Neural Antibodies in First-episode Psychosis Patients with Warning Signs for Autoimmune Encephalitis
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Objective: Autoimmune encephalitis (AE) remains an essential differential diagnosis in patients with first-episode psychosis (FEP). In this study, we aimed to assess to prevalence of AE in a cohort of FEP patients. Methods: We used a phenotype-driven algorithm to detect AE in patients with FEP. Initially, we screened patients for warning signs with a low or high pre-test probability for AE, defined as “yellow” and “red flags”, respectively. In the next step, patients with red flags underwent cerebrospinal fluid analysis (including neural antibodies), while patients with yellow flags underwent tests for serum neural antibodies, electroencephalography, and brain magnetic resonance imaging. Results: We screened 78 patients with FEP and found that eight (10.3%) had at least one warning sign for AE: four (5.13%) patients had at least one red flag, while four (5.13%) had only yellow flags. Among these, two patients (2.56%) had anti-N-methyl-D-aspartate receptor encephalitis, while the remaining six (7.69%) received a primary psychiatric disorder diagnosis. Conclusion: Our study highlights the importance of considering AE in the differential diagnosis of FEP.
Abstract
Objective: Autoimmune encephalitis (AE) remains an essential differential diagnosis in patients with first-episode psychosis (FEP). In this study, we aimed to assess to prevalence of AE in a cohort of FEP patients. Methods: We used a phenotype-driven algorithm to detect AE in patients with FEP. Initially, we screened patients for warning signs with a low or high pre-test probability for AE, defined as “yellow” and “red flags”, respectively. In the next step, patients with red flags underwent cerebrospinal fluid analysis (including neural antibodies), while patients with yellow flags underwent tests for serum neural antibodies, electroencephalography, and brain magnetic resonance imaging. Results: We screened 78 patients with FEP and found that eight (10.3%) had at least one warning sign for AE: four (5.13%) patients had at least one red flag, while four (5.13%) had only yellow flags. Among these, two patients (2.56%) had anti-N-methyl-D-aspartate receptor encephalitis, while the remaining six (7.69%) received a primary psychiatric disorder diagnosis. Conclusion: Our study highlights the importance of considering AE in the differential diagnosis of FEP.
참고문헌 (26)
- Titulaer MJ, "Autoimmune encephalitis in first episode psychoses : all smoke and no fire?", Neurology, 97, pp.16~17 (2021)
- Ross EL, "Cost-effectiveness of routine screening for autoimmune encephalitis in patients with first-episode psychosis in the United States", J Clin Psychiatry, 82, pp.19~ (2020)
- Guasp M, "Clinical, neuroimmunologic, and CSF investigations in first episode psychosis", Neurology, 97, pp.e61~e75 (2021)
- Graus F, "A clinical approach to diagnosis of autoimmune encephalitis", Lancet Neurol, 15, pp.391~404 (2016)
- Pollak TA, "Time for a change of practice : the realworld value of testing for neuronal autoantibodies in acute first-episode psychosis", BJPsych Open, 4, pp.262~264 (2018)
- Tebartz van Elst L, "Reader response : clinical, neuroimmunologic, and CSF investigations in first episode psychosis", Neurology, 98, pp.905~906 (2022)
- Kelleher E, "Prevalence of N-Methyl-d-Aspartate Receptor antibody(NMDAR-Ab)encephalitis in patients with first episode psychosis and treatment resistant schizophrenia on clozapine, a population based study", Schizophr Res, 222, pp.455~461 (2020)
- Scott JG, "The prevalence and treatment outcomes of antineuronal antibody-positive patients admitted with first episode of psychosis", BJPsych Open, 4, pp.69~74 (2018)
- Bien CG, "Neural autoantibodies in cerebrospinal fluid and serum in clinical high risk for psychosis, first-episode psychosis, and healthy volunteers", Front Psychiatry, 12, pp.654602~ (2021)
- Jeppesen R, "Antineuronal antibodies in cerebrospinal fluid and serum of 104 patients with psychotic disorders compared to 104 individually matched healthy controls", Schizophr Res, 252, pp.39~45 (2023)
- Theorell J, "Screening for pathogenic neuronal autoantibodies in serum and CSF of patients with first-episode psychosis", Transl Psychiatry, 11, pp.566~ (2021)
- Herken J, "Red flags : clinical signs for identifying autoimmune encephalitis in psychiatric patients", Front Psychiatry, 8, pp.25~ (2017)
- Pollak TA, "Autoimmune psychosis : an international consensus on an approach to the diagnosis and management of psychosis of suspected autoimmune origin", Lancet Psychiatry, 7, pp.93~108 (2020)
- Scott JG, "Testing for antibodies to N-methyl-d-aspartate receptor and other neuronal cell surface antigens in patients with early psychosis", Aust N Z J Psychiatry, 52, pp.727~729 (2018)
- Steiner J, "Autoimmune encephalitis with psychosis : warning signs, step-by-step diagnostics and treatment", World J Biol Psychiatry, 21, pp.241~254 (2020)
- Dalmau J, "Autoimmune encephalitis and related disorders of the nervous system", pp.210~254 (2022), Cambridge University Press
- Kayser MS, "Frequency and characteristics of isolated psychiatric episodes in anti–N-methyl-d-aspartate receptor encephalitis", JAMA Neurol, 70, pp.1133~1139 (2013)
- Gresa-Arribas N, "Antibody titres at diagnosis and during follow-up of anti-NMDA receptor encephalitis : a retrospective study", Lancet Neurol, 13, pp.167~177 (2014)
- Warren N, "Refining the psychiatric syndrome of anti-N-methyl-d-aspartate receptor encephalitis", Acta Psychiatr Scand, 138, pp.401~408 (2018)
- Espinola-Nadurille M, "Neuropsychiatric phenotypes of anti-NMDAR encephalitis : a prospective study", Psychol Med, 53, pp.4266~4274 (2023)
- Dalmau J, "Anti-NMDA-receptor encephalitis : case series and analysis of the effects of antibodies", Lancet Neurol, 7, pp.1091~1098 (2008)
- Ford H, "Psychiatric manifestations of autoimmune encephalitis", Autoimmun Rev, 21, pp.103145~ (2022)
- Andrews FM, "Albumin quotient, IgG concentration, and IgG index determinations in cerebrospinal fluid of neonatal foals", Am J Vet Res, 55, pp.741~745 (1994)
- Titulaer MJ, "Treatment and prognostic factors for longterm outcome in patients with anti-NMDA receptor encephalitis : an observational cohort study", Lancet Neurol, 12, pp.157~165 (2013)
- Sonderen AV, "Predictive value of electroencephalography in anti-NMDA receptor encephalitis", J Neurol Neurosurg Psychiatry, 89, pp.1101~1106 (2018)
- Ruiz-García R, "Limitations of a commercial assay as diagnostic test of autoimmune encephalitis", Front Immunol, 12, pp.691536~ (2021)