Steroid-Responsive Chronic Schizophreniform Syndrome in the Context of Mildly Increased Antithyroid Peroxidase Antibodies

Abstract

BackgroundSchizophreniform syndromes can be divided into primary forms from polygenic causes or secondary forms due to immunological, epileptiform, monogenic, or degenerative causes. Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT) is a secondary immunological form associated with increased thyroid antibodies, such as antithyroid peroxidase antibodies and shows a good response to corticosteroids.Case presentationWe present the case of a 41-year-old woman suffering from a schizophreniform syndrome. Starting at the age of 35, she developed psychotic exacerbations with formal thought disorder, acoustic hallucinations, cenesthopathic experiences, and loss of ego boundaries. At the same time, she began to suffer from chronic sexual delusions and olfactory hallucinations, which did not respond to neuroleptic medication. Her levels of antithyroid peroxidase antibodies were slightly increased, and the blood–brain barrier was disturbed. An electroencephalogram (EEG) showed intermittent generalized slowing, and cerebral magnetic resonance imaging (cMRI) depicted mild temporolateral atrophy. High-dose corticosteroid treatment led to convincing improvement of attentional performance and the disappearance of delusions and olfactory hallucinations.ConclusionSREAT can mimic typical symptoms of schizophreniform syndromes. The increased titer of antithyroid peroxidase antibodies in combination with the EEG slowing, blood–brain barrier dysfunction, and the cMRI alterations were the basis for suspecting an immunological cause in our patient. Chronic delusions, olfactory hallucinations, and cognitive deficits were successfully treated with corticosteroids. The occurrence of secondary immunological forms of schizophreniform syndromes demonstrates the need for innovative immunosuppressive treatment options.

Plasmapheresis Responsive Rapid Onset Dementia with Predominantly Frontal Dysfunction in the Context of Hashimoto’s Encephalopathy

“…However, if proven to be unsuccessful, alternative treatment options, like plasmapheresis or intravenous immunoglobulins, could be considered ( 30 , 31 ). We have previously published two cases of HE mimicking schizophreniform and affective disorders, demonstrating the potential importance of this intervention in HE as a potentially treatable disorder mimicking classical psychiatric phenotypes ( 3 , 6 ). As the next step in investigating this link, case series should be performed to detect the frequency and the characteristics of isolated psychiatric manifestations of HE.…”

“…Hashimoto’s encephalopathy (HE) is a rare immunological neuropsychiatric disorder that is typically characterized by mixed neurological (seizures in 47%, speech disorders in 37%, gait disturbances in 27%, myoclonic jerks in 22%, headaches in 16%) and psychiatric symptoms [confusion in 46%, memory disturbances in 43%, delusions in 25%, depression in 12% ( 1 )]. In addition, isolated schizophreniform, depressive, or bipolar syndromes have been described at single-case levels ( 2 – 6 ). The link between HE and rapid progressive dementia has been previously described; however, most of these patients also suffered from seizures or other neurological symptoms (e.g., ataxia or gait disturbances).…”

Do patients with schizophreniform and bipolar disorders show an intrathecal, polyspecific, antiviral immune response? A pilot study

“…Interest in immunological encephalopathies has increased in the last decade. Paraneoplastic limbic encephalitis (e.g., associated with anti-Hu antibodies), idiopathic autoimmune encephalitis (e.g., associated with anti-NMDAR- or anti-VGKC-LG1 antibodies), or Hashimoto encephalopathy (in the context of Hashimoto thyroiditis) can mimic schizophreniform and, in single cases, bipolar disorders, as well [ 3 , 5 – 7 ]. These observations are highly relevant in understanding the etiology of psychiatric disorders because they show the necessity for a broad, organic diagnostic workup and for new treatment strategies with immunomodulatory medications, such as corticosteroids, intravenous immunoglobulins, or plasmapheresis [ 3 , 8 ].…”

Autoantikörper-assoziierte schizophreniforme Psychosen: Pathophysiologie, Diagnostik und Therapie

“…Sie treten typischerweise paraneoplastisch auf und haben keine direkte pathogene Wirkung. Sie stellen lediglich ein Epiphänomen eines systemischen tumorgetriggerten Immunprozesses dar, ursächlich für die entzündliche Ner- [2,4,5,7,9,12,13,14,15,16,17,18…”

“…Abb. 3), die auch im psychiatrischen Setting relativ einfach eingesetzt werden können [4,9,29,42]. Auf eine steroidinduzierte Manie oder Psychose muss geachtet werden [43].…”