomatology. Here, we showcase the first description of an adolescent patient, in which severe and complex psychiatric symptoms presented along with adipsic hypernatremia. The patient experienced delusion, hallucinations, restlessness and pronounced depression. Further, he showed ritualized, aggressive, disinhibited and sexualized behavior, as well as self-harm and psychomotor symptoms. Due to his severe condition, he was hospitalized on the emergency unit of the child and adolescent psychiatry for 8 months. Key symptoms of the presented clinical picture are: childhood-onset complex and treatment-resistant psychosis/catatonia, pronounced behavioral problems, fatigue, absent thirst perception, hypernatremia and elevated prolactin levels. This case report renders first evidence speaking for a causal link between the autoimmune adipsic hypernatremia and the psychotic disorder. Moreover, it sheds light on a new form of autoimmune psychosis.
这是对一名患者的首次描述，该患者患有罕见的自身免疫性脑炎——无渴感高钠血症，并伴有包括精神病和紧张症在内的复杂精神症状。无渴感高钠血症的特征是存在针对脑内口渴中枢的自身抗体。这些自身抗体在水稳态的关键区域引发炎症和细胞凋亡，导致口渴感缺失和血清钠水平大幅升高。迄今为止，虚弱、疲劳和嗜睡等症状与无渴感高钠血症有关，但尚无精神症状的报道。在此，我们展示了对一名青少年患者的首次描述，该患者在患有无渴感高钠血症的同时出现了严重且复杂的精神症状。患者经历了妄想、幻觉、烦躁不安和明显的抑郁。此外，他还表现出仪式化、攻击性、脱抑制和性化行为，以及自我伤害和精神运动症状。由于病情严重，他在儿童和青少年精神病学急诊室住院了8个月。所呈现临床症状的关键表现为：儿童期起病的复杂且难治性精神病/紧张症、明显的行为问题、疲劳、无口渴感知、高钠血症和催乳素水平升高。本病例报告首次证明了自身免疫性无渴感高钠血症与精神障碍之间存在因果联系。此外，它还揭示了一种新形式的自身免疫性精神病。
