Autoantikörper-assoziierte schizophreniforme Psychosen: Pathophysiologie, Diagnostik und Therapie

Elst, Ludger Tebartz van; Bechter, Karl; Prüß, Harald; Hasan, Alkomiet; Steiner, Jo Hann; Leypoldt, Frank; Endres, Dominique

doi:10.1007/s00115-019-0735-1

Cited by 29 publications

(35 citation statements)

References 43 publications

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“…The recommendations worked out here for Abs assessment and respective diagnostic and therapeutic consequences in schizophreniform psychoses were based on consensus from emerging clinical evidence rather than from systematic randomized studies as is the case with the present recommendations for diagnosis and treatment of AE [31]. Beyond, it should be recognized that indeed both well-established clinical terms (like encephalitis, encephalopathy, neuroinflammation) and newly proposed terms (such as AP, AE) are hardly exactly defined, thus for clinical use typically represent just clinical case definitions based on respective Table 3 The most important known autoantibodies that can be associated with symptoms of schizophreniform psychoses [9,15,31,34,36,37,38,48,63,71,79,81,82,84,85,90 limited and steadily emerging clinical consensus [6,12]. In addition, the possibility of underlying so far not identified new Abs is also limiting the whole issue.…”

Section: Limitationsmentioning

confidence: 99%

“…factors [81]. Large, genome-wide studies have identified over 100 distinct gene sites that contribute to the relative risk of psychotic symptoms [73].…”

mentioning

confidence: 99%

“…Large, genome-wide studies have identified over 100 distinct gene sites that contribute to the relative risk of psychotic symptoms [73]. Secondary forms are based on clearly identifiable causes in the sense of etiology or according to recognizable pathogenesis [45,81]. Such secondary forms can be linked to autoantibody (Ab)-associated autoimmune processes such as anti-N-Methyl-d-aspartate receptor [NMDA-R] encephalitis [44].…”

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confidence: 99%

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Autoimmune encephalitis as a differential diagnosis of schizophreniform psychosis: clinical symptomatology, pathophysiology, diagnostic approach, and therapeutic considerations

Endres

Leypoldt

Bechter

et al. 2020

Eur Arch Psychiatry Clin Neurosci

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Primary schizophreniform psychoses are thought to be caused by complex gene-environment interactions. Secondary forms are based on a clearly identifiable organic cause, in terms of either an etiological or a relevant pathogenetic factor. The secondary or "symptomatic" forms of psychosis have reentered the focus stimulated by the discovery of autoantibody (Ab)associated autoimmune encephalitides (AEs), such as anti-NMDA-R encephalitis, which can at least initially mimic variants of primary psychosis. These newly described secondary, immune-mediated schizophreniform psychoses typically present with the acute onset of polymorphic psychotic symptoms. Over the course of the disease, other neurological phenomena, such as epileptic seizures, movement disorders, or reduced levels of consciousness, usually arise. Typical clinical signs for AEs are the acute onset of paranoid hallucinatory symptoms, atypical polymorphic presentation, psychotic episodes in the context of previous AE, and additional neurological and medical symptoms such as catatonia, seizure, dyskinesia, and autonomic instability. Predominant psychotic courses of AEs have also been described casuistically. The term autoimmune psychosis (AP) was recently suggested for these patients. Paraclinical alterations that can be observed in patients with AE/AP are inflammatory cerebrospinal fluid (CSF) pathologies, focal or generalized electroencephalographic slowing or epileptic activity, and/or suspicious "encephalitic" imaging findings. The antibody analyses in these patients include the testing of the most frequently found Abs against cell surface antigens (

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Section: Limitationsmentioning

confidence: 99%

“…factors [81]. Large, genome-wide studies have identified over 100 distinct gene sites that contribute to the relative risk of psychotic symptoms [73].…”

mentioning

confidence: 99%

mentioning

confidence: 99%

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Autoimmune encephalitis as a differential diagnosis of schizophreniform psychosis: clinical symptomatology, pathophysiology, diagnostic approach, and therapeutic considerations

Endres

Leypoldt

Bechter

et al. 2020

Eur Arch Psychiatry Clin Neurosci

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“…Das limbische System stellt einen Prädilektionsort für Autoimmunenzephalitiden dar [33,34,35]. Man hat mittlerweile mehrere mit einer limbischen Enzephalitis assoziierte Zielproteine entdeckt (NMDA, AMPA, GA-BAb, LGI1, GAD65, Hu, Ma2 u.…”

Section: Autoimmunenzephalopathienunclassified

“…Der Verlauf gestaltet sich zumeist progredient, zum Teil fluktuierend, oft mit ausgeprägten vegetativen Symptomen. Im EEG können als "sensitivste, wenngleich wenig spezifische, apparative Methode" [34] Verlangsamungen und epilepsietypische Potentiale mit temporaler Lokalisation sowie die sogenannten extreme delta brush gefunden werden [37]. Der Liquor zeigt eine Pleozytose (< 100) in 60-80 % und einen erhöhten IgG-Index oder oligoklonale Banden in ca.…”

Section: Autoimmunenzephalopathienunclassified