Ramirez-Bermudez Jesus, Espinola-Nadurille Mariana, Restrepo-Martinez Miguel, Martínez-Ángeles Victoria, Martínez-Carrillo Francisco, Cascante Lissy, Valdeiglesias Paloma, Mondragón Monserrat, Armenta Jazmín, Almánzar Josué García, Rivas-Alonso Verónica, Flores-Rivera José, Arias-Carrión Oscar, Pollak Tomas A
Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico, Mexico; School of Medicine, Universidad Nacional Autónoma de México, Mexico.
Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico, Mexico.
Schizophr Res. 2025 Jul;281:10-19. doi: 10.1016/j.schres.2025.04.024. Epub 2025 Apr 29.
The diagnostic criteria for "autoimmune psychosis" have been proposed to identify patients presenting with psychotic symptoms of autoimmune origin. Here, we aim to characterize the psychopathological features and outcomes of patients diagnosed with autoimmune psychosis.
We describe a cohort study conducted at the National Institute of Neurology and Neurosurgery of Mexico, including patients with psychotic symptoms exhibiting features of possible autoimmune psychosis: a) catatonia, b) dyskinesia, c) seizures, d) signs of neuroleptic malignant syndrome or clinical worsening after use of antipsychotics, or e) severe cognitive impairment.
Of 195 psychotic patients under assessment, 164 patients were diagnosed as having psychosis of autoimmune origin and received immunotherapy. Hallucinations were present in 83 %, delusions in 77 %, and disorganized speech in 64 % of the cases. Severe cognitive dysfunction was present in 75 % while 64 % were diagnosed with catatonia. Seizures were the most common neurological feature (63 %), followed by movement disorders and autonomic abnormalities. Most patients (71%) were diagnosed as having definite anti- NMDAR encephalitis. A significant proportion of the cases (39 %) had been previously misdiagnosed as having a primary psychiatric disorder. After immunotherapy, most patients with anti-NMDA receptor encephalitis, or with a negative determination of NMDA receptor antibodies, experienced cognitive and functional improvement, and a significant reduction in psychotic symptoms.
Our study supports previous observations about the value of the autoimmune psychosis construct, the pleomorphic psychopathological patterns of autoimmune encephalitis, and the significant improvement of psychopathology after immunotherapy.
“自身免疫性精神病”的诊断标准已被提出，用于识别具有自身免疫性起源的精神病性症状的患者。在此，我们旨在描述被诊断为自身免疫性精神病患者的精神病理学特征和预后。
我们描述了在墨西哥国家神经病学和神经外科研究所进行的一项队列研究，纳入具有可能的自身免疫性精神病特征的精神病性症状患者：a）紧张症，b）运动障碍，c）癫痫发作，d）使用抗精神病药物后出现神经阻滞剂恶性综合征或临床恶化的体征，或e）严重认知障碍。
在195名接受评估的精神病患者中，164名患者被诊断为自身免疫性起源的精神病并接受了免疫治疗。83%的病例出现幻觉，77%出现妄想，64%出现言语紊乱。75%存在严重认知功能障碍，64%被诊断为紧张症。癫痫发作是最常见的神经学特征（63%），其次是运动障碍和自主神经异常。大多数患者（71%）被诊断为明确的抗NMDAR脑炎。相当一部分病例（39%）此前被误诊为原发性精神障碍。免疫治疗后，大多数抗NMDA受体脑炎患者或NMDA受体抗体检测为阴性的患者，认知和功能得到改善，精神病性症状显著减轻。
我们的研究支持了先前关于自身免疫性精神病概念的价值、自身免疫性脑炎的多形性精神病理学模式以及免疫治疗后精神病理学显著改善的观察结果。
