A clinical approach to new-onset psychosis associated with immune dysregulation: the concept of autoimmune psychosis
Abstract Growing data point to the overlap between psychosis and pathological processes associated with immunological dysregulation as well as inflammation. Notably, the recent discovery of antibodies against synaptic and neuronal cell membrane proteins such as anti-N-methyl-d-aspartate receptor pro...
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| Format: | Article |
| Language: | English |
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BMC
2018-02-01
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| Series: | Journal of Neuroinflammation |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12974-018-1067-y |
| _version_ | 1828860693787443200 |
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| author | Souhel Najjar Johann Steiner Amanda Najjar Karl Bechter |
| author_facet | Souhel Najjar Johann Steiner Amanda Najjar Karl Bechter |
| author_sort | Souhel Najjar |
| collection | DOAJ |
| description | Abstract Growing data point to the overlap between psychosis and pathological processes associated with immunological dysregulation as well as inflammation. Notably, the recent discovery of antibodies against synaptic and neuronal cell membrane proteins such as anti-N-methyl-d-aspartate receptor provides more direct evidence of the etiological connection between autoimmunity and subsequent hazard of psychosis. Here, we advocate the use of term “autoimmune psychosis,” as this term suggests that autoimmune disorders can masquerade as drug-resistant primary psychosis, and this subtype of psychosis has anatomical and immunological footprints in the brain, despite the frequent absence of structural abnormalities on conventional brain MRI. Furthermore, this term might serve as a reminder not to overlook appropriate neurological workup such as neuroimaging and EEG testing, as well as CSF analysis, for cases with acute or subacute atypical onset of neuropsychiatric presentations including those dominated by acute psychotic symptoms. We propose etiologically and serologically oriented subclassification as well as multi-modal diagnostic approach to address some of the challenges inherent to early diagnosis of patients presenting with atypical and refractory new-onset psychotic symptoms of autoimmune origin. This is particularly relevant to the diagnosis of seronegative but probable autoimmune psychosis (SPAP) that might masquerade as antipsychotic drug-resistant primary psychotic disorder. This distinction is therapeutically important as autoimmune-related psychotic symptomatology can frequently respond well to timely treatment with proper immune modulatory therapies. |
| first_indexed | 2024-12-13T02:45:19Z |
| format | Article |
| id | doaj.art-495df8a45bd142fb9ce8b8731e99fee1 |
| institution | Directory Open Access Journal |
| issn | 1742-2094 |
| language | English |
| last_indexed | 2024-12-13T02:45:19Z |
| publishDate | 2018-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Neuroinflammation |
| spelling | doaj.art-495df8a45bd142fb9ce8b8731e99fee12022-12-22T00:02:12ZengBMCJournal of Neuroinflammation1742-20942018-02-011511810.1186/s12974-018-1067-yA clinical approach to new-onset psychosis associated with immune dysregulation: the concept of autoimmune psychosisSouhel Najjar0Johann Steiner1Amanda Najjar2Karl Bechter3Department of Neurology, Zucker School of Medicine at Hofstra/NorthwellDepartment of Psychiatry, University of MagdeburgDepartment of Neurology, Lenox Hill HospitalUlm UniversityAbstract Growing data point to the overlap between psychosis and pathological processes associated with immunological dysregulation as well as inflammation. Notably, the recent discovery of antibodies against synaptic and neuronal cell membrane proteins such as anti-N-methyl-d-aspartate receptor provides more direct evidence of the etiological connection between autoimmunity and subsequent hazard of psychosis. Here, we advocate the use of term “autoimmune psychosis,” as this term suggests that autoimmune disorders can masquerade as drug-resistant primary psychosis, and this subtype of psychosis has anatomical and immunological footprints in the brain, despite the frequent absence of structural abnormalities on conventional brain MRI. Furthermore, this term might serve as a reminder not to overlook appropriate neurological workup such as neuroimaging and EEG testing, as well as CSF analysis, for cases with acute or subacute atypical onset of neuropsychiatric presentations including those dominated by acute psychotic symptoms. We propose etiologically and serologically oriented subclassification as well as multi-modal diagnostic approach to address some of the challenges inherent to early diagnosis of patients presenting with atypical and refractory new-onset psychotic symptoms of autoimmune origin. This is particularly relevant to the diagnosis of seronegative but probable autoimmune psychosis (SPAP) that might masquerade as antipsychotic drug-resistant primary psychotic disorder. This distinction is therapeutically important as autoimmune-related psychotic symptomatology can frequently respond well to timely treatment with proper immune modulatory therapies.http://link.springer.com/article/10.1186/s12974-018-1067-yAutoimmunePsychosisNMDAREncephalitisNeuroinflammationMicroglia |
| spellingShingle | Souhel Najjar Johann Steiner Amanda Najjar Karl Bechter A clinical approach to new-onset psychosis associated with immune dysregulation: the concept of autoimmune psychosis Journal of Neuroinflammation Autoimmune Psychosis NMDAR Encephalitis Neuroinflammation Microglia |
| title | A clinical approach to new-onset psychosis associated with immune dysregulation: the concept of autoimmune psychosis |
| title_full | A clinical approach to new-onset psychosis associated with immune dysregulation: the concept of autoimmune psychosis |
| title_fullStr | A clinical approach to new-onset psychosis associated with immune dysregulation: the concept of autoimmune psychosis |
| title_full_unstemmed | A clinical approach to new-onset psychosis associated with immune dysregulation: the concept of autoimmune psychosis |
| title_short | A clinical approach to new-onset psychosis associated with immune dysregulation: the concept of autoimmune psychosis |
| title_sort | clinical approach to new onset psychosis associated with immune dysregulation the concept of autoimmune psychosis |
| topic | Autoimmune Psychosis NMDAR Encephalitis Neuroinflammation Microglia |
| url | http://link.springer.com/article/10.1186/s12974-018-1067-y |
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