Format

Send to

Choose Destination
Lancet Psychiatry. 2020 Jan;7(1):93-108. doi: 10.1016/S2215-0366(19)30290-1. Epub 2019 Oct 24.

Autoimmune psychosis: an international consensus on an approach to the diagnosis and management of psychosis of suspected autoimmune origin.

Author information

1
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. Electronic address: thomas.pollak@kcl.ac.uk.
2
Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
3
Department of Psychiatry and Psychotherapy Charité Campus Mitte (CCM), Charité-Universitätsmedizin Berlin, Berlin, Germany.
4
Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
5
Department of Neurology, Charité - Universitätsmedizin Berlin, Germany; German Center for Neurodegenerative Diseases, CharitéCrossOver, Berlin, Germany.
6
Department of Psychiatry and Psychotherapy, Medical Center, and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.
7
Department of Assertive Community Treatment, Lentis Mental Health Institute, Leek, Netherlands; Department of Assertive Community Treatment, VNN Addiction Care Institute, Groningen, Netherlands; Medical Imaging Centre, University of Groningen, Groningen, Netherlands.
8
Department of Psychiatry and Psychotherapy and Center for Behavioral Brain Sciences, Otto von Guericke University of Magdeburg, Magdeburg, Germany.
9
Psychiatry Research Centre, Beijing Huilongguan Hospital, Peking University, Beijing, China; Department of Physiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia.
10
Interdisciplinary Institute for NeuroSciences, Université de Bordeaux, Bordeaux, France.
11
Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany.
12
Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia; The Florey Institute of Mental Health and Neurosciences, The University of Melbourne, Parkville, VIC, Australia; Department of Psychiatry, University of Münster, Münster, Germany.
13
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
14
Department of Pediatrics, Stanley Neurovirology Division, Johns Hopkins School of Medicine, Baltimore, MD, USA.
15
Psychiatry and Clinical Psychobiology, Division of Neuroscience, Scientific Institute Ospedale San Raffaele, Milano, Italy; University Vita-Salute San Raffaele, Milano, Italy.
16
Department of Psychiatry, Loyola University Medical Center, Maywood, IL, USA.
17
Research Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Institute of Medical Science, Toronto, ON, Canada; Departments of Psychiatry and Department of Pharmacology and Toxicology, Institute of Medical Science, Toronto, ON, Canada.
18
Institute for Response-Genetics, Psychiatric University Hospital, Zurich, Switzerland.
19
Inserm U955, Fondation FondaMental, Department of Psychiatry and Addiction, Mondor University Hospital, University Paris-Est-Créteil, Créteil, France.
20
Division of Biological Chemistry, Biocenter, Innsbruck Medical University, Innsbruck, Austria.
21
Department of Neurology, University Clinic, Ulm University, Ulm, Germany.
22
Department of Immunopathology and Department Clinical Immunology, New South Wales Health Pathology, Institute for Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia.
23
Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
24
Department of Neurology, Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY, USA.
25
Department of Psychiatry and Psychotherapy II, Ulm University, Bezirkskrankenhaus Günzburg, Günzburg, Germany.

Abstract

There is increasing recognition in the neurological and psychiatric literature of patients with so-called isolated psychotic presentations (ie, with no, or minimal, neurological features) who have tested positive for neuronal autoantibodies (principally N-methyl-D-aspartate receptor antibodies) and who have responded to immunotherapies. Although these individuals are sometimes described as having atypical, mild, or attenuated forms of autoimmune encephalitis, some authors feel that that these cases are sufficiently different from typical autoimmune encephalitis to establish a new category of so-called autoimmune psychosis. We briefly review the background, discuss the existing evidence for a form of autoimmune psychosis, and propose a novel, conservative approach to the recognition of possible, probable, and definite autoimmune psychoses for use in psychiatric practice. We also outline the investigations required and the appropriate therapeutic approaches, both psychiatric and immunological, for probable and definite cases of autoimmune psychoses, and discuss the ethical issues posed by this challenging diagnostic category.

Comment in

PMID:
31669058
DOI:
10.1016/S2215-0366(19)30290-1
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center