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Lopes J, Malaquias MJ, Freitas J, Valido R, Carneiro P, Neves E, Moreira AM, Samões R, Santos E, Correia AP. Blood and CSF anti-neuronal antibodies testing in psychotic syndromes: a retrospective analysis from a tertiary psychiatric hospital. Immunol Res 2024:10.1007/s12026-024-09457-w. [PMID: 38291273 DOI: 10.1007/s12026-024-09457-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/13/2024] [Indexed: 02/01/2024]
Abstract
A Consensus of Psychoimmunology Experts (Pollak et al., 2019) established a set of red flags and proposed diagnostic criteria for psychosis of autoimmune origin (AIP). Previous studies on AIP are limited by the scarcity of CSF analysis, preventing the valorization of blood anti-neuronal antibodies (Ab). The aims of this study are to determine the relative frequency and characterize AIP in a cohort of psychotic patients that underwent CSF workup. This work is a retrospective study in a tertiary psychiatric hospital. Clinical and paraclinical data were collected from medical records, and patients were classified according to Pollak et al. (2019) criteria. From 68 patients, ten (14.7%) had positive anti-neuronal antibodies (Ab): n = 5 in CSF and blood (n = 4 anti-NMDAr, n = 1 -GAD65), and n = 5 in blood only (n = 1 anti-GABAb, n = 1 -GAD65, n = 1 -SOX1, n = 1 -NMDAr, n = 1 -zic4). After 5- (2-10)-year follow-up, n = 6/68 (8.8%) had AIP diagnosis in context of autoimmune encephalitis (AE), and the remaining (n = 4/10, blood-only Ab) alternative diagnoses (n = 2 dementia, n = 1 schizophrenia, n = 1 intellectual disability). Ten of the 13 patients that fulfilled criteria for possible AIP were mimics, and only three AE had criteria for probable AIP. All AIP developed neurological manifestations (mostly cognitive dysfunction); EEG was usually abnormal (66.7%), and all had normal MRI. We found statistically significant associations between AIP/AE and systemic autoimmune disease, presentation with seizures and EEG abnormalities. All AE developed neurological symptoms alongside psychosis. Ab positivity occurred predominantly in AE but also in other neuropsychiatric disorders. Clinical suspicion based on the knowledge of the described presentations of established Ab is crucial in the psychotic patient approach.
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Affiliation(s)
- Joana Lopes
- Neurology Department, Centro Hospitalar Universitário de Santo António, Largo Do Prof. Abel Salazar, 4099-001, Porto, Portugal.
| | - Maria João Malaquias
- Neurology Department, Centro Hospitalar Universitário de Santo António, Largo Do Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Joana Freitas
- Psychiatry Department, Hospital de Magalhães Lemos, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Rodrigo Valido
- Psychiatry Department, Hospital de Magalhães Lemos, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Paula Carneiro
- Department of Immunology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine (UMIB), Instituto de Ciencias Biomedicas Abel Salazar, Universidade Do Porto, Porto, Portugal
| | - Esmeralda Neves
- Department of Immunology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine (UMIB), Instituto de Ciencias Biomedicas Abel Salazar, Universidade Do Porto, Porto, Portugal
| | - Ana Maria Moreira
- Psychiatry Department, Hospital de Magalhães Lemos, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Raquel Samões
- Neurology Department, Centro Hospitalar Universitário de Santo António, Largo Do Prof. Abel Salazar, 4099-001, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine (UMIB), Instituto de Ciencias Biomedicas Abel Salazar, Universidade Do Porto, Porto, Portugal
| | - Ernestina Santos
- Neurology Department, Centro Hospitalar Universitário de Santo António, Largo Do Prof. Abel Salazar, 4099-001, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine (UMIB), Instituto de Ciencias Biomedicas Abel Salazar, Universidade Do Porto, Porto, Portugal
| | - Ana Paula Correia
- Neurology Department, Centro Hospitalar Universitário de Santo António, Largo Do Prof. Abel Salazar, 4099-001, Porto, Portugal
- Psychiatry Department, Hospital de Magalhães Lemos, Centro Hospitalar Universitário de Santo António, Porto, Portugal
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Hansen N, Rentzsch K, Hirschel S, Bartels C, Wiltfang J, Malchow B. Long-Term Course of Neural Autoantibody-Associated Psychiatric Disorders: Retrospective Data from a Specifically Immunopsychiatric Outpatient Clinic. Antibodies (Basel) 2023; 12:antib12020034. [PMID: 37218900 DOI: 10.3390/antib12020034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/20/2023] [Accepted: 05/04/2023] [Indexed: 05/24/2023] Open
Abstract
Background: Autoantibody-associated psychiatric disorders are a new terrain that is currently underrepresented considering immunopsychiatry's potential importance for therapeutic aspects. The aim of our research was thus to present initial pilot data on the long-term clinical course of our patients in an outpatient clinic specializing in autoantibody-associated psychiatric disorders. Methods: Thirty-seven patients were examined clinically in our outpatient clinic at regular intervals over a 1.5-year period. We collected clinical data on their demographics, psychopathology, and cognition, and magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) data as well as the status of neural autoantibodies in blood and/or serum. Results: Our main finding was that affective, psychotic, and cognitive symptoms did not change significantly over the 1.5-year period, thus revealing no progression. We divided the entire cohort of autoantibody-positive patients (n = 32) into subgroups consisting of patients with dementia (n = 14), mild cognitive impairment (MCI) (n = 7), psychotic disorders (n = 6), and a CSF profile of Alzheimer's disease (n = 6). Relying on established classification schemes, we identified the following percentages in our autoantibody-positive cohort: 28% with autoimmune encephalitis, 15% with autoimmune psychosis, and 63% with autoimmune psychiatric syndromes. Discussion: These initial pilot results suggest that autoantibody-associated diseases do not show a significantly progressive course in the long-term and are often characterized by impaired verbal memory recall when cognitive impairment progresses to dementia. These initial data need to be verified in larger cohorts. We believe that this pilot study underscores the importance of promoting such a specialized outpatient clinic to better characterize various aspects of autoantibody-mediated psychiatric disorders.
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Affiliation(s)
- Niels Hansen
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, 37075 Göttingen, Germany
| | | | - Sina Hirschel
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Claudia Bartels
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, 37075 Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), 37075 Göttingen, Germany
- Neurosciences and Signaling Group, Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, 37075 Göttingen, Germany
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