Luo Yuanyuan, Sun Hao, Fan Jian, Zhang Xu, He Ying
Department of Psychiatry, West China Airport Hospital, The First People's Hospital of Shuangliu District, Sichuan University, Chengdu, Sichuan, 610200, China.
Department of Neurology, West China Airport Hospital, The First People's Hospital of Shuangliu District, Sichuan University, Chengdu, Sichuan, 610200, China.
BMC Psychiatry. 2025 Jul 10;25(1):691. doi: 10.1186/s12888-025-06787-3.
Partial psychotic disorders such as autoimmune psychosis do not respond adequately to conventional antipsychotic drugs or psychotherapy. Autoimmune psychosis presents with isolated psychiatric symptoms, responds to immunotherapy, and differs from typical autoimmune encephalitis. Previous study has proposed an approach to identifying autoimmune psychosis, however, further research remains necessary to enhance our understanding of this condition.
We describe 3 patients presenting with acute or recurrent psychiatric symptoms (patient 1, 2 and 3), accompanied by cognitive impairment (patient 1), autonomic dysfunction (patient 2), and/or abnormal electroencephalogram (patient 1). Brain magnetic resonance imaging results and autoimmune antibodies in cerebrospinal fluid testing were normal. However, the cerebrospinal fluid-restricted oligoclonal bands were detected in patient 1 and patient 2, while patient 3 showed positive tissue-based assay results in cerebrospinal fluid. Combined steroid therapy could enhance the limited improvement in patient 1, who had been treated with blonanserin, valproate and modified electroconvulsive therapy, and could also prevent symptom recurrence in patient 2, who received antipsychotic treatment. In contrast, in the absence of combined steroid therapy, patient 3 had only partial improvement with risperidone and valproate.
Cerebrospinal fluid-restricted oligoclonal bands and tissue-based assay in cerebrospinal fluid could both provide sufficient evidence for autoimmune psychosis in the absence of clear neurological symptoms. For patients with mild psychiatric symptoms, low-dose of steroids may also be a treatment option. Autoimmune psychosis should be considered when antipsychotic drugs or modified electroconvulsive therapy are not effective in patients with psychotic disorders.
部分精神障碍如自身免疫性精神病对传统抗精神病药物或心理治疗反应不佳。自身免疫性精神病表现为孤立的精神症状，对免疫治疗有反应，且与典型的自身免疫性脑炎不同。先前的研究提出了一种识别自身免疫性精神病的方法，然而，仍需进一步研究以加深我们对这种疾病的理解。
我们描述了3例出现急性或复发性精神症状的患者（患者1、2和3），伴有认知障碍（患者1）、自主神经功能障碍（患者2）和/或脑电图异常（患者1）。脑磁共振成像结果和脑脊液检测中的自身免疫抗体均正常。然而，在患者1和患者2中检测到脑脊液限制性寡克隆带，而患者3的脑脊液基于组织的检测结果呈阳性。联合类固醇治疗可增强患者1的有限改善，患者1曾接受过布南色林、丙戊酸盐和改良电休克治疗，也可预防接受抗精神病治疗的患者2的症状复发。相比之下，在没有联合类固醇治疗的情况下，患者3使用利培酮和丙戊酸盐仅部分改善。
在没有明确神经症状的情况下，脑脊液限制性寡克隆带和脑脊液基于组织的检测均可为自身免疫性精神病提供充分证据。对于精神症状较轻的患者，低剂量类固醇也可能是一种治疗选择。当抗精神病药物或改良电休克治疗对患有精神障碍的患者无效时，应考虑自身免疫性精神病。
